HomeMy WebLinkAbout09-30-101505610140
REV-1500 EX (01-10)
OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
Po Box 2sosol 2 1 1 0 D 4 1 5
Harrisbur , PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 7 7 7 4 9 0 2 4 0 4 0 4 2 0 1 0 0 1 0 4 1 9 9 3
Decedent's Last Name Suffix Decedent's First Name MI
J O H N S O N J E S S I E E
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
MI
FILL IN APPROPRIATE OVALS BELOW
^ 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death
prior to 12-13-82)
^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Retum Required
death after 12-12-82)
^ 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will)
9. Litigation Proceeds Received
^ (Attach Copy of Trust)
10. Spousal Poverty Credit (date of death
^
haxOunder Sec. 9113(A)
11 • A
h S
between 12-31-91 and 1-1-95) c
ttac
( )
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Daytime Telephone Number
Name
D A V I D J L E D E R M A N N 7 1 7 7 6 3 11 21
First line of address
S H U M A K E R W I L L I A M S~ P C
Second line of address
3 4 2 5 S I M P S 0 N
City or Post Office
C A M P H I L L
F E R R Y R O A D
State ZIP Code
REGISTER OF WILLS USE ONLY
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Correspondent's e-mail address: l e d e r m a n n a s h u m a k e r w i 11 i a m s• c o m
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATI.IRE OF PERSON REySPON~IBL~OR FILING RETURN ~gT^ r ~ ~ 1
HUU CJJ
47 STONEHOUSE ROAD CARLISLE PA 17
SIGNI~RE OF PRE~A~R ~-IER,THAN REPRESENTATIVE ~ /a ~ /( ~
Hvvn~.~.~ v
3425 SIMPSON FERRY ROAD CAMP HILL PA 17011
PLEASE USE ORIGINAL FORM ONLY
L 1505610140
Side 1
150561014D J
C
1505610240
REV-1500 EX
Decedent's Name: J E S S I E E- JOHNSON Decedent's Social Security Number
1 7 7 7 4 9 0 2 4
RECAPITULATION
1.
...........................................
Real Estate (Schedule A) 1' •
2. Stocks and Bonds (Schedule B) ...................................... 2. •
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages and Notes Receivable (Schedule D) .......................... 4. •
3 7 5 0 0. 0 0
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers & Miscellaneous N n-Probate Property
uested
Billin
Re
t
~ S
7
.......
g
q
epara
e
(Schedule G) .
8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 3 7 5 D 0 . 0 0
9.
..................
Funeral Expenses and Administrative Costs (Schedule H) 9. 9 4 4 2 . 1 0
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10.
11. Total Deductions (total Lines 9 and 10) ............................... 11. 9 4 4 2 . 1 0
12. Net Value of Estate (Line 8 minus Line 11) ............................ 12. 2 8 D 5 ~ • 9 D
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ...................... 13•
14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... 14. 2 8 D 5 7 • 9 D
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
16. Amount of Line 14 taxable D • D D
at lineal rate X •00 ** 16.
17. Amount of Line 14 taxable
at sibling rate X .12 17. •
18. Amount of Line 14 taxable
at collateral rate X .15 18. •
19. TAX DUE 0 • D O
......................................................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^
** No tax is owed since decedent was under age of 22 years old, died intestate, and
sole beneficiaries were decedent's parents.
1505610240
Side 2
15O561O24D
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 10 0415
DECEDENT'S NAME
JESSIE E• JOHNSON
STREET ADDRESS
476 STONEHOUSE ROAD
CITY
CARLISLE STATE
PA ZIP
17015
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund.
(3)
(4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) $ 0.0 0
Make check payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred : ................................................................. ..... ^ ^X
b. retain the right to designate who shall use the property transferred or its income; ......................... ...... ^
X
^
c. retain a reversionary interest; or .......................................................................................... ...... ^
^ ^X
d. receive the promise for life of either payments, benefits or care? ................................................. ......
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? .................................................................................
th?
hi
h
d
"
" ...... ^
^ ^X
Q
er
...
s or
ea
orpayable-upon-death bank account or security at
intrust for
3. Did decedent own an ......
4. Did decedent own an individual retirement account, annuity or other non-probate property, which
contains a beneficiary designation? ............................................................................................ ...... ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1,1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse i;
3 percent [72 P.S. §9116 (a) (1.1) (i)J.
For dates of death on or after Jan.1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in
72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
(1)
$0.00
Total Credits (A + B) (2)
REV-1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
JESSIE E• JOHNSON 21 10 0415
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Wrongful Death/Survival Action Claims - Decedent died as a result $37,500.00
of injuries sustained in an automobile accident. The
Administrator, on his own behalf and the behalf of his wife,
filed a wrongful death and survival action in the Court of
Common Pleas of Cumberland County, Case No• 10-5178• Those
claims have been settled in a gross amount of $125,000• The
Administrator proposed to allocate the settlement of 70i to the
wrongful death claim and 30i to the survival action claim. The
Administrator notified the Department of Revenue and the Court
having jurisdiction of this action of the proposed allocations.
The approvals of the PA Department of Revenue and the Court of
Common Pleas of Cumberland County are attached hereto.
TOTAL (Also enter on line 5, Recapitulation) I $
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (10-09)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
FILE NUMBER
ESTATE OF
JESSIE E• JOHNSON 21 10 0415
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER
A.
1.
B.
1
2.
3.
4.
5.
6.
7
DESCRIPTION
FUNERAL EXPENSES:
Hollinger Funeral Home & Crematory, Inc•
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City
Year(s) Commission Paid:
Attorney Fees:
Family Exemption: (If decedents address is not the same as claimants, attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
Probate Fees: Cumberland County Register of Wills $169.50
Accountant Fees:
Tax Return Preparer Fees:
Shumaker Williams, P•C• - Tort Attorney's fee allocated to $5,652.60
Survival Action Claim-
State ZIP
AMOUNT
$3,620.00
TOTAL (Also enter on Line 9, Recapitulation) I $ 9 , 4 4 2
If more space is needed, use additional sheets of paper of the same size.
REV-1513 EX+ (Ot-70)
Pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ca i w i ~ ur: FILE NUMBER:
JESSIE E. JOHNSON _ _ _
~y Lu u 4J,S
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal disfibutions and transfers under
Sec. 9116 (a) (1.2).J
1. James M• Johnson Lineal 507
476 Stonehouse Road
Carlisle, PA 17015
2• Teresa E• Johnson Lineal 507
476 Stonehouse Road
Carlisle, PA 17015
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
n more space Is neeaea, use aoartlonal sheets of paper of the same size.
"~~i~= ~~7 Pennsylvania
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' DEPARTMENT OF REVENUE
July 14, 2010
Marc G. Tarlow, Esquire
Shumaker Williams, PC
1 East Market Street, Suite 301
York, PA 17401
Re: Estate of Jessie E. Johnson
File Number 2110-0415
Court of Common Pleas Cumberland County
Dear Mr. Tarlow:
The Department of Revenue has received the Petition for Approval of Settlement Claim to be
filed on behalf of the above-referenced Estate in regard to a wrongful death and survival action. It has
been forwarded to this Bureau for the Commonwealth's approval of the allocation of the proceeds paid to
settle the actions.
Pursuant to the Petition, the 17 year old decedent died as a result of a motor vehicle accident.
Decedent is survived by her parents.
Please be advised that, based upon these facts and for inheritance tax purposes only, this
Department has no objection to the proposed allocation of the gross proceeds of this action, $87,500.00 to
the wrongful death claim and $ 37,500.00 to the survival claim. Proceeds of a survival action are an asset
included in the decedent's es#ate and are subject to the imposition of Pennsylvania inheritance tax. 42
Pa.C.S.A. §8302; 72 P.S. §9106, 9107. Costs and fees must be deducted in the same percentages as the
proceeds are allocated. In re Estate of Menyman, G69 A.2d 1059 (Pa. Cmwlth. 1995).
I trust that this letter is a sufficient representation of the Department's position on this matter. As
the Department has no objections to the Petition, an attorney from the Department of Revenue will not be
attending any hearing regarding it. Please contact me if you or the Court has any questions or requires
anything additional from this Bureau.
cerely,
~• ~
annon E. Baker
Trust Valuation Specialist
Inheritance Tax Division
Bureau of Individual Taxes
_,..
Bureau of Individual Taxes { PO Box 280601 (Harrisburg, PA 17128 { 717.783.5824 ~ shabaker@state.pa.us
AUG ~ 0 '1Q10
ESTATE OF JESSIE E. JOHNSON IN THE COURT OF COMMON PLEAS
by James M. Johnson, Administrator of OF CUMBERLAND COUNTY, PA
the Estate of Jessie E. Johnson =
Petitioner
V. :CASE NO. lp - 5~7$ ~tivi ~ ~~
Thomas Oyler
Respondent :CIVIL ACTION: LAW
ORDER APPROVING SETTLEMENT
AND NOW, this ~~day of ~ , 2010, it is hereby
ordered and decreed that James M. Johnson, Executor of the Estate of Jessie E. Johnson
is authorized to execute the Release as set forth in Exhibit "A," and the settlement and
distribution of the proceeds of the Plaintiff s claim shall be as follows:
1. $92.00 to the law offices of Shumaker Williams, P.C. for costs
advanced in the suit.
2. $18,750.00 to the law offices of Shumaker Williams, P.C. as
attorney's fees.
3. Under the Wrongful Death Act: $74,310.60 to be paid in equal
part to James M. Johnson and Teresa E. Johnson.
4. Under the Survival Act: $31,847.40 to be paid to the Estate of
Jessie E. Joimson.
$. James M. Johnson, Executor of the Estate of Jessie E. Johnson is hereby
authorized to execute the Release attached to the within Petition as Exhibit "A."
BY THE COURT: /
.I
TRUE COPY FROM RECORD
In Tesi(mony whereof, I here unto set my hand
and the se I of said Co at Garllsle, Pa.
This . j,day of , 20 (( J
Prothono
~~ t
SHUMAKER
WILLIAMSP~.
LEGAL AND BUSINESS COUNSEL
WRITER'S DIRECT DIAL: 717.909.1646
WRITER'S EMAIL: ledermann@shumakerwilliams.com
Admitted to Pennsylvania, Michigan and Florida Bars
September 29, 2010
~_
`
Glenda Farner Strasbaugh, County of Cumberland, Register of Wills ~o
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CUMBERLAND COUNTY COURTHOUSE
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One Courthouse Square
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Carlisle, PA 17013-3387 -`''
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RE: Estate of Jessie E. Johnson , `
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PA File No.: 21-10-0415 ~ ~ ` ~'
Our File No: 10-723(2)
Dear Ms. Strasbaugh:
We enclose, for filing, on behalf of our client the Estate of Jessie E. Johnson, a completed
REV-1500 Inheritance Tax Return, Resident Decedent, with all supporting documents and the
Estate Inventory. We submit the Return to your office in duplicate as requested in the
Department of Revenue's instruction booklet for the same. Attached to the Return is a check in
the amount of $100 ($70 represents the additional probate fee, and $30 is the fee for the filing of
the tax return and inventory). Since the decedent was under the age of 22 and died intestate with
her parents being her only surviving beneficiaries, there is no inheritance tax due.
We also enclose one (1) extra copy of the Return and Inventory, and request that you
time stamp these copies and return copies in the self-addressed stamped envelope provided.
Please advise the undersigned with any questions.
DJLJvae:234665
Enclosures
cc: James M. Johnson (w/out enc
Sincerely,
SHUMAKER WILLIAMS, P.C.
By David J. dermann CORRESPONDENCE
P.O. BOX 8:
HARRISBURG, PA 1710
PHONE: 717.763.112
FAX: 717.763.741
CAMP HILL, PA 717.763.11=
STATE COLLEGE, PA 814.234.32
TOWSON, MD 410.825.52:
YORK, PA 717.848.51
mail@shumakerwilliams.co
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