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HomeMy WebLinkAbout02-01-12J 1505610143 REV-1500 EX(°'-'°> PA Department of Revenue Bureau of Individual Ta pennsylvania OFFICIAL USE ONLY DEPA C xes PO 60X.280601 RTMENT OF REVENUE ounty Code Year File Number Harrisburg, PA 17128-0601 INHERITANCE TAX RETURN 21 09 ENTER DECEDENT INFORMATION BELOW 0337 RESIDENT DECEDENT Social Security Number Date of Death 201 16 5804 O Date of Birth 1 18 2009 10 29 1924 Decedent's Last Name FEALTMAN Suffix Decedent's First Name MI CHARLES W (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name ~'EALTMAN Suffix Spouse's First Name MI JENNIE Spouse's Social Security Number C THIS RETURN MUST BE FILED IN DUPLICAT E WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return ^ 2. Supplemental Return 3. Remainder Return (date of death ^ 4. Limited Estate ^ prior to 12-13-82) qa Future Interest Compromise (date of death after 12 ~ 5 12 F 82 d l . - - e ) era Estate Tax Return Required g Decedent Died Testate (Attach Copy of Will) ^ y Decedent Maintained a Living Trust (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes ^ 9. Litigation Proceeds Received ^ 1 ~ Spousal Povert Credit (date of death between 12-31 X91 and T-1-s5) ^ 11.Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name JAMES D BOGp~ Daytime Telephone Number 717 737 8761 REGISTER OF ~ LS USE ONLY First line of address _ = =0 "-' _-U ;~ ONE WEST MAIN STREET ,- ~ -rt v' ~ rat ~ n ~ ~ ~ ; C`a r ~; ; Second line of address r -- ` ° `` ~ I J ` _ ~~~~ ~ - ., r ~-= z City or Post Office C.~ ii '-~ ~ ~> 1 r -- ~"T~ ~` State ZIP Code SHIREMANSTOWN DATE_ L~ GJ ' `~ ' PA 17011 ~'~ ~~ Correspondent's a-mail address: jbogar@bogarlaW.COnI Under penalties of perjury, I declare that I have examined this return including accompanying schedules and statements, and to the best of my knowled it is true, correct and complete. Declaration of preparer other than the personal representatro i b e s ge and belief, ased on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN (' iJ~ry.~.- ~( t'~~~rcm~si~~ Jennie C. Fealtman DATE ADDR s I I ~~,~ ~ 1126 Fernwood Avenue Cam Hill PA 17011 SIGNATU, PREPAR~2 O R THAN REPRESENTATIVE / !/ a{/'( DAT ( J James D. Bogar E ADDRES One West Main Street, S remanstown, PA 17011 Side 1 1505 610143 1505610143 J IJ 1505610243 REV-1500 EX Decedent's Social Security Number °ecede(if~S Name: Fealtman, Charles W. 201 16 5804 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 & Notes Receivable (Schedule D) ........... ......................................... .... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .. 5 ......... .... . 49.46 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ......... 7. Inter-Vivos Transfers & Miscellaneous f~Qn,-Probate Property ... 6. (Schedule G) LJ Separate Billing Requested......... ... 7. 8. Total Gross Assets (total Lines 1-7) .................... .............................................. ... $~ 49.46 9. Funeral Expenses & Administrative Costs (Schedule H) .................................... ... g. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................ .. 10. 11. Total Deductions (total Lines 9 & 10) ............................. .................................... .. 11. 12. Net Value of Estate (Line 8 minus Line 11) ................ ................ . ....................... 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which .. 1 z. 4 9. 4 6 an election to tax has not been made (Schedule J) .. ........................................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . ............................................ .. 1 a. 4 9. 4 6 TAX COMPUTATION -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 .o0 4 9. 4 6 15. 0 O O 16. Amount of Line 14 taxable . at lineal rate X .045 0. 0 0 16. 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. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ l_ Side 2 1505610243 1505610243 J REV-1500 EX Page 3 File Number 21-09-0337 Decedent's Complete Address: DECEDENT'S NAME Fealtman, Charles W. STREETADDRESS 1126 Fernwood Avenue CITY Camp Hill STATE ZIP PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 0.00 2. Credits/Payments A. Prior Payments B. Discount 0.00 Total Credits (A + g) (2) 0.00 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 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: a. retain the use or income of the property transferred :.......................................................................... Yes No b. retain the right to designate who shall use the property transferred or its income :.................................. c. retain a reversionary interest; or .............................................................................................................. ~ 0 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 x receiving adequate consideration?....... ^ ^ ........................................................................... ... ........... 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... 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 January 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)]. A sibling 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 CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTHOFPENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT tJlAlt OF Fealtman, Charles W. Include the proceeds of litigation and the date the proceeds were received by the estate. , All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION 1 Kelley & Ferraro, L.P. -proceeds of products liability claim 2 Kelley & Ferraro, LLP -proceeds of products liability claim 3 Kelley & Ferraro, LLP -proceeds of products liability claim The Last Will and Testament of Charles W. Fealtman was probated for purposes of following through with a products liability lawsuit against various national distributors of asbestos containing products instituted by the Decedent on January 29, 1999, prior to the Decedent's date of death. The lawsuit was filed in the Cuyahoga County (Ohio) Court of Common Pleas, at Case No. CV-99-376610. The above payments only have been received. A petition for court approval of settlement and/or a copy of a signed Court Order has not been issued. It is anticipated that no further payments will be received on account of this litigation, which is an asbestos tort, products liability case. A case summary from the Cauyahoga County Court of Common Pleas is provided and attached. TOTAL (Also enter on Line 5, Recapitulation) VALUE AT DATE OF DEATH 7.88 3.33 38.25 49.46 FILE NUMBER 2T-09-0337 (If more space is needed, additional pages of the same size) ~ Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Case Summary CASE SE1tVIN1ARY Case Number: Case Title: Case Designation: Filing Date: Judge: Magistrate: Room: Next Action: File Location: Last Status: Last Status Date: Last Disposition: Last Disposition Date: Prayer Amount: ©PROWARE 1997-2012 Page 1 of 1 CV-99-376610 ESTATE OF CHARLES FEALTMAN vs. A BEST PRODUCTS COMPANY ET AL ASBESTOS TORT-PRODUCT LIAB 01 /29/1999 NANCY A. FUERST ASBESTOS N/A N/A N/A PEND.FILE INACTIVE 11 /09/2008 DISP.OTHER 10/20/2008 $25, 000.00 http://cpdocket.cp. cuyahogacounty.us/p_CV_CaseSummary.aspx?isprint=Y 1 /23/2012 REV-1513 EX+ (11.08) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES Fealtman, Charles W. FILE NUMBER 21-09-0337 NUMBER NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE PERSON(S) RECEIVING PROPERTY DECEDENT TAXABLE DISTRIBUTIONS [include outright spousal ~ t ~ s e (Words) ($$$) I~ distributions, and transfers under Sec. 9116(a)(1.2)1 Jennie C. Fealtman Spouse 1126 Fernwood Avenue One Hundred Camp Hill, PA 17071 percent of rest, residue and remainder Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 ovOeasheet, as a I riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1 Copyright (c) 2009 form software only The Lackner Group, Inc. 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