HomeMy WebLinkAbout10-17-1115D5610140
REV-1500 EX (°'-'°'
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 0 7 1 1 0 2
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
2 0 0 6 0 0 0 9 6 0 3 2 1 2 0 0 6 0 5 24 1 9 6 4
Decedent's Last Name Suffix Decedent's First Name MI
K I L L I N G E R M I C H A E L S
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
K I L L I N G E R C H E R Y L A
Spouse's Social Security Number
1 9 9 5 0 0 8 8 1 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Return
4. Limited Estate
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
2. Supplemental Return
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust ~
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
State ZIP Code
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION !iHOULD BE DIRECTED T0:
Name Daytime Telephone Number
C H R I S T O P H E R E- R I C E 7 1 7 2 4 3 3 3 4 1
First line of address
M A R T S O N L A W O F F I C E S
Second line of address
1 0 E H I G H S T
City or Post Office
C A R L I S L E
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate: Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
REGISTER f3F11~lILtLS USE ONCY
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D~1E: FILED r' _.. '~~
P A 1 7 0 1 3
Correspondent's a-mail address: crice(a~martsonlaw.com
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 otpreparer other than the personal representative is based on all information of which preparer has any knowledge.
SIG TU E OF PE~~ESPOI~jSII~LE(F~ FIiIN~RETURN ~~ J ~ DBE' ,'
146 GRAHYN'(S WOODS ROAD CARLISLE PA 17015
SIG E O PREPARER OTH THAN REPRESENTATIVE DATE
ADDRESS
10 E HIGH ST CARLISLE PA 17013
PLEASE USE ORIGINAL FORM ONLY
.1.
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~~
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Side 1
1505610140 1505610141D
1505610240
REV-1500 EX
Decedent's Social Security Number
oecedenYsName: MICHAEL S KILLINGER 2 0 0 6 0 0 0 9 6
RECAPITULATION
....................... 1.
1. Real Estate (Schedule A) .................... 0 ' 0 0
2. Stocks and Bonds (Schedule B) 2, 0 ' 0 0
......................................
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages and Notes Receivable (Schedule D) .................... .. .... 4.
7 2 4 7 1 6
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E). .. .... 5. .
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested . .. .... 6. 0 • 0 0
7. Inter-Vivos Transfers & Miscellaneous N~Probate Property
0
0
0
(Schedule G) Separate Billing Requested . .. .... 7. .
8.
....................
Total Gross Assets (total Lines 1 through 7) . .. .... 8. 7 2 4 7 . 1 6
9. Funeral Expenses and Administrative Costs (Schedule H) ............ .. .... 9• 1 2 5 5 4 . 0 0
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....... .. .... 10. 0 • 0 0
11. Total Deductions (total Lines 9 and 10) ......................... .. .... 11. 1 2 5 5 4 . 0 0
12. Net Value of Estate (Line 8 minus Line 11) ...................... .. .... 12. - 5 3 0 6 . 8 4
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. - 5 3 0 6 • 8 4
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.00 0 0 0 15. 0. 0 0
16. Amount of Line 14 taxable
at lineal rate X .045 0 0 0 1 g. 0. 0 0
17. Amount of Line 14 taxable
at sibling rate X .12 0 0 0 17. 0. 0 0
18. Amount of Line 14 taxable
at collateral rate X .15 0 0 0 18. 0• 0 0
19. TAX DUE ................................................ .. ....19. 0 • 0 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^
Side 2
1505610240 15056102410
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 07 1102
DECEDENT'S NAME
MICHAEL S KILLINGER
STREET ADDRESS
146 GRAHAMS WOODS ROAD
CITY
CARLISLE STATE
PA ZIP
17015
Tax Payments and Credits:
~ ~ 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 TAX DUE.
0.00
Total Credits (A + B) (2) 0.00
(3)
(5)
(4) 0.00
0.00
Make check payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING GIUESTIONS 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 : ...................................................................... ^
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? ....................................................... ^ X^
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ^ 0
3. Did decedent own an "intrust for" or payable-upon-death bank account or security at his or her death? ......... ^ ^Q
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 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 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.
REV-1508 EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MICHAEL S. KILLINGER 21 07 1102
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. Net proceeds from Survival Action on behalf of Michael S Killinger (copy of Court Order, 7,247.16
letter from PA Department of Revenue approving settlement and check attached hereto)
Note: All other assets were owned jointly with spouse in excess of one year
TOTAL (Also enter on line 5, Recapitulation) l $ 7,247.16
(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
ESTATE OF FILE NUMBER
MICHAEL S. KILLINGER 21 07 1102
Decedent's debts must be n:ported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Ewing Brothers Funeral Home, Carlisle, PA 7,500.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s) _
Street Address _
City State ZIP _
Year(s) Commission Paid:
2, Attorney Fees: Martson Law Offices (estimated)
3. Family Exemption: (If decedents address is not the same as claimants, attach explanation.)
Claimant Cheryl A. Killinger
Street Address 146 Grahams Woods Road
C;ty Carlisle State PA Zlp 17015 _
Relationship of Claimant to Decedent Spouse _
4. Probate Fees:
1,500.00
3,500.00
39.00
5 Accountant Fees:
6. Tax Return Preparer Fees:
7. Register of Wills, filing fee, Inheritance Tax Return 15.00
TOTAL (Also enter on Line 9, Recapitulation) I $ 12,554.00
If more space is needed, use additional sheets of paper of the same size.
REV-1513 EX+ (01-10)
pennsylvania ~ SCHEDULE J
DEPARTMENT OF REVENUE I BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF:
FILE NUMBER:
MICHAE L S. KILLINGEK Z1 U"/ 11UZ
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 distributions and transfers under
Sec. 9116 (a) (1.2).)
1. Cheryl A. Killinger Spousal
146 Grahams Woods Road Not applicable
Carlisle, PA 17015
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HHEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed, use additional sheets of paper of the same size.
IN THE COURT OF COMMON PLEAS OF PHILADELPHIA COUNTY
FIRST JUDICIAL DISTRICT
CHERYL ANN KILLINGER, As Administrator : CIVIL TRIAL DIVISION
of the ESTATE OF MICHAEL KILLINGER,
Deceased; and In Her Own Right MARCH TERM, 2008
v. No. 1168
SMITHKLINE BEECHAM CORPORATION Control No. 075100
d/b/a GLAXOSMITHKINE
ORDER
AND NOW, this day of AUGUST, 2011, upon consideration of the Petition
~~
to Approve Settlement and Distribution of Wrongful Death and Survival Action
Proceeds, it is hereby ORDERED and DECREED that Petitioner is authori~:ed to enter
into a settlement with Defendants for the gross sum of Eighty-Nine Thousand Eight
Hundred Fifty-One Dollars and Forty Cents ($89,851.40). Defendants sl}all forward
all settlement drafts or checks to Petitioner's counsel for proper distribution.
IT IS FURTHER ORDERED and DECREED that the settlement proceeds be
allocated as follows:
1. Wrongful Death Claim:
2. Survival Claim:
85%
15%
IT IS FURTHER ORDERED and DECREED that the settlement piroceeds be
distributed as follows:
1. To: Anapol, Schwartz, Weiss, Cohan, Feldman & Smalley, P.C.
Reimbursement of Costs $2,900.96
2. To: Anapol, Schwartz, Weiss, Cohan, Feldman & Smalley, P.C.
Counsel Fees $35,940.;56
(4% MDL Costs paid by Counsel in the amount of $3,59'1.06)
3. To: Common Benefit Expense Fund $2,695.54
(3% MDL Costs paid by Claimant)
4. The Wrongful Death Claim in the sum of $41,067.31
shall be paid as follows:
Page 1 of 3
~.(1PIGC CGr~tT PI IRCI IAnIT T(1 Pa R (' P 7`?R(h1 (~ R~XTFR (1R/i ~/7M 1
Killinger Vs Srnithkline-ORWDX
nllVIIII~IUhI~IIVII V~
1
a. To: Cheryl Killinger, Spouse $33,283.60
b. To: Holly Marie Killinger, Adult Child $3,891.79
c. To: Daniel Scott Killinger, Minor Child $3,891.79
Date of Birth 3/18/1994
(as provided hereunder):
COUNSEL (and not the parents and/or guardlians of the
minor) is hereby AUTHORIZED and specifically DIRECTED to
execute all documentation necessary to deposit the funds
belonging to the minor in an interest bearing savings account or
savings certificate in a federally insured bank or savings institution
having an office in Philadelphia County IN THE NAME OF THE
MINOR ONLY.
The savings account shall be titled and restricted as follows:
Daniel Scott Killinger, a minor, not to be
withdrawn before minor attains majority or
upon prior Order of Court.
The savings certificate shall be titled and restricted as
follows:
Daniel Scott Killinger, a minor, not to be
redeemed except for renewal in its entirety, nor
to be withdrawn, assigned, negotiated, or
otherwise alienated before the minor attains
majority, except upon prior Order of Court.
5. The Survival Claim in the sum of $7,247.1fi shall be paid to Cheryl
Killinger, Administratrix of the Estate of Michael Killinger, Deceased;
provided however, that counsel shall not distribute any funds to the said
Administratrix until additional security, as may be required by the Register
of Wills of Cumberland County, pursuant to 20 Pa.C.S. § 332:3 (b)(3), is
posted.
Page 2 of 3
IT IS FURTHER ORDERED and DECREED that this Order shall be filed Under
Seal, pursuant to the Decree of the Honorable Sandra Mazer Moss, dated Judy 6, 2011.
Within sixty (60) days from the date of this Order, counsel for petitioner shall file
an Affidavit with the Civil Motions Clerk (296 City Hall), certifying compliance with this
Order. The Affidavit shall bear the caption of the case and shall contain thE: court term
and number. A copy of this Order shall be attached thereto.
BY THE COURT:
O'K FE, AD . J.
Page 3 of 3
r p~nnsylvania
DEPARTMENT OF REVBNUB
January 1 ], 201 ]
Amber M. Racine, Esquire
Anapol Schwartz
1710 Spruce Street
Philadelphia, PA 19103
• Re; Estate of Michael Killinger
•• File Number 2107-1102 •
Court of Common Pleas Philadelphia County
;, .. .
Dear Ms. Racine:
~.. •• . ,
•. ' ~ The Department ofReveriue has:received the P~tition'fo,r~:A.pprpval ol'Settlement (Maim to•beA ;`•.~•~~'.
.,,.... i:led on behalf of the above~refereri~ed Estate'izi,.regard;to.a..wrongful death apld,survival acstiian'. ~ It has••1!~ ,,..''
• bean forwarded to this Bureau+~'oxithe Commpnwealth's approval of the allocation of the p>roaeeds••paid to • •
•.... ~ ..:. • 'settle 'the'actions. ~• •~ ... , ; ..: . • ~ . •. ..
~•• • • . Pursuant to the Petition;•the 41 dear old~decedent diecl.a's•a result•of eomplioations from tha".• •,....:;. ;
• .... ..
. ,. medic&tion Avandia. Deaed'ent'is survived b~ liis wife'~d tyvo•~li:ildren, one a minor,: •'i'+'
• ~,• •• .~
' ' Pleas~•ba advised•thaf, b~§ed ifpori these ;E~o%~•aind`~far irihenitarice'tax purposes onY;y, this ' ~~ ' ;; .° .
'' ' Department has•no objection to the pr'opdsed allocxtion~of the~nerproeeeds.of this aotion,'$'.4]067~r1.8 taP.
• • the •wrongful death claim and $ 7,247..16 to the suxvival claim. Proceeds of a 'survival, action ane an asset'
inoluded in the decedent's estate and are subject to the imposition o;f ]:'ennsylvania inheritance tax. 42
Pa,C,S,A, §8302; 72 P.S. §9106, 9107, Costs and fees must be deducfed'in the same percentages as the '
• prooeeds are allocated. In rq,~g~gte{ of Me_(r 'xman, 669 A.2d 1059 (Pa. Cmwlth. 1995). ~ '
-I trust that this letter is a Sufi xcient representation of the Department's position on this matter, As
the Department has no objections to .the Petition, an attorney from the ~Jepartment of Revenue will not'be
attending any•hearing regarding it: Please •contact me;if you or the Court has any.questians•or,rrvquires
anything additional fronn this,Bureau. • ' • ~ ~ .: ,~
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..Bureau of Indlv9dual Taxes •~• PO Box 280601 ~ Harrl~burg, PA' 17128 ~ 717.783.•5824 •~'Sha6~iieyCtp~t~tb.pa,us
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