HomeMy WebLinkAbout05-02-14 J 1505610140
REV-1500 EX (01-10)
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 2 0 9 7 8
Harrisburg PA 17126-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 8 8 3 2 4 8 6 5 0 8 0 5 2 0 1 2 0 7 2 5 1 9 4 1
Decedent's Last Name Suffix Decedent's First Name MI
K 0 R N F E L D M A R C C
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
K 0 R N F E L D J E N N I F E R C
Spouse's Social Security Number
2 1 0 4 4 7 4 8 6 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
❑ 1.Original Return 2.Supplemental Return 3. Remainder Return(date of death
prior to 12-13-82)
4.Limited Estate 4a. Future Interest Compromise(dale of ❑ 5. Federal Estate Tax Return Required
death after 12-12-82)
6. Decedent Died Testate 7. Decedent Maintained a Living Trust 0 8.Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
F] 9. Litigation Proceeds Received 10.Spousal Poverty Credit(dale 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 CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
H U B E R T X G I L R 0 Y 7 1 7 2 4 3 3 01
REGISMRBF WILLS 3 USE O-
First line of address r rn
M A R T S O N L A W O F F I C E S r1) �
Second line of address v <'� o =D
O -rt
1 0 E A S T H I G H S T R E E T �' f✓
City or Post Office State ZIP Code DATE FILE
CIO C A R L I S L E P A 1 7 0 1 3 C
Correspondent's e-mail address: HG[LROY@MARTSONLAW.COM
Under penalties of perjury,I declare that 1 have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNAT F PE ON RESPONS LE F R F LI RETURN D TE '
A T a
1A4 G IS R CO RT A MECHANICSBURG PA 17055
SIGNA R ER T RTH REPRESENTATIVE
AD SS
10 EAST HIGH STRE CARLISLE PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140 J
1505610240
REV-1500 EX Decedent's Social Security Number
Decedent's Name: MARC C • K O R N F E L D 1 8 8 3 2 4 8 6 5
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . 1 0 ' 0 0
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.
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . 5. 9 8 0 0 0 . 0 0
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 0 , 0 0
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested . . . . . . . 7. 0 . 0 0
8. Total Gross Assets(total Lines 1 through 7) . . . .. . . . . . . . . . . . . . . . . . . . .. . 8. 9 8 0 0 0 , 0 0
9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . .. . . . . . . . . 9. 0 • 0 0
10. Debts of Decedent,Mortgage Liabilities, and Liens(Schedule 1) . . . . . . . . . . . . . 10. 0 . 0 0
11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . 11. 0 • 0 0
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 9 8 0 0 0 • 0 0
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. 9 8 0 0 0 0 0
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.00_ 9 8 0 0 0 . 0 0 15. 0 . 0 0
16. Amount of Line 14 taxable
at lineal rate X.0_ 0 . 0 0 16. 0 . 0 0
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 17, 0 . 0 0
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 0 0 18, 0 . 0 0
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 0 . 0 0
20, FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
1505610240 1505610240 J
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 21 12 0978
DECEDENT'S NAME
MARC C. KORNFELD
STREET ADDRESS
1104 GREGOR COURT
CITY STATE ZIP
MEC14ANICSBURG PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0.00
2. Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+B) (2) 0.00
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (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; ...................................................................... ❑❑ IZI
b. retain the right to designate who shall use the property transferred or its income; ............................... X
c. retain a reversionary interest;or ................................................................................................ ❑ I]
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ (]
2. If death occurred after December 12,1982,did decedent transfer property within one year of 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? ......... ❑ 0
4. Did 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 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
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. §9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined,undo
Section 9102,as an individual who has 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:
MARC C.KORNFELD 21 12 0978
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
t. Net proceeds from Wrongful Death Action on behalf of Marc C. Kornfeld,decedent 98,000.00
See attached copy of Court Order.
TOTAL(Also enter on Line 5,Recapitulation) $ 98 000.00
If more space is needed,insert additional sheets of paper of the same size
REV-1513 EX.(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
MARC C.KORNFELD 21 12 0978
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
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. Jennifer C.Kornfeld Spousal 98,000.00
1104 Gregor Court Residue
Mechanicsburg,PA 17055
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART 1I-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
*J
!LED-OFFICti
Hubert X. Gilroy, Esquire t-iE PZOTHONOTAP,
MARTSON DEARDORFF WILLIAMS & OTTO
I.D. 29943 244 JAN 23 PH f:: 33
10 East High Street CUt'1QRlAIr0 Gi?UNT'1'
Carlisle, PA 17013 F 'NNSYLVANIA
(717) 243-3341
Attorneys for Plaintiff
ESTATE OF MARC C. KORNFELD, by : IN THE COURT OF COMMON PLEAS OF
JENNIFERC.KORNFELD,Administrator : CUMBERLAND COUNTY, PENNSYLVANIA
of the ESTATE OF MARC C. KORNFELD,
Plaintiff
V. : NO: 2013 - 3963 CIVIL TERM
HAYDEN T. WERNER,
Defendant
qq ORDER
AND NOW this,(3 ad y of January, 2014, upon the consideration of the attached Petition
for Court Approval of Settlement, and it appearing that all parties have reached an agreement in
connection with settlement in this case and all parties have requested the Court to approve the
settlement without a hearing,and it further appearing to the Court that the Pennsylvania Department
of Revenue does not need to issue any opinion in this matter in that there will be no Pennsylvania
Inheritance Taxes owing from the proceeds of this settlement, and it further appearing to the Court
that there are no minor children or incapacitated parties who will receive proceeds from this
settlement that the Court would need to address pursuant to Pennsylvania Rule of Civil Procedure
2206, it is ordered and directed as follows:
1. The settlement between the parties as set forth in the Petition for Court Approval of
Settlement filed by the Plaintiff in the above matter is approved.
2. Progressive Insurance shall pay the gross settlement fund of $100,000.00 to the
Plaintiff.
3. The Plaintiff is authorized to execute the release attached to the Petition as Exhibit
`D' and deliver that release to the Defendant and Progressive Insurance.
4. This action is hereby settled and dismissed with the Court only retaining jurisdiction
to enforce the terms of this Order as set forth above.
BY THE
Judge
cc: Hubert X. Gilroy, Esquire
Jeffrey A. Ramaley, Esquire
TRUE COPY FROM RECORD
In Testimony whereof, 1 here unto set my hand
and the se of said Co rt at Carlisle, Pa.
This yof�_ 20
Proth Lary
SETTLEMENT KORNFELD ESTATE V. WERNER
Settlement Progressive $100,000.00
Settlement Horace Mann $ 50,000.00
TOTAL SETTLEMENT $150,000.00
COSTS ADVANCED:
Register of Wills Probate Fees $ 75.50
Register of Wills Inheritance Tax Return Fee $ 15.00
Register of Wills Additional Probate fee $ 340.00
Register of Wills Supplemental Inheritance Tax Return $ 15.00
Medical Bills Hershey Medical Center $ 434.56
Rickard & Associates Expert Report $ 737.80
Cumberland County D.A.'s Office Discovery Documentation $ 20.00
Expert Opinion Narrative Report Dr. Edward J. Fox $ 300.00
Cumberland County Prothnotary Filing Fee $ 103.75
Sheriff Service Fee Cumberland County & York County $ 250.00
Conrad Siegel Actuary Report $ 950.00
TOTAL $ 3,241.61
NET SETTLEMENT $146,758.39
Attorney's Fees-1/3-Martson Law Offices $ 48,914.57
NET PAYABLE to the Estate of Marc C. Kornfeld $ 97,843.82
Rounded $ 98,000.00
F\FILES\Client.04891 Komfeld\14891.2 personal injnry\14891.2.Settlement Kornfeld Estate v Wemer wpd