HomeMy WebLinkAbout03-27-12 (2)i
1505610140
REV-1500 ~` ~°'-'°'
OFFICIAL USE ONLY
PA Departrment of Revenue Caun Code Year File Number
Bureau of Irhdividual Taxes tY
PO sox 2f~osol INHERITANCE TAX RETURN 2 1 1 2 0 1 2 3
Harrisburg, PA 17128-OS01 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
Decedent's Last Name Suffix Decedent's First Name MI
W A L S H C O N S T A N C E L
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
W A L S H J O H N W
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
^X 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Retum (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return 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) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
M A R C U S A M c K N I G H T I I I 7 1 7 2 ~9 2 3~ 3
First line of address
I R W I N &
Second line of address
6 0 W E S T
City or Post Office
C A R L I S L E
Correspondent's e-mail adtlress:
P A 1 7 0 1 3
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Under penalties of perjury, I deCla~e that I have examined this return, including accompanying schedules and statemeMS, and to the best of my knowledge and belief,
it is true, correct and com te. DeGaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF P F FI RETURN DATE
2452 WALLA
SIGNATURE OF
M c K N I G H T P C
F.~
REGISTER OF~~h~ USE ON
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DATE FILED W
P OM F R E T S T R E E T
State ZIP Code
ROA
TIVE
CARLI
60 WEST POMFREIT.JSTREET CARLISLE
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610140
PA 17
PA 17013
1505610140 J
1505610240
REV-1500 EX Decedent's Social Security Number
4 8 1 5 2 1 9 8 0
oecedent'sName: CONSTANCE L• WALSH
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. '
2 1 8 0 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 -Probate Property
sted
R
Billi
~
7
....
eque
ng
Separate
(Schedule G) .
...
8 2 1 8 0 0 0. 0 0
8. Total Gross Assets (total Lines 1 through 7) ........................ ...
.
9. Funeral Expenses and Administrative Costs (Schedule H) ............ .... .. 9• 5 7 3 2 9 . 6 9
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....... .... .. 10. '
11. Total Deductions (total Lines 9 and 10) ......................... .... .. 11. 5 7 3 2 9. 6 9
12. Net Value of Estate (Line 8 minus Line 11) ...................... .... .. 12• 1 6 0 6 7 0 . 3 1
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. 1 6 0 6 7 0 . 3 1
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
1 0 0 6 7 0. 3
1
15.
0.
0
0
(a)(1.2)x.o _
16. Amount of Line 14 taxable
6 0 0 0 0. 0
0
16 0 . 0 0
at lineal rate X 0_ .
17. Amount of Line 14 taxable 0 . 0 0 17. 0 • 0 0
at sibling rate X .12
18. Amount of Line 14 taxable 0 . 0 0 18 0 . 0 0
at collateral rate X .15 .
19. TAX DUE ......................................................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
1505610240
Side 2
0. 0 0
1505610240
'REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 12 0123
DECEDENT'S NAME
CONSTANCE L. WALSH
STREET ADDRESS
2452 WALNUT BOTTOM 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
0.00
0.00
Total Credits (A + B) (2) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page $, Line 20 to request a refund.
(3)
(4) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00
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 : ...................................................................... ^
b. retain the right to designate who shall use the property transferred or its income; ............................... ^
c. retain a reversionary interest; or ................................................................................................ ^ X^
d. receive the promise for life of either payments, benefits or care? ....................................................... ^ Q
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ^ Q
3. Did decedent own an "intrust for" or payable-upon~ieath bank account or security at his or her death? ......... ^ X^
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. §91160)(1)].
• The tax rate imposed on the net valve 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 fnas at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX+ (11-10)
Pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE
CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
CONSTANCE L. WALSH 21 12 0123
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 ACTION -NON-TAXABLE PORTION 200,000.00
ORPHANS' COURT DIVISION 21-12-0123
SURVIVAL ACTION -TAXABLE PORTION 18,000.00
ORPHANS' COURT DIVISION 21-12-0123
FIRST $30,000 OF THE ESTATE PLUS ONE-HALF OF THE BALANCE TO THE
SURVIVING SPQUSE -REMAINING ONE-HALF OF THE BALANCE TO THE
SURVIVING ISSUE.
TOTAL (Also enter on Line 5, Recapitulation) ~ S 21
If more space is needed, insert additional sheets of paper 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
CONSTANCE L. WALSH 21 12 0123
Decedent's debts must be n:ported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. HOLLINGER FUNERAL HOME & CREMATORY, INC. 2,014.65
B
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
Ciry
Year(s) Commission Paid:
State ZIP
2. AttomeyFees: PERSONAL INJURTY LITIGATION FEES 54,500.00
3, Family Exemption: (If decedent's address is not the same as claimants, attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: REGISTER OF WILLS 52.50
5 Accountant Fees:
6. Tax Retum Preparer Fees:
7. STATE FARM INSURANCE -PROBATE BOND 100.00
8. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 75.00
9. THE SENTINEL -ESTATE NOTICE 189.54
10. REGISTER O,F WILLS -FILING FEE 30.00
11. COMMONWEALTH OF PA -POLICE REPORT 8.00
12. CPCRS - REt~ORDS 55.00
13. ORPHANS' CIOURT -FILING FEE (PETITION) 15.00
14. REGISTER OIF WILLS -ADDITIONAL PROBATE FEE 290.00
TOTAL (Also enter on Line 9, Recapitulation) 3 57.329.69
If more space is needed, use addfional sheets of paper of the same size
• REV-1513 EX+ (01-10)
Pennsylvania I SCHEDULE J
DEPARTMENT OF REVENUE I BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF:
FILE NUMBER:
CONSTA NCE L. WALSH 11 11 011:3
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDR SS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS' [Include outr' ht spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. JOHN W. WALSH Spousal 100,670.31
2452 WALNUT BOTTOM ROAD
CARLISLE, PA 17015
2. JOHN B. WALSH Lineal 15,000.00
690 N. MIDDLETON ROAD
CARLISLE, PA 17013
3. PATRICK A. WALSH Lineal 15,000.00
670 N. MIDDLETON'ROAD
CARLISLE, PA 17013
4. MICHAEL J. WALSH Lineal 15,000.00
3285 CANYON DRIVE #32
BILLINGS, MT 59102
5. DANIEL B. WALSH Lineal 15,000.00
123 WALKER LANE
KING OF PRUSSIA, PA 19406
ENTER DOLLAR AMOUNT FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBU IONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. E
If more space is needed, use additional sheets of paper of the same size.
-._._ __._.. __.... -r-.
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2.
The settlement proceeds shall be allocated as follows:
A. 'Wrongful Death ..................................................................$200,000.00
B. Survival Action .....................................................................$18,000.00
3.
The legal fees and expenses to Irwin & McKnight, P.C. are approved as follows:
Less Legal Fees to Irwin & McKnight, P.C.:
(25% pf Settlement) ........................................................................$54,500.00-
Less l~xpenses:
(Probate, Bond, Advertising Fees) .......................................................$430.04
4
The di$tribution of the Survival Action proceeds is as follows:
Survivval Action ..................................................................$18,000.00
(100°Xo of proceeds distributed to surviving spouse)
Less expenses to Irwin & McKnight, P.C .......................................$430.04
ESTATE OF CONSTANCE WALSH,
A TRUE COPY FROM RECORD
in Testimony wherof, I hereunto
set my hand and the ~
of said Court at Garlisie.. PA ~
: INiI' ~ t ~. OOURLEAS OF
CUMBERLANIk ~i',QsB1~QSYLVANIA
ORPHAN'S COURT DIVISION
NO. 21-12-00123 ~ ~,~
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ORDER OF COURT ~~~n
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AND NOW, this day of March, 2012, upon consideration of the attached Pet'ri# yin of
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the Plaintiff/Petitioner, it is hereby ORDERED that the approval of the settlement of Plaintiffs'
claims are granted as follows:
1.
The Administrator, John W. Walsh, shall settle for the amount of $218,000.00 on behalf
of the Estate of Constance Walsh from the Defendants, Paul E. Baer and Citizens Fire Company
No. 1.
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Less prorated legal fees to Irwin & McKnight, P.C.(25%)..........$4,500.00
Balance for Distribution .............................................................$13,069.96
Distribution to John W. Walsh, Surviving Spouse ....................$13,069.96
5.
The distribution of the wrongful death proceeds is as follows:
Wrongful Death Action ............................................................$200,000.00
Less. legal fees to Irwin & McKnight, P.C.(25%) ......................$50,000.00
Balance for Distribution ...........................................................$150,000.00
The final wrongful death distribution is as follows:
John W. Walsh, Surviving Spouse .............................................$90,000.00
John B. Walsh, Son ....................................................................$15,000.00
Patrick A. Walsh, Son ................................................................$15,000.00
Michael J. Walsh, Son ...............................................................$15,000.00
Daniel'B. Walsh, Son .................................................................$15,000.00
By the Court:
Judg
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Hollinger Funeral Home & Crematorq, Inc.
Eric L. Hollinger. Supervisor
December 21, 201.
John W. Walsh
2452 Walnut Bottdm Rd.
Carlisle. PA 17015
The Funeral Service for Connie L. Walsh:
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every
way we can. Please feel free to contact us if you have any questions in regaM to this statement.
THE FOLLOWING ISM AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDI~!E THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
Professiongi Service -Cremation Package C
Merchandise- Slate Urn
Custom Mlemorials, Register Book,
Acknowledgement cards
$ 2745.00
395.00 _ _..- __ - - _
175.00
AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO OTHERS
AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES.
Cash Advahces
Des Moines Register 398.50
Knoxville Journal 42.00
Patriot Ne~rspaper 306.57
Sentinel 177.58
Minister 125.00
Death Certificates (121 72.00
Cumberlarhd Co. Coroner Fee 25.00
Flowers &!Tax 53.00
Total Charges
1/3/2012 Car Insurance Received
$ 4514.65
2500.00
Balance 5 2014.65
501 NORTH BALTIMORE AVENUE • MOUNT HOLLY SPRINGS. PENNSYLVANIA 17065 • (7l 7) 486-3433 • FAX (717) 486-3515
www.holIingerfuneralhome.com