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HomeMy WebLinkAbout04-03-12 (2)1505610101 REV-1500 °"°'-'°' ~ OFFICIAL USE ONLY PA Department of Revenue PennsylvaMa County Code Year File Numtler OEPRR}NEMOi REVFNYE Bureau of Individual Taxes INHERITANCE TAX RETURN Po Box sso6oi 2 1 0 7 0 4 4 8 Harrisburg, PA i~>.z8-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW rrSocial Security NuTTmber Date of Death MMDDYYYY Ll~l.~~® 0 4 Decedent's Last Name Suffix (N Applicable) Enter Surviving 8pouse's Information Below Date of Birth MMDDYYYY 0 8 0 4 1' L~LJ Decedent's First Name MI rrri~ Em Spouse's Last Name Suffix Spouse's First Name MI ® z~ a Spouse's Social Secudty Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 1. Original Return O 4. Limited Estate O 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received ~ 2. Supplemental Retum O 4a. Future Interest Compromise (date of death after 12-12-82) O 7. Decedent Maintained a Living Trust (Attach Copy of Trust) O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) O 3. Remainder Retum (date of death prior to 12-13.82) O 5. Federal Estate Tax Retum Required 8. Total Number of Safe Deposit Boxes O 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 T0: Name Daytime Telephone Number'-~~``~~~~ E ~~ 2 5L~61~_ REGIS pftWILLSU,~ONLY First line of address Second line of address 70. -i7 t W O ~ 3 1.1x131 IFlrlolnltl IsltlrlPlPlt1 1 1 1 1 1 D-, '`:' Clty Of POSt Offlce State 21P Code DATE FILE B o i l i n 1 ~~~, ~Tf !"a J r,.~ _ .7 -_= t _. r ~~ r Correspondent's e-mail address: Under penahies 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. Dedaredon of preparer other than the personal representative is based on all information of which preparer has any knowledge. 'Sf~`RATLI}2E OFPERSON RESPQfJSIBLIJ FOR FILING RETURN DarF - ADDRESS tEPARER R T N P ENTATIVE ~ .uy n ~..2 ~.C.C.6r_._. .t~s~I /'P~e~ : 1pe/~~itt~ c~f/itJGS; PLEASE USE ORIGINAL FO Side 1 1505610101 DATE a "7 S/!~//.~ 1505610101 J ~'~b REV-1500 EX Decedents Narrre: 1. Real Estate (Sdiedu~ A) ............................................. 1. 2. Shx:ks and Bonds (Sclredute B) ....................................... 2. 3. Ck~ely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes itecefvable (Schedule D) ........................... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 6. Jointly Ovened Property (Schedule Fj O Separate. Biking Requested ....... 6. 7. Chter-Vtvos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate BNlthg Requested........ 7. 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 9. Funeral Expenses and Administrathre Costs (Schedule H) ................... 9. 10. Debts of Decedent, Mortgage Liabilities, and liens (Schedule I) .............. 10. 11. Total Deductions (total lines 9 and 10) ................................. 11. 12. Net Valus of Estab (Line 8 minus Line 11) .............................. 12. 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. TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (ax1.2) X .0_ 18. Amount of Llne 14 taxable at lineal rate X .0 17. Amount of Line 14 taxable at s~kng rate X .12 18. Amount of Line 14 taxable at cokateret rate X .15 15. 16. 17. 18, 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTNKi A REFUND OF AN OVERPIIIIMENT Side 2 15056bOb05 15056bObD5 b505610105 Decedents Social Security Number O J REV~150B E% • (7.871 SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHRESIDENTDE EDENTRN PERSONAL PROPERTY ESTATE OF FILE NUMBER Mary C. Marconi 21-07-0448 Include the proceeds of litgation 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~' Allocation of proceeds of Civil Action filed in the Court of Common Pleas, in and for Cumberland County, Pennsylvania to NO. 09-2181 regarding the survival action. See attached Department of Revenue letter dated January 25, 2012 from Shannon E. Baker, Trust Valuation Specialist. Please abate any interest and/or penalties since these assets were received as a result of a wrongful death and survival action that was recently settled. $66,250.00 TOTAL (Also enter on Tine 5, Recapitulation) 13 6 6 , 25 0. 0 0 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10.06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF Mary G. Marconi FILE NUMBER 21-07-0448 Debts of decedent must be reported on Schedule I. A. I FUNERAL EXPENSES: 1. e. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Denise L. Kurr $3,300.00 Name of Personal Representative(s) _ Street Address 626 Gutshall Road City Boiling Springs, state pA Zip 17007 Year(s) Commission Paid: 2 01 2 2• Attorney Fees Anthony L. DeLuca, Esquire $1,700.00 3. Famify Exemption: (If decedent's address Is not the same as claimants, attach explanation) Claimant 4. 5. 6. ~. 8. Street Address _ Cily State Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees 1/2 of Attorney's fee and 1/2 of cost of litigation expenses. See attached Distribution Sheet Filing fees for supplemental Inheritance Tax and Inventory 34,609.16 30.00 TOTAL (Also enter on line 9, Recapitulation) ~ $ 3 9 , 6 3 9. 1 6 (If more space is needed, insert additional sheets of the same size) REV-1512 EX« (t2-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Mary, C. Marconi ---------- 21 - 0 7- 0 4 4 8 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death. includinn ~~nracmti~~.~e~[ n,sa[~.[ .,........... ~~~ uiu~c ayacn is neeaea, msen aaaalonal sheets of the same size) REV•1513 EX+ (9.00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Mary C. Marconi 21-07-0448 RELATIONSHIP TO DECEDENT AMOUNT OR SNARE 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. Denise L, Kurr Daughter 25$ 626 Gutshall Road Boiling Springs, PA 17007 2. Estate of Eugene L. Marconi Son 25$ C/O 626 Gutshall Road Boiling Springs, PA 17007 3, Robert G. Marconi Son 25$ 218 N. Arch Street Mechanicsburg, PA 17055 4. Joseph D. Marconi Grandson 12.5$ 155 Lawrence Lane Carlisle, PA 17013 5. Jacob. A. Marconi Grandson 12.5$ 155 Lawrence Lane Carlisle, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRIATE, O N REV•1500 COVER SHEET II NONTAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV•1500 COVER SHEET $ -0 - (If more space is needed, insert additional sheets of the same size) penns~Lva~ni DEPARTMENT DF REVEIJUE January 25, 2012 Richard A. Sadlock, Esquire Angino and Rovner 4503 North Front Street Harrisburg, PA 17110-1799 Re: Estate of Mary Marconi File Number 2107-0448 Court of Common Pleas Cumberland County Dear Mr. Sadlock: 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. According to the Petition, the decedent died as a result of medical negligence. Decedent is survived by her two adult children. Her son Eugene Marconi, who was deceased prior to the completion of this cause of action, is not an eligible wrongful death beneficiary. Hodge v. Loveland, 690 A.2d 243 (Pa.Super. 1997) . The getition also indicates that all of the beneficiaries are adults were not dependent on the decedent, and have sufferc;d limited pecuniary (financial) loss. Pursuant to the Supreme Court of Pennsylvania, before there can be any recovery in damages by one in family relation for negligent death of another in the same relation, there must be a pecuniary loss. Manning v. Caoelli, 411 A.2d 252, 270 Pa.Super. 207, Super.1979. Family relation required to maintain action under Wrongful Death Act is defined to require showing of pecuniary loss by relatives seeking damages as result of wrongful death of decedent; there must be pecuniary loss by one in family relation before there is any recovery in damages. Hod.~e v. Loveland, 690 A.2d 243, 456 Pa.Super. 188, Super.1997, reargument denied, appeal denied 723 A.2d 672, 555 Pa. 701. Occasional gifts and services are not sufficient on which to ground a pecuniary loss. Gavdos, Supra, 301 PA at 530, 152 A. and 552. ~,,.--- Please be advised that based upon these facts and case law, the Department disagrees to the proposed allocation of a 80/20 split between wrongful death and survival action. However, for inheritance tax purpose only, this Department would not object to the allocation of the gross proceeds of this action, $66,250.00 to the wrongful death claim, and $66,250.00 to the survival claim. This is equal to a 50/50 split. Proceeds of a survival action are an asset included in the decedent's estate and are subject tathe imposition of Pennsylvania inheritance tax. 42 Pa.C.S.A. §8302, 72 P.S. §9106, 9107. I trust that this letter is a sufficient representation of the Department's position on this matter. Please contact me if you or the Court has any questions or requires anything additional from this Division. S cerely, `~/" r~ ~ ,/ on E. B~akl ,er Trust Valuation Specialist Bureau of Individual Taxes I PO Box 280601 I Harrisburg, PA 17128 1717.783.5824 I shabaker@pa.gov angino-rovner 4503 NORTH FRONT STREET RICHARD C. ANGINO HARRISBURG,PA 17110-1799 NEIL J. ROVNER PHONE: (717) 238-6791 DAVID L. LuTz FAX: (717) 238-5610 MICHAEL E. KOSIK RICHARD A. $ADLOCK www.angino-rovner.com LISA M. B. WOODBURN E-mail: rsadlock@sngino-rovntr.Cnm DARYL E. CHRISTOPHER DENISE L. KURR, PERSONAL REPRESENTATIVE of the ESTATE of MARY MARCONI v. MARK A. OSEVALA, D.O., et al. DISTRIBUTION SHEET TOTAL AMOUNT OF SETTLEMENT $132,500.00 DEDUCTIONS: Attorney's Fee (35%) 46 375.00 Balance $86,125.00 Reimbursement of expenses paid by attorneys to others for records, experts, etc. 22 843.3 Balance $63,281.68 Escrow for Reimbursement expenses paid by attorneys of Medicare lien 8 938.25 BALANCE TO CLIENT PLUS ANY INTEREST EARNED WHILE HELD IN BANK ESCROW $54,343.43 FINAL DNISION: Attorney's Fee $46,375.00 Client's Balance $54,343.43 Reimbursement of Expenses $22,843.32 Ester Medicare lien $8,938.25 This settlement/verdict may be taxable. We recommend that you consult your accountant or tax attorney for the calculation of your tax liability and any deductions to which you may be entitled. WARRANTY AND NOW, this day of , 20 , I acknowledge that I have read, understood, approved and obtained a copy of this Distribution Sheet. I further acknowledge that the above balance constitutes my total reimbursement for medical expenses, wage losses, pain and suffering and any other losses sustained or claims resulting from our accident. I warrant that if there aze any outstanding medical bills, child support arreazages or claims other than as set forth above, they will be my responsibility; I further warrant that I will pay any outstanding Blue Cross, Blue Shield, Public Assistance, Medicaze/Medicaid, medical subrogation liens or any other liens and expenses not noted above. WITNESS DENISE L. KURR, PERSONAL REPRESENTATNE of the ESTATE of MARY MARCONI assssz ang-no-rovner 4503 NORTH FRONT STREET FIARRISBURG, PA 17110-1799 PHONE: (717) 238-6791 FAx:(717)238-5610 www.angino-rovner.com E-mail: rsadlock@angino-rovner.com RICHARD C. ANGINO DAVID L. LUTZ RICHARD A. SADLOCK DARYL.E. CHRISTOPHER NEIL J. ROVNER MICHAEL E. KGSIK LISA M. B. WOODBURN KRISTEN N. SINISi February 14, 2012 MSPRC - NGHP P.O.Box138832 Oklahoma City, OK 73113 Re: Beneficiary Name: Estate of Mary S. Marconi H I C #: 177241385A CaselD #: 201013709001382 D/injury: 4/20/2007 Dear Sir/Madam: Ena!osed please find this firm's check in the amount of $8,938.25 as full payment for the Medicare lien applicable to the Estate of Mary Marconi. As requested, I have enclosed a copy of your February 3, 2012; fetter to me regarding the instant lien. Thank you. Ve tt ours ichard A. Sadlock RAS/mam Enclosures cc: Denise L. Kurr (w/out encls.) 492223 REV-7500 EX Page 3 Decedent's Complete Address: Fib Number 21-07-0448 DECEDENTS NAME Mary C. Marconi _ STREET ADDRESS 105 Brighton Drive Clrv Carlisle, STATE PA nP 17015 Tax Payments and Clredits: 1. Tax Due (Page 2, Lino 19) 2. CtediLslPaymeMs A. Prior Payments B. Discount -0- 3. Interest -o- 4. H Line 2 is greater tt~ Line 1 * Line 3, enter the difference. This is the OVERPAYMENT. Fitl M ~ on Ppe 2, Line 2li to rpuest a refund. Twat Credits (A + s) (2) (3) (4) (1) $996.38 -0- 5. N Lirre 1 ~ Line 3 is greeter ttren Line 2, eater the difference. This a the TAX DUE. (5) $ 9 9 6.3 8 Make Check payab{e to: REGISTER ~F WILLS, AGENT. PLEASE ANSNtER THE FOLLOWING QUESTIONS @Y PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decadent make a transfer and: Yes No a. retain the use a income of the propeAy transferred :.......................................................................................... ^ b. retain the right ro designate who shah use the properly transferred or its income : ............................................ ^ c. retain a reversionary interest or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits a care? ...................................................................... ^ 2. H death occurred after Dec. 12,1982, did deoedent transfer property within one year of death .. wrthaut recervrng ada4uate consideration? .............................................................................................................. 3. Did deoedent own an 'in trustfor" apayable-upon-death bank account ar security at his or her death? .............. ^ 4. Did decedent own an individual retirement account, annuity or otfx~r non-probate property, which ..................................................................................................... contains a benefiaary designation? ................... ® ^ IF TIC ANSWER TO ANY OF THE ABOVE QUESTIQNS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN. Fa Baths of death on a after July 1,1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers 1o a fa the use of the surviving spouse is 3 percent [l2 P.S. §9116 (a) (1,1) (i)]. Fa dates ~ death on a after Jan. 1, 1995, the tax rate imposed on the rtet v~ue of transfers ro a fa fhe use of the surviving spouse is 0 peroent (72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer ro a surviving spouse from tax, and the statutory retfirirements fa disclosure ~ assets and fiGrg a tax rebrnl are ssl appYcable even if the surviving spouse is the ady befrefiaary. Fa Babas of death on a after July 1,2000: • The fax rate imposed on the net value of transfers from a deceased child 21 years of age a younger at death th a fa the tme of a nahual parerd, an adoplNe parent a a stepparent of the Bold ~ 0 percent 172 P.S. §9116(aM1.2)]. • The tax rate i on the net value of traraters th a fa the use of the decedents tinsel benefir~arieg is 4.5 percxtnt, extx~rt as Holed in 72 P.S. §9116(1.2 [72 P.S. §9116(aMi)]. • The ~gc rate imposed on the net value of transfers to or fa the use of the deoedents ' ' is 12 patent [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in wnxrron with the decedent, w then by blood a adoptron.