HomeMy WebLinkAbout11-24-101505610101
~ ~~~ i ~ ~ o Ex co~_~o,
PA Department of Revenue Pennsylvania OFFICIAL USE ONLY
DEIAN(t1ENi DF REVEN!!E County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN -~-- --~~--"
PO BOX 280601 G
Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~ J ~ a ~ 7 ~ _
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
211-24-6538 02/23/2007 :05/18/1931
Decedent's Last Name Suffix Decedent's First Narne MI
Rohrer Eugene ~ E
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
~- J-^---~------~- ~ -- THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF 1~ILLS
FILL IN APPROPRIATE OVALS BELOW
O 1. Original Return ~ 2. Supplemental Return O 3. Remainder Return (date of death
prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
O 5. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Bexes
(Attach Copy-of Will) (AttachCopy of Trust)
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(~~)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
Ronald E. Johnson, Esq (717) 243-0123
First line of address
78 West Pomfret Street
Second line of address __ _ __
City or Post Office
Carll5le
State ZIP Code
PA 17013
ri
REGISTER OF LS USE ONL'h~'
r ;'' ~ n~.. ~
r~ ~
~~ i
~
~
~ ~ r.w .~;
~
~ "
~~
~ ~
r
::1~7
DA~ FILED
~~
-~...1
Correspondent's a-mail address:. relohnson@pa.net
-__ , + ~ , i
:;
Ii
{.
.+
Under penalties of perjury, l 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.
SIGNAT RE OF PERSON RESP SIBLE F ILl RETURN DATE
~ d ~ ~ i
ADDRESS
c/o 78~/est Pomfr t Street, C~Nrsfe, PA 17013 _
SIG, OF~RE9ARTrR OTH PRESENTATIVE DATE
Side 1
250561,0101, 15~561~2~1;
~ PLEQSE USE ORIGINt~:L FORM OhlLY
J
1,50561,0105
REV-1500 EX
Decedent's Social Security Number
Decedents Name: Eugene E, Rohrer 211-24-6538
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.
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E}...... , 5. 13,OF~7.11
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. ,
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property -~-~
(Schedule G) O Separate Billing Requested........ 7.
8. Total Gross Assets (total Lines 1 through 7) .................. . ...... . ... 8. 13,087.11
9, Funeral Expenses and Administrative Costs (Schedule H) .... . ... . ....... . . . 9. 165.00
10. Debts of Decedent,,Mortgage Liabilities, and Liens (Schedule I) ........ . . . ... 10.
11. Total Deductions (total Lines 9 and 10) ............. . ........... . .... . .. 11. 165.00
12. Net Value of Estate (L•ine 8 minus Line 11) ... . .......................... 12. 12,922.11
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. 12,922.11
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec, 9116 ____----
(a)(1,2) X .0 ^ 15.
16. Amount of Line 14 taxable -" -'--~`~~-"~-~~~
at lineal rate X .0 45 12,922.11 16. 581.49
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 1 g.
19. TAX DUE .......................................................... 19. 581.49
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Q
Side 2
1,505610105 1,50561;01,05
REV 1500 EX Page 3
Decedent's Complete Address:
File Number ~~ ~~ ~ ~ D/ /~
DECEDENT'S NAME
Eugene E. Rohrer
STREET ADDRESS
~a ~ Sow>~1-r S `~r1 d `~~~r ~`yc'~'
CITY~~ /~ f~ STATE ZIP ~ ~/7~~
Tax Payr~nents 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.
5. if Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAn DUE.
Make check payable to: P,EGiSTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING GiUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOGKS ~~
1. Did decedent make a transfer and: Yes No
a. retain the use or income.of the.property transferred :.......................................................................................... ^
b, retain the right to designate who shall use the property transferred or its income : ............................................ ^
c~ retain a reversionary interest; or .............................................
d. receive the promise for life of either payments, benefits or care? ...................................................................... ^
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. ^
3. Did decedent own an "in trust fog" or payable-upon-death bank account or security at his or her death? .............. ^
4. Did decedent own an individua4 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 is
3 percent [72 P.S. §9116 (a) (1,1) (i)].
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 ofi 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(x)(1.2}],
c1> s~/•y~
Total Credits (A + B) (2)
(3)
(4)
a 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(x)(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(x)(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.
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANIOUS PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Eugene E. Rohrer 21-07-00192
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 DESCRIl'TION VALUE AT DATE
NUIvIBER OF DEATH
Net proceeds from a personal injury action filed by the decedent
prior to his death in the Court of Common Pleas of Cumberland
County, PA to No. 07-7501. This action was settled and the
proceeds dispersed on 11/12/2010. (see copy of net proceeds
check and Settlement Memorandum attached hereto) $13,087.11
We respectfully request that no interest and,penalties be assessed
as the amount received is being timely reported following
ascertainment and the receipt of funds.
TOTAL (also online 5, Recapitulation) $13 , 0 8 7.11
7175411577 Trane Parts
rvrr=, ~u~rt ~riti,n~rs~n~M R ~ t VhiT~'tY5-R ! -La~Y
ESTATE'OF EtJGi/NE ROHRER
1 0663-20 1 097 l 1/12/2010
MLK
~~'i ZGER Y~/1CKE~SH~~f ~
ATTORNEYS-AT LAW ~-~---
P.O. BOX 5~0 =~-~-~,-~+
HARRISBURG, PA 17110-Q3a0 60-880-3I3
(117) 23&5187
PAY
TO Tkir=
ORDER
OF
55855
007614
DATE 11/12/2010 A7dC)UNT
Thirteen thousand eighty-seven acid eleven/100*******#************************************'~******* 130$7.11
ESTATE OF EUGENE ROHRER
_s.
e
e
m
~~
LS 1
I,UT'hk?RiZF.D_S}aNATUAE ~
01:29:50 p.m, 11-12-2010 1 /7
~~855
55855
13087.11 13087.11 0.00
~I`0 5 5$ 5 5--° ~:0 3 ~ 30880 7~: ~ 200 S LO~r~ CSI'
7175411577 Trane Parts 01:30:29 p.m, 11-12-2010
11 /9/2010 10:47 AM
77-00023 !Rohrer, lair. Eugene
SETTLEl~1ENT r~9E~iORANDUf~
RECOVERY:
RECOVERY USAA
DEDUCT AND RETAIfd TO P~iY:
FJfetzger 1'Vickersham
ChartONE, Inc.; medical records $ 33.36
ChartONE, Inc.; Medical Records; Carlisle Regional $ 23.98
Phelan, Dr. William; Medical records $ 25.Q0
Belvedere Medical Corporation; Medical Records and Bills $ 21.15
Orthopedic and Spine Physical Therapy; Medical Records and Bills $ 67.97
Mira Orthopedics; Medical Records $ 38,75
Metzger Wickersham; Photographs $ 16.00
ChartONE, 1nc.; Medicai Records ~ Bills ~ Carlisle Regional Med Ct $ 48.86
Cumberland Valley Pain Management; Medical Records and Bi11s $ 30.D0
ChartONE, Inc.; Medical Bills from Carlisle Regional Medical Cente $ $9.53
Cumberland County Prothonotary; Filing fee for Writ of Summons $ 78.50
Cumberland County Sheriff; Fee for service of Writ of Summons $ 100.00
REFUND -Cumberland County Sheriff $ =51.20
Cumberland County Prothonotary; filing fee far reissuing Writ of Summons$ 10.00
Cumberland County Sheriff; fee for service of reissued Writ of Summo ns$ 100.00
Refund -Cumberland County Sheriff $ -86.62
Metzger Wickersham; Digital Photographs $ 2,Op
Capitol Copy Service; Photocopies and bottom exhibit tabs $ 566.19
Metzger Wickersham; Digital Photographs $ 2.00
Lafferty IV, Esq., Francis J.; Parking for depos on 9116/09 $ 10.50.
Hughes, Albright; Deposition transcripts from 9/16/09 depos $ 321.75
Hughes, Albright; Transcripts of 9117/09 depos, split w/77-22 $ 215.45
Cumberland County Register of Wills; Fee for Short Certificate $ 4.00
Candelarlo, Ms. Jackeline; Notary Fee -Release $ 5,00
Metzger Wickersham; Fax $ 6ti:00
Metzger Wickersham; Long distance phone calls $ 3.28
Metzger Wickersham; Photocopies $ 147,42
Metzger Wickersham; Postage $ 170, ~ 2
4 /7
Page 1 of 2
$ 25,000.00,_,.. , .
$ 25,000.00
7175411577 Trane Parts
11/912x10 1(}:47 AM
77-000231 Rohrer, N1r. Eugene
Total Due Metzger 1tltickersham
DEDUCT AND'RETAIN TQ~PAY'TO OTHERS:
Cumberland Valley Pain Management
Kinetic imaging
Metzger W ickersham, Atty Fee
MSPRC-NGHP
Tatal Due Others:
Total Deductions:
Total l~,mount Due To Client
Less Previously Paid To Client
Net Amount Due Client:
01;30:45 p,m. 11-12-2010 5 /7
Page 2 of Z
$ Z,o7s.99
$ 275.25
$ 19.34
$ 8,333.33
$ 1,207.98
$ 9,$35.90
$ 11,912.89
$ 13,087.11
~ o.ao
~ 13,0$7.11
I hereby approve the above settlement and distribution of proceeds. Metzger Wickersham will pay out of the recovery the
medical bills and liens listed above, t acknowledge that any furtt~ler medical bills or liens not reflected in this SettlernE~nt
Memorandum are solely my responsibiiity to pay.. I a}so .acknowledge my. obligations to pay back any child support owed
out of the distribution before any other liens ar funds are distributed to me.
~~~tz~~~
Date Gregory Roh r, Administrator of the Estate of Eugene Rohrer
7175411577 Trane Parts 01:30;01 p.m. 11-12-2010 2 /7
SINCE 1888
3211 North Front Street
P.O. Box 5300
Harrisburg, PA 17110-0300
717-238-8187
Fax: 717-234-9478
November 1?, 2010 th r f5ces
Lancaster Shippensburg
717-43]-0138 717-530-7515
Wilkes-Barre York
570-825-7500 7:[ 7-843-0502
Mr. Gregory Rohrer
4045 Carlisle Road
Gardner, PA 17324
FtE: Eugene Rohrer motor vehicle accident of 12/22/05
Dear Greg:
Attached please find our Final Settlement Memorandum and a check made payable solely to the
Estate in the amount of $13,0$7.11. The check represents the Estate's share of the settlement
proceeds after deducting my contingent fee and the outstanding expenses.
The Release which you signed have been delivered to USAA Insurance and Erie Insurance.
Thank you for placing your trust in us and for choosing our office to represent yau. I hope you
were pleased with the way in which we handled this matter. If~you have~any rcLV~-nrlendations
regarding how we may better serve our clients, we are most anxious to hear them and we
encourage you to communicate them to us.
With regards to future medical expenses under your automobile insurance policy, there is a
statute of limitations in Pennsylvania under the Motor vehicle Financial Responsibility Law.
Generally, the statute of limitations is for four years. What this means is that if benefits have not
been paid, an action for benefits must commenced within four years from the date of the
accident. Or, if benefits, have been paid, an action for further benefits must be brought within
four years of the last date. of paym.ent.. Basically,, this., means..that yo.u.. cannot..let.four. years. go _by
without claiming any medical expenses, and then try to claim them at a later date,
While it appears that all incident-related medical expenses have been paid, we cannot guarantee
that all medical expenses related to the incident have in fact been paid. You remain solely
responsible for payment of any medical expenses nod satisf ed thus far.
jarnes F. Carl
Edward E. Knauss, IV"
Clark DeVere'
Francis J. Lafferty, IV
Andrew W. Norfleet'
Mi~ael J. Boone
x55615-1 Andrea M. Cohick
_ ~~\
' Board Certified in civil 1~:~-
triallaw and adzrocacy
7175411577 Trane Parts 01:30:20 p.m. 11-12-2010 3 /7
Mr. GregoryRohrer
November 12, 2010
Page Two
If at. any time in..t.he fu~ture.,you,.yaur -fama.Iy or your .friends are.in need ~of legal services, please
feel free to contact us. Gur law firm provides a full range of legal services.
We enjoyed working with you.
Sincerely,
1\hETZG ~ICKERSHAM, KNAUSS & ERB, F.C.
F cis J. Laffe , IV
F.IL/mlk
Enclosures
45615-1
SCHEDULE H
FUNERAL EXPENSES, ADMINISTRATIVE
COSTS AND MISCELLANEOUS EXPENSES
ESTATE OF
FILE NUMBER
Eugene E. Rohrer 21-07-00192
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A.
1
2
B.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
Funeral Expenses:
Administrative Costs:
Personal Representive Commissions
Name of Personal Representative(s)
Social Security Number of Personal Representative:
Street Address:
City: ....State.:. ....:Zip.:
Year(s) commissions paid:
Attorney fees to Andrews & Johnson (add'1 fee not previously charged) $150.010
Family Exemption
Claimant
Street:
City: State & Zip
Relationship of Claimant to Decedent:
Probate Fees to Register of Wills
Accountant Fees to Patricia Rosendale, CPA
Tax Return Preparer's Fees
Register of Wills -Inheritance Tax filing fee $15.00
-TOTAL (also on line 9, Recapitulation) ~ $165.00
S CKEDULE J
BENEFICIARIES
ESTATE OF
Eugene R. Rohrer
FILE NUMF3ER
2l -~7-~Ol 92
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSH~ AMOUNT OR SI~~RE
Do Not List Trustee(s) OF ESTATE
I ThXABL DISTRIBUTIONS [include outright spousal distributions, and transfccs uadtr Scs. 9116(a}(1.2))
1 Gregory Gene Rohrer
4045 Carlisle Road; Gardners, PA 1'7324 son 45%
2 Tammi Lynn Rohrer Madaus
4045 Carlisle Road, Gardners, PA 17324 daughter 45%
3 Eugene Frank Rohrer Earhart
PSC 817 Box 2550, FPO AE 09622 son 10%
II NON-TAXAEiLE DISTRIBUITONS:
A. SPOUSAL DISTRIBUTIONS UNDER.SECTION 81.1:3.rOR WNICH'AN ELECTION TO TAX.IS.NOT B.EIN.G.MADE
B, Charitable and Governmental Bequests: