HomeMy WebLinkAbout04-26-13 1 1505610105
J REV-1500EX�o�_,,,�Fl, �
OFFICIAI USE ONLY
PA Department of Revenue pennsylvania
BureauofIndividualTaxes "u„"�"��`"�` CountyCode Year. FileNumber
PO BOXZ8o6oi INHERITANCE TAX RETURN . �
Harrisburq,PA i9iz8-o6oi RESIDENT DECEDENT � 0� � �) �� ''�,,
ENTER DECEDENT INFORMATION BELOW
Social Securiry Number Date of Death MMDDYVYY Date of Birth MMDDYYVY
159-74-2591 . 11/03/2008 06/12/1941 '
DecedenCs Last Name Suffix DecedenPs Pirst Name MI
TRAN _ . Quang T
(If Applicable)Enter Surviving Spouse's Information Below � � �
Spouse's Last Name Suffix Spouse's First Name MI
__. _._ ..._ ._.._ __.. __. .__. .._........
VO ; Ngoo-Loan T
Spouse s Social Secunty Number �� � �
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
�5saa-ss�t ', REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
O 1.Original Return O 2.Supplemental Return O 3. Remainder Retum(Date of Death
Priorto 12-73-82)
O 4. Limited Estate O 4a.Future Interest Compmmise(date o� O 5. Fetlerel Estate Tax Retum Required
death after 12-12-82)
O 6. Decedent Died Testate O 7. Decedent Mainiained a Living Trust _ 8. Total Number o/Safe Deposi[Boxes
(Attach Copy of Will) (Atlach Copy of Trust.)
m 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to 7a<under Sec.9113(A)
Belween 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT- TNIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE�IftFC7ED T0:
Name ... .. ....... ..... ...... .... ... ..... . .Daytime Telephone Numbe�": ... �.m..
Richard A. Sadlock, Esq � o w m t'
_ _ _ _ _ � � � � �
� �
REGiy'1ER�F WILL9 USE ONLW
� yy f" N [..'; �rl
r Z rn c� ,
First Line of Address , .. .... ., � v? "�'—�� G�
_ -^`- -.. -, r
Tren Estate _ _ _ ' v c, r- _. -.
' � ,:.-� C? �.� _3 .:
.. ��' ' _�
Second Line ofAddress.. .. .. . . .. .. . .. . . . . . . . . .. ... .. . .. c:�; t—, :�' �'�
'4503 North Front Stre '� � �-' �'° y
City o�Post OffiCe�� � � � �� �� � Slate ZIP�Code ���DATE i1LED ��
, . _.. . _.. . ...._ _.... ..._ ..... . .__ _....
Harrisburg , PA i 17110
CorrespondenYs e-mau address:rsadlock@angino-rovner.com
Untler panalties of perjury,I declare that 1 have examined this raNm,inclutling accompanying schetlutes and statemenis,antl b the best o1 my knowletlge and ballef,
it is�me,correct and mmplete.Declaration of preparer oNar ihen lhe personal represeMative is 6ased on all infortnation of which preparer has any knowledge.
SIGNATURE OF PERS RESPONoSIBLE FO'Rp FILI7NG��RENRN DATE
� ��.GiPlt(l1Xl�.V° f�z/Z7/�3
ADDRESS —�
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610105 1505610105 J
�
� zsns5�a�os
REV-t500 EX(FI) pecedenPs Sociai Security Number
oecedenrs Name: TRAN Quehg T. 159-74-2591
RECAPITULATIQN
7. Reai Estate(Scheduie A}. ............................................ L �.
2. Siocks and Bonds(Schedule B) ......._...... ........................ 2. ..��. �,
3. Gloseiy Neid Oorporatinn,Partnersh'rp ar Sole-Propdetorefiip{Schedule C} ..,.. 3. �� �
4. Mortgages and Notes Receivable(Sahedule D).......... .... ............. 4. '. �
5. Cash,Bank Depasifs and Mlsceitaneous Persanal Property(Sohedute E}....... 5. .� 29,951.00 '�.
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ..... .. 6. �
7. tnter-Viws Transfers&Miscelian�us Non-P`obate Property �� � � � � - � � �
{Schedule G} O Separate Billing Requested....,... 7.��, -
B. Total Gross Assets(tntal Lines t through 7). .... .... ......... .. .. ....... 8. �, 29�981.00
9. Funeral Expenses and Adm(nistrative Costs(Schedu7e H}................... 9.��
70. Debts of Decedent, Mnrtgage Liabilities and Liens(Schedule I).... ........... 10. �, _
, . .. . _.. . _ .. ._. .. . ._ ...�
tt 7otal 6educftOns{Wtal E.ines 9 aqd'10)............._.................. 1L ��, �.
12. Net Value af Estate(Line 8 minus Line 71) ... ,_.. ...................... 12. ! 29,951.00 ��
t3. CharilaWe ar�d Govemmentai BequesistSec Sti 3 7rusts fot which �' �� � - � ��� -- -� � - � ��� " ��'�
an eiedron to fax has raat been made(Schedu7e.1) ........................ 13. . ;
14. Net Vaiue Subject to Tax(Line 12 minus Line 13) ............. .. .. ....... 14. ' 79�9$1.00 �
TAX CALCULATfON-SEE INSTRUCTIONS F6R APP�lCABLE RATES
'I5. Amount of�i�re t4 taxa6ie
at the spousal tax rate,or
transfers under Sec.9116 . ... . .. . . .. . . . 29.951.0(1 .. .. . . ...... .. .. . .... �
(a)(12)X.OQ 75. (}.OQ .._
i6. Amount of Une'14 taxabie : � " .
attinealrate X.0_ ��, �6. �
17. Amount of Lino 14 taxablo � � � � � � � �� � � � � '�
at si6ling rate X.12 17, � -
. ._. . ... ... ._.... .. _ . . . . . ._., ._ ... ......... ... . .
t8. Amount of�ine 74 taxabig � �
at collaterel�ele X.15 � 18. �
i8. TAXDUE. ..__........................................_......_. t9. . ._.. . . ,... .. ... .._ ._ ,4.00 '.
20. PILL IN THE OVAL IF YOU ARE REqUESTING A REFUN6 pP AN OVERPAYMENT p
Side 2
� Z505610205 15�5610205 J
REV-1500 EX(FI) Paga 3 Flle Number
Decedent's Gomptete Address:
OECEDENi'S NAME
TRAN Gluang T,
STREEFAODftE5S ��
13'10 112 Brandt Avenue
CiTY STATE --. ZIP .- .
New Cumberland PA 17076
Tax Payments and Credits:
t. 7ax 4ae(Page 2.l.ine 18} (7) 0.00
2. Credits/Payments �
A.Prior Payments _.__.__,._-----� ----.---.
B_Oiscount
.�.—�...�i�—-----��— Totai Credits(A+8 j (2)
3. interest '�
(3}
4. if Line 2 is grezter than�ine 1+line 3,anter the difference, This is tl�OYERPAYk�ENT. � T
Fiii in uvai on Page 2,Line 20 to tequest a refumi. (4j
5. If Line 4+Line 3 is greater than Line 2,enter the d�ference.7fiis is the TN(DUE. {5) 0.04
Make check payable ta: REGISTER OF WELLS,AGENT.
PLEASE AN5WER TWE FOLLOWING QUESTION5 BY PLACING AN"X"1N THE APPROPRIATE BLQCKS
f. Ord decedeni make a fransfer and: Yes No
a. retain the use or income of the property transferred..........................................................._.................._......... ❑ �
b. retain the nght to designate who shall use the propedy trensterced or its income............................................ ❑ �
c. ret2in 2 reve�sionary interest................................_..........................................._.................................._........... ❑ �
d. receive the promise for Iife of either payments,benefts or care?.........................................................._.......... ❑ �
2. If death occurred after pec. 12,1962,did decedent transfer property within one year of death
without receiving adequate consideration?......._........_._._................. ❑ �
..............................._............................
3. Did decedeM own an"in Uusi for"or payablwpon-death 4ank accoant or securi#y ai his ar her deaih?.............. ❑ �
4. Did decedent own an individual retirement account,annuity or other non•probete property,which
contains a benefciary designationl .................._.................................................................................................... � �
IF THE ANSWER TO ANY OF THE ABOVE 4UE5TIONS 15 YES,YOU MUST CdMpIETE SCHEDULE G AND FILE iT AS PART dF THE RETURN.
For dates ot death on or after July t,1934,and before Jan.f,1995,the tax rate imposed on the net value of transfers ta w for the�se af the surviving spoose
is 3 perr�nt[72 P.S.§91i@(a){1.9)(i}}
For dates of death on or after Jan. 1, 1A95, the tax rate imposed on the net value pf kransfers tn or for the use of the suroiving spouse is 0 percent
[72 P.S.§9118(a)(1.1)(ii)J.7he statute does not exempt a lrans(er to a surviving spouse frorn�ax,and lhe statutory requirements for disclasure of assets and
fiiing a tax retum are still app(icable even if#he surviving spaise is ihe only bene8ciary.
Far dates of death on or after July 1,2000:
. The tax rate imposed on the net value of transfers hom a deceased child 21 yeare nt age or younger at death to or for the use of a natural parent,an
adoptive parent or a steppsreni of the chiid is 0 percent[72 P.S.§9116{a){t2)].
• 7he tax rafe imposed on the net value of[ransfers fo or for the use of the dacedenYs lineal beneficiaries is A.5 perceot,except as noted in[72 P.S.§9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedenPs siblings is 12 percent[72 P.S.§9118(aJ{1.3J].A sibOng is defined,
under Section 9102,as an individuai vaha has at Ieast one parent io commo�with#he decedent,whether tiy blood or adoption.
REV-15o8 EX+(o8-i2)
� pennsylvania SCHEDIlLE E
oePaRTnenroFneveNUe CASH, BANK DEPOSITS & MISC.
rnnearrnNCernxaEruaN pERSONAL PROPERTY
RFSIDENT DECEDENT
ESTATE OF: PILE NUMBER:
TRAN Quang T. 21-OS-1187
Indude the proceeds of litigation and[he date the praeeds were received by the estate.
All property joindy owned wfth right of survivorship must be disclosed on Schedule F.
�M VALUE AT DATE �
NUMBER DESCRIPTION OF DEATH
�, Proceeds from Survival Action 29,951.00
In the Court of Common Pleas
Cumberland County, Pennsylvania
Na.09-7673
Proceeds Received by Estate January 2013
PLEASE NOTE: Supporting Documents for this tax return are being supplied
to the Department of Revenue ONLY
TOTAL(Also enter on Line 5, Recapitulation) $ 29,951.00
If more space is needed,use additional sheets of paper of the same size.
REV-1513 E%+ (01-10)
� pennsylvania SCHEDULE ]
INHERITANCE TA%RETURN BENEFICIARIES
RESI�EM DECEDENT
ESTATE OF: FILE NUMBER:
TRAN Quang T. 21-08-1187
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(5)RECEIVING PROPERTY Do Not List Truatee(s) OF ESTATE
I TAXABLE DIS7RIBUTIONS[Include outright spousal distnbutions and trdnsfers under
Sec.9116(a)(1.2).]
1. Ngoc-Loan T.Vo 100%
1310112 Brandt Avenue
NewCumberland,PA 17070-1533
ENTER DOLLAR AMOUNTS FOR D[STRIBUT[ONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRtBUTI0N5 UNDER SECiION 9113 FOR WHICH AN ELECfION TO TAX IS NOT TAKEN:
1.
B. CNARITABLE AND GOVERNMENTAL DlSTRIBUTIONS:
1.
TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEEL §
If more space is needed,use additlonal sheets of paper of the same size.
- - . _ . . . - - - i -
`�t � = p����lvania
, DEPARTMENT OF REVENUE
Deaember 18,2412
Richard A. Sadlock,Esquire
tingino and Rovner
4503 North Front Street
Harrisburg,PA 17110
Re: Estate of Quang Tan Tran ,
File Number 2108-I l$7
= Court of Common Pieas Cumbarland County
Dear Mr. Sadlock:
The Department of Revenne has received tha Petition for Approval of Settlement Claim to be
filed on behalf of the above-referenced Fstate in regard to a wrongful death and survival action. It has
been fonvazded to this Bureau for the Commonwealth's approval of the allocation of the praceeds paid to
settle the actions.
Pursuant to tha Petition, the 67 yaar oId decedent diad as a restilt of inedical negligence.
Decedarn is survived by his wife and two clrildren.
Please be advised fhat,based upon these facts and for inheritance tax purposes only,this
Department has no objection ta the proposed ailocation of the net proceeds of this action, $SS,b23.22 to
the wrangfui death ciaim and$29,950.95 to the survival claim. Proceeds af a survival action are an asset
included in the decedent's estate anfl are subject ta the impositian of Pennsyiva�ia inheritance ta�c. 42
Pa.C.S.A. §8342; 72 P.S. §4145,31Q7. CosLS and fees must be deducted in the same percentages as the
proceeds aze allocated. In re Estate of Memman, 664 A.2d 1059{i'a. Cmwlth. 1995).
I trust that Uus letter is a sufficienk representation of the Department's position on this matter. As
the Depar[rnent has no objections to the Petition,an attomey from the Departmznt of Revenue will not be
attendiug any heariug regarding it. Please contact me if you or the Court has any questions or requires
anything additional from this Burean.
Su erely, ��J�����/�y�� f
_e,f�,
h on E.Baker
Trust Valuation Specialist
Inheritance T�Division
� Bureau of Individual Taxes J P4 Box 28�6�1 � Harrisburg, PA 17i28 � 717.783.5824 � shabeker@pa,gav � A
' angino-rovner
�-- -
ASO3 N �F:11 I'L��INT STREET RICHARD C.ANGINO NEIL J.RUVNER
HARRI'. ei iu:.J \171I0•1799 DAV@ L.LOTZ MACHAEL E.KpSIK
PHONE {�-?) '..S-G791 RiCHARD A.SADLOCK LISA M.BENZIE
FAX:('1�� '_3N. �bIO DARY4 E.CHftiSTOPHER K[ttSTEN N.SICiiS[
www.A g� in-ri oer.com
E-maii r:aJloi I:@anginn-rovner.c4m
TRAN,OUANG TAN ESTATE bv NC>OGLOAN T. VO,ADMINISTRA.TRIX
v.
CHARLES� KINGSLEY M.D et al.
DISTRIBUTION SHEET
TCYTA�-AMt)I7NT CYF SETTL.BMENT $150,000.00
DEllt C'CiONS:
�tGrney's Fee(35°l0} 52 SOO.ao
Balanca $97,500.00
Reim!>ursemenY of expenses paid by attorneys
to odiers for records, experts,etc. 11 917.03
PALANCE T'{?CLIENT PLUS ANY 1N`CEREST EARNEL3
WHII,E HELD IN BANK ESCROW $85,582.97
PTNAI I)TVISION:
��.ttorney's Fee $52,500.00
C'lient's Balance $$5,582.91
I2.eimbursementofExpenses $11,917.03
This s rttlemendverdict may be taxable. We recommend that you consult your aocountanY or ta�c attorney for the
calcula ion of your tax liability and any deductions to whicl�you may be entitled.
WARRANTY
AND NOW,this day af , 2013, I acknowledge that [ have read, understood,
approv :d and obtained a copy of this Distributian Sheet. Z further acknowledga that the above balance constihates my
total reimbursement far medioal expenses, wage losses, pain and suffering and any other losses suskained or claims
result'rr g from my accident. I warrant that if thera aze any outstanding medical bills, child support arrearages or claims
ather tl an as set forth above, they will be my responsibility; I further warrant that I will pay any outstanding Biue Cross,
BIue Slield, Public Assistance, MedicazelMedicaid, medical subrogation liens or any other liens and expenses not noted
abave.
WIT'NI SS Ngoc-Loan T.Vo,Administratrix of the Estate of
Quang Tan Tran
stsza�
- ' IUeAL REGISTRAR'S CERTiFiCATtON G1F DEATH
WARNING; !t Is iUega! #a dupiicate this copy by photostat ar phatograph.
ee far this cereificate, $6.00 ���°� ��«.,,� Thi� is to certify tliat the inEormati4n here eiken
���pttN-QFPf,f.y'�'i- Sul�filad w,th mre as�l,ocal�fte�traz cThe�o D�;
,� Y 8 ' n
certiticate will be forwarded ua the State Vi
* * i��a Rec�ffice fo�err*ianent filing�pV O � Z��
P 1 � 8091 �� x � �.~ � °� ! J
Certification Numbef t�FN��F'"�� 4�t�.
Local Begistrur Daze issued
v nrsma COMMONWEALTH OF PENNSYWANIA�oEFART#IENT 4F HEALTH•VITAL RBC4R0ffi
urt w
�M CEHTIFlCATE dF DEATH
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. ._ ... . _. . . _. ._. . . ._ ..
ongino-rovner
4503 NORTH FRONT STREET RICHARD C.AHGIHO NEIL J.ROVNER
Hnrse�sacac,PA 17110-1799 Dnv�n L.Lurz M�cxne�E.KoSIK
PHONE:(717)238-6791 RICNARD A.SADLOCK LISA M.BENZIE
FAX: (717)238-$610 DARVL E.CHRISTOPHER KRISTEN N.SINt31
www.angino-rovner.com
E-mail: rsadlock@angina-rovner.cam
April 25, 2013
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
RE: Estate of Quan T. Tran
File No. 2008-01187
Dear Register:
Enclosed please find a check in the amount of$15.00, your filing fee, and the original and one copy of
the Inheritance Tax Return for the Estate of Quan T. Tran.
Should you have any questions, please do not hesitate to contact me.
Very truly yours,
�
wen Baughman, aralegal
to Richard A. Sadlock, Esquire
RAS/gab
Enclosure: check #90782
szaiai
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