HomeMy WebLinkAbout08-10-1215D56041158
REV-1500 Ex cos-o5)
PA Department of Revenue Ot=FlC1Al t1SE ONLY
Bureau of lndividusl Taxes County Code Year File Number
Po sox 26o6ot INHERITANCE TAX RETURN
Harrisburg, PA 17126.0801 RE$~pj'I' pECEDENT ~~ J C~ 7 (~ ~ /,,
ENTER DECEDENT iNFORMATtON BELOW `-~
Social Securityy Number Oate of Death Date of Birth
160-82-2086 0?302007 09062003
Decedent's fast Name
RACER
Suffix Decedents First Name
DAMEN
MI
A
(If Applicable) Enter Surviving Spouse's IMotTttation Below
Spouse's Last Name Suffnc Spouse's First Name
Spouse's Social Security Number
- - THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
MI
FILL IN APPROPRIATE BOXES BELOW
a 1. Original Return ^ 2. Supplemental Return
^ 3. Remainder Return (date of death
4. Limited Estate
^ 4a
Future interest Compromise (date of prior to 12-13-82)
^ 5
^ 8. Decedent Died Testate
^
death after 12-12-82) . Federal Estate Tax Return Requited
(Attach Copy of Wtln 7. Det~dent Maintained a UNng Trust
(Attach Copy of Trust) ~ 8. Total Number of Safe
Deposit Boxes
LJ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95) ^ 11. Election to tax under Sec. 9113(A)
CORRESPONDENT - TI{fS SECTION MUST ~ COMPLETED ALL CORRESPONt)E (Attach Sch. O)
Name HICE AND CONFIDENTIAL TAX INFORMATION 8HOULD 8E OtRECTED TO:
Daytime Telephone Number
KARYN A• VAN BUSKIRK
f .
856-787-4238
Firm Name (If Applicable) ,'
~ ;:.~=;
BEGLEY LAW GROUP '~ ~ ~ ~~
~._
a C::7
First Itne of address _ . ~_ - -
509 S LENOLA ROAD BLDG 7 ~
~
~~~~~ : ~ ~ ~ .~ C:i
Second Nne of address ~ C~ - -.-r ' -T
°
City or Post Office
State ZIP Code --+
Y ~~_
DATE ~D (1"; ., ~ ~
--r1
MOORESTOWN NJ 08057
Correspondenrse-matladdress: KVANBUSKIRKa~BEGLEYLAWGROUP • COM
Under penaltles of perprry, 1 declare thffi i have examined this return, including aceompanying schedules and statements, and to the best of m know)
R le true. correct and comptffie. Dedaratbn of preparor other than the personal representative is based on all information of which Y edge and belief,
SIGNA7IJRE OF PERSON RESPONS,If(t,E FOR FILING RETURN PrePamr has any knowledge.
~( i~, ... ~.~ ~. ~d"~c~' _ LATE
-:~Ca.. ~
S~IATtJRE OF PREPARER OTHER THAN REPRESENTATIVE
Ran y H. Roger 285 Joya irc)e, Harris urg, PA 17112
Side 1
{..~ 15056041158 swiae~~3aoo ],5056041158
C
~' REV-1500 Ex(os-05) 15056041158
PA Department of Revenue OFFICIAL USE ONLY
Bureau of IndNAdual Taxes County Code Year Fila Number
Po sox z8osot INHERITANCE TAX RETURN
Harrisburg, PA 17128.0607 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Soaa1 Security Number Date of Death pate of Birth
160-82-2086 07302007 09062003
Decedent's Last Name
RACER
Suffer Decedent's First Name
DAMEN
(If Applicable) Enter Surviving Spouse's information Below
Spouse's last Name Suffnt
Spouse's Social Security Number
FILL IN APPROPRIATE BOXES BELOW
Q 1. Original Retum ^ 2.
^ 4 Li lted ES
Spouse's First Name
MI
a
MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
Supplemental Retum ~ 3. Remainder Retum (date of death
prior to 12-13-82)
m fate 4a Future Interest Compromise (date of
death after 12-12-82)
6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust
(Attach Copy of Will) (Attach Copy of Trust)
L~J 9. Litigation Proceeds Received ^ 10. Spousal Poverty Cred'R (date of death
between 12-31-91 and 1-i-95)
CORRESPONDENT - THIS SEC710N MUST 8E C~APLETED. ALL CORRESPONDENCE ANO CONFIt
Name
^ 5. Federal Estate Tax Retum Required
~. 8. Total Number of Safe Deposit Boxes
^ 11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
IENTIAL 7AXlNFORMATION SHOULD l9E DIRECTED TO:
Daytime Telephone Number
KARYN A• VAN BUSKIRK 856-787-4238
Firm Name (If Applicable)
B E G L E Y LAW GROUP REGISTER DF WILLS USE ONLY
City or Post OHIce State ZIP Code DAIS ~~p
MOORESTOWN NJ 08057
First line of address
509 S LENOLA ROAD BLDG 7
Second Nne of address
Correspondenrse-mailaddress: KVANBUSKIRKa~BEGLEYLAWGROUP • COM
Urber penalties of pery'ury, i dedere that I have examined this return, induding aceompanying schedules and statements, and to the best of m know)
rt is true. coned and complete. Dedaratton of preparer other than the personal representative is based on all lntormatian of which re Y edge and belie!,
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN P P~ has any knowledge.
DATE
ADDRESS
~ o r .~~ . .-. - ~. ..- - -
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
ADDRESS
~, 15056041158
V ~YQ ~
BM6847 3.000
15056041158
J 15056042159
REV-1500 EX
Decedent's Social Security Number
Decedent's Name Q 16 0- 8 2- 2 0 8 6
RECAPITULATION A
1. Real estate (Schedule A) .
.1.
2. Stocks and Bonds (Schedule B) . 0.00
2
0.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . 3
.
0.00
4. Mortgages ~ Notes Receivable (Schedule D).
.
. 4.
0.00
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . 5,
393985.00
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested
6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
0 . 0 0
(Schedule G) ~ Separate Billing Requested 7,
o•oo
8. Total Gross Assets (total Lines 1-7).
g.
393985.00
9. Funeral Expenses & Administrative Costs (Schedule H) .
,
' " 9.
2625.00
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I).
1 p,
0.00
11. Total Deductions (total Lines 9 & 10) .
1 1.
2625.00
12. Net Value of Estate (Line 8 minus Line 11)
12,
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
3 913 6 0 • 0 0
an election to tax has not been made (Schedule J) . 13,
0.00
14. Net Value Subject to Tax (Line 12 minus Line 13)
14.
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RAT
3 913 6 0.0 0
ES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2)x.o~
391,360 • 00 15.
16. Amount of Line 14 taxable 0 • 0 0
at lineal rate X .O~S
0 • 0 0 16.
17. Amount of Line 14 taxable
0 . 0 0
at sibling rate X .12 0 • 0 0 17.
18. Amount of Line 14 taxable 0 • 0 0
at collateral rate X .15 0 • 0 0 18.
0.00
19. TAX DUE 19.
0.00
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
],5056042159 15056042159
6M4648 2.000
REV-1500 EX Page 3
File Number
Decedent's Complete Address:
DECEDENTS NAME
STREET ADDRESS
CITY
STATE
ZIP
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit 0 - (] ~
B. Prior Payments Q - n a
C. Discount ~ - ~ ~
Total Credits (A + B + C)
3. Interest/Penalty if applicable
D. Interest _ O a O
E. Penalty ~ - 0 0
(1) ~ • (]~
(2) ~-00
Total Interest/Penalty (D + E) {3) O - O O
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in box 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.
A. Enter the interest on the tax due.
(4) - Q
(5) o . a o
(5A)
. j]
B. Enter the total of line 5 + 5A. This is the BALANCE DUE. (5g)
~•~~
Make Check Payable to: REGISTER OFWILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" !N 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 ro
p perty 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
f
year o
death
without receiving adequate consideration? .
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ~
X
0
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 January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three {3) percent [72 P.S. 9116 (a) (1.1) (i)j.
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 zero (0} percent
[72 P.S. §9116 (a) (1.1) {ii)J. The statute does not exempt a transfer to a survivin s
filing a tax return are still applicable even if the surviving spouse is the only benefi 9a use from tax, and the statutory requirements for disclosure of assets and
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (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 four and one-half (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 twelve (12) percent [72 P.S. ~9116(a)(1.3)j. 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.
6 M4671 7.000
RE~_,5o2EX.l6s8, SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant fads.
Real property which is jointlyawned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
None
DESCRIPTION
VALUE AT DATE
OF DEATH
TOTAL (Also enter on line 1, Recapitulation)
swasss t ooo (If more space is needed, insert additional sheets of the same size)
REV-1503 EX + (6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
WHERITANCE TAX RETURN
RESIDENT DECEDENT
~.~ ~ r, ~ ~ yr FILE NUMBER
A
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
TOTAL (Also enter on Tine 2, Recapitulation) I $
VALUE AT DATE
OF DEATH
3wasss i.ooo (If more space is needed, insert additional sheets of the same size)
REV-1507 EX + (6-98)
SCHEDULE D
COMMONWEALTH OF PENNSYLVANIA MORTGAGES 8c NOTES
INHERITANCE TAX RETURN
RESIDENT DECEDENT RECEIVABLE
ESTATE OF
FILE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
None
TOTAL (Also enter on line 4, Recapitulation) $
VALUE AT DATE
OF DEATH
3wasAC i.ooo (If more space is needed, insert additional sheets of same size)
REV-1508 EX + (6-98)
COMMONWEALTH. OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
ITEM
NUMBER
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.
DESCRIPTION
1 Litigation Proceeds:
Enclosed please find court order dated February 9, 2011
ordering 12.5$ of the proceeds to Randy E. Rager & Tammy
Rager as Co-Administrators of the Estate of Damen Rager
pursuant to the Survival Act.
Proceeds received by the estate in June, 2011.
See attached documentation
VALUE AT DATE
OF DEATH
393,985
TOTAL Also enter on line 5, Reca itulation $ 393 , 985
3wasaD t.ooo (If more space is needed, insert additional sheets of the same size)
REV-'1509 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX'RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
tJ1Alt VF
FILE NUMBER
H an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. ---
S URV N ING JOINT TENANT(S) NAME
RELATIONSHIP TO DECEDENT
JOINTLY-0WNED PROPERTY:
~~ LETTER DATE DESCRIP110N OF PROPERTY
FOR JOIN
I1hA DE
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT
NUMBER OR
DATE OF DEATH % OF DATE OF DEATH
NUMBER TENANT JOINT SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR DECD'S VALUE OF
None JOINTLY-HELOREAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST
TOTAL (Also enter on fin 6 Re anitulation) I $ 0
(~
more space Is needed, Insert addRlonal sheets of the same size)
3W4GAE 1.000
REV-1510 EX+ (Cr98)
COMMONWEALTH Of' PENNSYLVANIA
INHEPITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
Damen A.
FILE NUMBER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes
ITEM
NUMBS
1 DtSCRIPTION OF PROPERTY
~rc~u.~.,~ wNnF of rr~ raanlsFEREE rr,EiR aE~nriorvsniP ro oECEOENI aNO
rrcoarEOr raar~s.ER nrrncnncoFV of rnE ncFO FoR aEnr ESrATE
None
DATE OF DEATH
VALUE OF ASSET
%OF DECD'S
INTEREST ---
EXCLUSION
IFnPPUCne~E> _ ______________
TAXABLE
VALUE
-- ---
I
i
TOTAL (Also enter on line 7, Recapitulation) I $
(If more space is needed, insert additional sheets of the same size)
3W46AF 1.000
REV-1511 EXti (10.06)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES 8~
ADMINISTRATIVE COSTS
cair~itvr
T,...
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM - --------
NUMBER DESCRIPTION ~- AMOUNT
A FUNERAL EXPENSES i ----
~ None
B.
1
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City
Year(s) Commission Paid:
State Zip
2. Attorney Fees
2,500
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
4
5
6
7
City State Zip
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
None
125
TOTAL (Also enter on line 9, Recapitulation) $ 2 , 625
~wasac i.ooo (If more space is needed, insert additional sheets of the same size)
REV-512 EX.~~2-03)
COMMONWEALTH O~ PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
Darren A. Raaer___ _
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
t None
VALUE AT DATE
OF DEATH
TOTAL (Also enter on line 10, Recal
swasAr+ z o00 (If more space is needed, insert additional sheets of the same size)
REV-i5.3 EX* (9-00)
SCHEDULE J ~
COMMONJVtALTH OF PENNSYLVANIk ~ BENEFICIARIES
INHERITANCE 7AX RETURN
RESIOENTDECEDENT
ESTATE OF -- _
Damen A . Ra er FILE NUMBER
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
_.~-_
----
I TAXABLE DISTRIBUTIONS [include outright spousal distributi
n Do Not List Trustee(s)_ __ OF ESTATE
~ -
o
s. and transfers
under Sec. 9116 (a) {1.2)J
1 Tammy Rager
195 Beagle Club Road
;Carlisle, PA 17013 I
50~ of Residue: 195,680 Mother
195,680
2 Randy H. Rager
285 :Joya Circle
Harrisburg, PA 1.7112
50~ of Residue: 195,680 Father
195,680
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE. ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS: ~ -
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I
Is o
3.;,f,~,;, , ~~a (If more space is needed, insert additional sheets of the same size)
Case 1:08-cv-01482-YK Document 73 Filed 02/11/11 Page 1 of 2
IN TFIE UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF PENNSYLVANIA
RANDY E. RACER, Individually and as Co-
Administrator ofthe Estate of DAMEN
RACER, deceased, and
TAMMY RACER, Individually and as Co-
Administrator of the Estate of DAMEN
RACER, deceased, and as Administrator of
the Estate of CAMREN M. RACER,
deceased, and
STATE FARM F[RE AND CASUALTY CO.
a/s/o Randy E. Ragcr and Tammy Rager,
Plaintiffs,
v.
C1VIL ACTION
;08-cv-01482-YK
JURY TRJAL DEMANDED
GENERAL ELECTRIC COMPANY
Defendant
ORDER
AND NOW, this _e2J 7 / I~Clay-e€'.lenamy; B'A'H', upon consideration of Plaintiffs' oral
motion for court approval of a proposed settlement of Survival Act claims, in which motion
Defendant joins, pursuant to Section 3323(b) of the Probate, Estates and Fiduciaries Code, 20
Pa.C.S. § 3323(b), it is hereby ORDERED that said motion is GRANTED. Settlement of Survival
Act claims brought ott behalf of the Estates of Darren Rager and Camren Rager is hereby approved
as proposed. Distribution of the settlement proceeds is further approved, after satisfaction of the
subrogation claim of State Farm Fire and Casualty Co., based upon the following allocation:
To RANDY E. RACER, Individually: 25%
"fo TAMMY RACER, Individually: 25%
To RANDY E. RACER and TAMMY RACER
as Co-Administrators of the Estate of DAMEN RACER
pursuant to the Survival Act: 12.5%
Case 1:08-cv-01482-YK Document 73 Filed 02/11/11 Page 2 of 2
'I-o R%1'~DY E. 1tAGIR and "G1MM1' R,AGER
as beneficiaries of DA;`11:v RACER pursuant to
the Wrongful Death Aci:
:2.s°r~
To l'AMMY Rr1GLR as Ad;nir.isiratrix ofthe Cstalr
of CAMRf3N M. RAGIR pursuant to the Survival Act
13.E°/u
To RANDY [;. 1ZACiF,Ft and 'I'~~Mi\4Y RACER
as beneficiaries of CAA1Rb:N M. RACER pursuant to
the Wronv~ful Death Act:
12.5%
8Y "fliE COURT:
Y~~ettc Kane, Chief Judge -
llnited States District Court
Middle District of Pennsylvania
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