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Home My WebLink About08-28-13 J 1505610143 REV-1500 EX`°z_", �, OFFICIAL USE ONLY PA Department of Revenue pennsylvania ce��y coae vaa� F�ia N„mbe, Bureau of Individual Taxes �^^^*M�*�fa�E��E Po Box.zaoso� INHERITANCE TAX RETURN 21 09 0337 Harrisburg, PA m2e-oso� RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth O1 18 2009 10 29 1924 DecedenPs Last Name Suffix DecedenPs First Name MI ��N CHARLES W (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffx Spouse's First Name MI F'F'nT•T�N JENNIE C Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FI�L IN APPROPRIATE OVALS BELOW � i. Original Return � 2. Supplemental Retum � 3. Remaintler Retum(Date of Death Priorto 12-13-82) � 4. Limited Estate � qa. FuWre InterestCOmpmmise � 5. Fetleral Estate iax Retum Required (tlate M tleath aker 1212E2) � 6 Decetlent Died Testa�e � � Decetlent Maint2med a Living Trust _ g, �'p�yl Numbef of Safe De osit BOXes - �AttachCopyofWill) - (AtlachCopyo(Imst) P � 9. Litigation Proceeds Received � ��-pgh°„eenP�i�ii�i anaii�(oa95�f oeam � >>.Election to tax under Sec.9113(A) (Attach Schedule O) CORRESPONDEN7-7HI5 SECTION MUS7 BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL 7AX INFORMATION SHOULD BE DIREC7ED TO: Name Daytime Telephone Number JAMES D BOGAR 717 737 8761 REGI�F�F WILLS,USE CINL�� c� ::,� . ..' c,, n i -. , v First Line of Address 'r� -';_ ��.. , , (— �'. , . , . :.r ONE WEST MAIN STREET r � ; ' . , Second Line of Adtlress ��" - � � , Ci or Post Office . -DATE FILED � - ty State ZIP Code . c -�� . SHIREMANSTOWN PA 17011 ' CorrespondenYse-mailaddress: JbOgOf�bOgaflBw.COfil Under penaHies of perjury,I tleclare that I have examinetl this retum,including accompanyinq schedules antl statemenis,and to the best of my knowletlge antl belief, it is true,correct antl rnmplete.Declaration of preparer other than the personal represeniative is based on all information of which preparer has any knowledge. $�('aWATURE OF PERSOI�$feSPON BLE FO FI NG RETURN DPTE JQN•L. l C: r1G-�m4 � �q22.��<. �aLF�n,v �/� Jennie C. Fealtman, by �5�/a3/�3 ADDRESS $3L-I]� R� FP.d��71�n� PO� 1126 Fernwood enue Cam Hill PA 17011 SIGNAT PREPAR ER THAN REVRESENTATIVE DATE James D. Bogar a3 ADDRESS One West Main Str , Shiremanstown, PA 17071 Side 1 � 1505610143 1505610143 � �� J 15�5610243 REV-1500 EX DecedenYs Social Security Number oe�tle^�'sName Fealtman, Charles W. 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 8 Miscellaneous Personal Property(Schedule E)._............ 5. 7 � $42 . �S 6. Jointly Owned Property(Schedule F) ❑ Separate Billinq Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous f�nq-Probate Property (Schedule G) U Separate Billing Requested............ 7. 8. Total Gross Assets (total Lines 1 through 7)........................................................ g, 7 , $42 . O5 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 11. Total Deductions(total Lines 9 and 10)................................................................ �� 12. Net Value of Estate(Line 8 minus Line 17).......................................................... 12. 7 � $42 . �$ 13. Charitable and Governmental Bequests/Sec 9113 Tmsts for which an election to tax has not been made(Schedule J)............................................... 13. 14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... �q. 7 � $Lj2 . Q$ TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(�2)x .00 7 � 842 . 05 �5. 0 . 00 16. Amount of Line 74 taxable at lineal rate X .045 0 . 00 16. 0 . 00 17. Amount of Line 14 taxable at sibling rate X .12 � . 0� 17. 0 . 00 18. Amount of Line 14 taxable at collateral rate X.15 � . 0� 18. 0 . 0� 19. TAXDUE_._..............................._....................._................................................... 19. 0 . 00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. � Side 2 L 1505610243 15056102�43 J REV-1500 EX Page 3 File Number 21-09-0337 DecedenYs Complete Address: DECEDENT'S NAME Fealtman, Charles W. STREETADDRESS 1126 Fernwood Avenue CITY STATE i_IP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 0.00 2. Credits/Payments A. Prior Payments B. Di5G0unt Total Credits(A +B) (z) 3. Interest (3) q. If Line 2 is greater than Line 1 +Line 3,enter the diHerence. This is the OVERPAYMENT. (q) Check 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. (5) 0.00 #rt Makeµg��C� heck Payable to: REGISTER OF WILLS, AGENT. 5µ �5 � •�Y?,. . v..T :�DU�� , . § .v .. . t��`� .� . .�.3 ��,: ,. � `#`;'�'�� ` , i"7'i�X..�� x . .".�` ;` i��'.�i 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:............................................................................... ❑ Q 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?............................................................ x 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.............._......._.__................_..._................................_...................___.... ❑ Qx 3. Did decedent own an"in tmst fo�' or payable upon death bank account or security at his or her death?....... ❑ � 4_ �id decedent own an individual retirement account,annuity,or other non-probate property which contains a beneficiary designation?.................................................................................................................. ❑ ❑x IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT A,S PART OF THE RETURN. >. ��t°k�� ,,,`�k«= "�r�� .,... . . . . , . . ....;5. §ar. " _ .��,,. . ,:"':: .. For dates of death on or after July 1, 1994 and before Jan. 1, 1995,the tax rete imposed on the net value of transfers to or fnr 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 rete 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 p2 P.S.§9116(a)(12)]. . The tax rate imposed on the net value of transfers to or for the use of the decedenYs lineal beneficiaries is 4.5 percent,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 decedenYs siblings is 12 percent[72 P.S.§9116(a)(1.3)]. A sibling is defined under Sedion 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. Rev4508 E%+�11d0) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE �NHER�TAN�ET�RET�RN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Feaitman, Charles W. 21-09-0337 Inclutle Ne pmceetls af litigation antl the tlate Ihe pmceetls were receivetl by the estate. PII property join[ly�ownetl with Ne right of survivorship mus[be discloseC on schetlule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Kelley& Ferrero, L.P. -proceeds of products liability claim 7,920.00 2 Kelley & Ferraro, L.P. -proceeds of products liability claim 246.75 3 Kelley& Ferraro, L.P. -proceeds of products liability claim 5,675.30 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 Counry (Ohio) CourC of Common Pleas, at Case No. CV-99-376610. Additional payments have been received as above reported. A petition for court approval of settlement and/ar a copy of a signed Court Order has not yet been been issued. It is uncertain as to whether or not additional payments will be received on account of this litigation, which is an asbestos tort, products liability case. The case summary from the Cuyahoga County Court of Common Pleas is provided and attached. TOTAL(Also enter on Line 5, Recapitulation) 7,842.05 Qf more space is needed,atlditional pages of the same size) Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-'I500 Schedule E(Rev. 11-10) Cuyahoga County Clerk of Courts - Case Summary Page 1 of 1 C Print CASE INFORMATION CV-99-376610 ESTATE OF CHARLES FEALTMAN vs. A BEST PRODUCTS COMPANY ET AL Summary Case Number: CV-99-376610 Case Title: ESTATE OF CHARLES FEALTMAN vs. A BEST PRODUCTS COMPANY ET AL Case Designation: ASBESTOS TORT-PRODUCT LIAB Filing Date: 01/29/1999 Judge: NANCY A. FUERST ASBESTOS Magistrete N/A Room: N/A Next Action: N/A File Location: PEND.FI�E Last Status: INACTIVE Last Status Date: 11/09/2008 Last Disposition: DISP.OTHER Last Disposition Date: 10/20/2008 Preyer Amount: $25,000.00 Only the official court records available from the Cuyahoga County Clerk of Courts, available in person, should be relied upon as accurate and current. For questions/comments please click here. Copyright �O 2013 PROWARE. All Rights Reserved. 1.0.63 http://cpdocket.cp.cuyahogacounty.us/CV_CaseInformation Summary.aspx?q=elxclyu0... 8/23/2013 REV-0513 EXr(0140� pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BEN EFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Fealtman, Charles W. 21-09-0337 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER pERSON(Sl RECEIVING PROPERTY DECEDENT (WOrds) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal distnbutions,and transfers under Sec.9116 a 1.2 Jennie C. Fealtman Spouse One Hundred 1126 Fernwood Avenue percent of rest, Camp Hill, PA 17011 residue and remainder Total Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet,as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. q.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-1500 COVER SHEE Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10) 1" J �_ � / ' u� � � / � s� �-�i, �C a ,;J TsT� �%�� T �. � �� r �e 5° Lv_ /-e � L� i i�� n 1— �1`'I,a � �e s l.U. � L l�7�� f/� C ,4��w' o� e'� ,�� C,�y�;�a h�, �� Lo;,�>r y�� N 5��,� C��.�� ,a- C a ) � � ��4 k�� / 1 z�(,G�, s � ct .n d CA c c� �e� v- � r s ,r� � /,yy �d� JT Uv��r L�. 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