HomeMy WebLinkAbout04-08-14 � =r ��_ �-�� �;�,..,��-��. _ „ ��.�, : m��� :� _
� -� REV-1504�`�°�-"� 1505610143
:
��,�.�r°�,�r¢°t:°.t��;=`°+�A �a.:�e;;�r��t� OFFICtALUSEONLY
--— _ .
Bureau of Individual Taxes �M*���� `�"y LOd° ''�� r�+�hw�r�r
t�o Box-28oso� lNHERITANCE TAX RETURN � 1 i a 1,2 5�
ei��sttu��.f,�, 9J92�-.�i�EitP9 �t��°S�f3��3���.'����'r
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date af Death Date af BiRh
� � n� � �, n �� n4 , q��
QecedenYs L.ast Name Suffa Decerfent's First Name MI
ir t�fit�i3�i' ���t�#5 f Jt� 2f
(if Applicable)Enter Surviving�pous8's fnformation Below
Spouse's Last Name Suffnc Spouse's First Name MI
5�5f�ii�c�'S��i:l�i SLC:�ii.y I�W'it�er'
THIS RETIIltN MUST BE FILEO 1{�DUPI.ICATE WITH THE
���������������
FILL IN APPROPft1ATE OVALS BELOW
� 1. Originai Fiefwn � 2. Suppiemental Retum 3, ematnder Retum(Date of Death
❑ Priorto 12-13-82)
'_T '_iGe�..�,_..��:9"r, � , ',= r�,r;ar�cs f.cxtux�=Tt��� � s, c.=�?_ ?_.;:�.. :ir.�:� e `.wi�',`�ic�'
"� � (date W death dler 12•12-82j
� 8.oeceaeru aea Temate � 7. oecedem Ma�winee a uvinp Th,st �f. Tatal lVumber of Safe Deposit goxes
glut�C,apy�iRQi� +'��+�PY aP 7ausf)
� 9. Litigation Proceeds ReCeived � 10.Sbe�n P�_v3erty9C�it7(_Da9�Death (� 11.�����`0)�9173(A)
nnca+qea�nee�=�'�','^�''°S[�.°.m^F°A.,.!e.....�T^r^^F,'.."��',?:'.3."LL�.°°.a:..t....'..',P3��::^L.�n7:I��«.`:r:�'P:'.".."L:r'�`..x.�d....°8.�7h.'.�7..,..�:1^"' 1'..-'�:�.t'.��'.'CL'T^-
Plame DayNme�lephone Nu�r � � •
LISA MARIE CQXNE 8�� 7 �,7 W� 0�#� � �
-c
REG0�17fi.�8R��SE�.1�
a � �, �rv
t-::Cr';g 1.PPC.�.. 4��...',^:i�Y�F:u.',';, � ' � 'p � ".
� n � � � �
3 9 01 MARKET STI�EL�T o � "n � � -`�
.�1 C,r� r= � .
Seeond Line of Address , -p � � � a
� � .�
DATE FILED
�k� A'.. i /�.ln.;,:ti. :1i�AS:` zns� .='°nM',^ J .
CAMP HILL PA 170114227
Cn�respondenY�e-ma(1 addresa: I i S a�C O y 8 S n d C O y n e.c o m
Under penaldea of pery'wy.l dedate that i have exammed this relum.inGuding accompanymg scheduks and statements,and to the best of my knowledge and beiief.
�ia rn�e�M+.,arr.1n!1 Tt^-^±�i°'Q.flpnl,7l;?N.i,��_:+w�nafor nAl�e•!!t �.�5.n Rsn�e,nn?t�a+n�nr. �nf s�o�..4.ecnA n ��1 lrtr.r++1..,e;•K,!nr�e�'i�nnel.�f°�Fh'e,?r�e rrin�ula+n,9_
,...� _�_
51G TllRE OF PERSON RESPOW518 OR F�LWG RETUFtN .- _ ���— - . :
Q 5usan B.�ogan �i mA.rec,i-+ �-o W
.
�.�� ._,_ _�.-_ � _ �.��
�o��
2501 Wigwam Parkway, t.221
Henderson,NV 890746272
5 TURE OF PR R OTHER REPRESENTATIVE DATE
LISA MARIE COYNE Esq � • i�
D
e 8 Coyne,P.C.
3 1 Market Street,Camp Hill,PA 170114227
Side 1
� ��Q56]�OZ43 �5�561�14� � `\�
�
� 1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent�s Neme: L O G A N� K E N N E T H R.
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&Miscellaneous Personal Property(Schedule E)................ 5. 5 0 , 0 0 0 . 0 0
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) � Separate Billing Requested............. 7.
g. Total Gross Assets(total Lines 1 through 7).......................................................... 8. 5 0 , 0 0 0 . 0 0
9. Funeral Expenses and Administrative Costs(Schedule H)..................................... 9. 1 9 , 0 8 5 . 5 0
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................. 10.
11. Total Deductions(total Lines 9 and 10).................................................................. ��. 1 9 , 0 8 5 . 5 0
12• Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 3 0 , 9 14 . 5 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. 3 0 , 9 14 . 5 0
TAX COMPUTATION-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 15.
16. Amount of Line 14 taxable
at lineal rate X .045 3 0 , 9 14 . 5 0 �s. 1 , 3 9 1 . 15
17. Amount of Line 14 taxable
at sibling rate X .12 ���
18. Amount of Line 14 taxable
at collateral rate X .15 �$•
19. TAX DUE................................................................................................................... 19. 1 , 3 9 1 . 1 5
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. �
Side 2
� 1505610243 1505610243 �
REV-1500 EX Page 3 File Number 21 - 10 - 1255
� Decedent's Complete Address:
N ' AM
Logan, Kenneth R.
STREET ADDRESS
50 Circle Drive
Camp, Hill Pennsylvania 17011
CITY STATE ZIP
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (�) 1,391.15
2. Credits/Payments
A. Prior Payments
B. Discount
Total Credits(A +B) (2) 0.0 0
3. Interest (3) 96.74
q. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) _
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) � ,4$7.$9
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:.................................................................................. x
b. retain the right to designate who shall use the property transferred or its income:.................................... ❑ ❑X
c. retain a reversionary interest;or.................................................................................................................. ❑ 0
d. receive the promise for life of either payments,benefits or care?.............................................................. ❑ 0
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without ❑ ❑
receivingadequate consideration?.......................................................................................................................
3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?......... ❑ Ox
4. Did decedent own an individual retirement account,annuity,or other non-probate property which ❑ ❑
containsa 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 Jan. 1,1995,the tax rate imposed on the net value of transfers to or for 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 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 ears 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)(�.2)].
•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 Section 9102,as an individual who has at least one parent in common with the decedent,wfiether by bloo�or adoption.
������,,� pennsylvania SCHEDULE E
'�� DEPARTMENTOFREVENUE CASH, BANK DEPOSITS AND MISC.
INHERITANCE TAX RETURN
RESIDENTDECEDENT PERSONAL PROPERTY
FILE NUMBER
ESTATE OF Logan, Kenneth R. 21 - 10- 1255
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.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 1/2 of Litigation Proceeds from Estate of Kenneth R. Logan, Deceased 50,000.00
(Settled December 11, 2012--Cumberland County O.C. Docket# 12-7451) (allocated 50% to
Survival Action and 50%to Wrongful Death Action)
TOTAL(Also enter on Line 5, Recapitulation) 50,000.00
�
�
individually;Susan B• In the Court of Common Pleas of
Susan B•Loga� Ivania
Logan. Administratrix of the Estate of Cumberland County,PennsY
Kenneth R.Logan, deceased;and
Susan B.Logan Trustee Ad Litem on
behaif of all individuals entitled to
share in the proceeds for thea ased
death of Kenneth R.Logan.
Plaintiff/Petitioner 2012 Civil Term�C� S '
`t
�i.
vs
' Givil Action-Law
State Fazm Mutua�Aufiomobile Pe�tion for App�v�of Settlement
��an�C�P��endant/Respondent and,�Distribution
�.
O_
2012, the payment of
AND NOW, on this the � day of��"'� ' � Mu�� Automobile
�1pp,ppp,p(} in liability insuranc� PrO�s by State F
insurance Company to the Estate of Kenneth R. Logan and the distribution as
requested in the attache�Petition is approved.
R� h�Court.
/s/ Hon. �� J
���°� �� ' .
. � N r�'
C �
--i
3 *�
-t3 �-,�
�rn m rT"'�
z� � m
cnr" — ��
- ..,�2? .� ._..;L�
��
_.:.—+�
D� � ��
_p c7
. T' -�i. � �r
.�. � a:�
—t U'1 -
—; �
✓�.�k �itr-►�
� ���5 �
�c��—
. , .� , :�
��'�`y r�, _-i _
` �m � f'1--
� � ��D C7
. ' ��-� = =�,,
f'"µ- x;=�,
�t= -S7 �,-:•�,
�,.-, 3 �-_
.:..�� -
Commonwealth of Penns lvania �`� r �
y �, �., �:�
County af Cumberland �
0
�
�, Susan B.Logan,individually;Susan B. In the Court of Common Pieas of
� Logan, Adminisfratrix of the Estate of Cumberland County, Pennsylvania
s Kenneth R.Logan, deceased;and
� Susan B.Logan Trustee Ad Litem on
o behalf of all individuals enti�led to
� share in the proceeds for the wrongfui
"' death of Kenneth R.Logan, deceased
fa -�y5�
Plaintifj 2012 Civil Term
a �
o �
� � VS
� �
.,,.
o �
K
�C State Farm Mutual Automobile Civil Action-Law
�d Insurance Company Petition for Approval of Settlement
y y Defendant and Distribution
.�
� ,�
Writ of Summons
�w
^� To: or
v rt State Farm Mufi.zal
� � Automobile Insurance Company Qaim Central-Complex
W � One State Farm Plaza PO Bax 106114
�� Bloomington, Illinois, 51710 Atlanta, GA 3034$-6114
o �
�
��
�
� You are hereby notified that
� Susan B.Logan,individually;Susan B. Logan,Admuustratrix of the Estate of
W Kenneth R.Logan, deceased;and, Susan B. Logan Trustee Ad Litem on behalf of
alI individuals entitled to share in the pmceeds for the wrongful death of
Kenneth R.Logan, deceased,have brought action against you.
DAV/D U,$UEL(,� PI'o ono
December�1,2012
-� ,�.. ::�
i � �. �� ,
' �� �� -
Z� � 'r'�'�.
�� n ���
C1��,. -- �;C�
��: -i C�_-
'�[-: �-r�•
� �i�-
��� � '.
�C � C.i`�
�. � _
Susan B.Logan, individually;Susan B. In the Court of Common Pleas o� �
Logan, Administratrix of the Estate of Cumberland County, Pennsylvania
Kenneth R. Logan, deceased;and
Susan B.Logan Trustee Ad Litem on
behalf of all individuals entitled to
share in the proceeds for the wrongful
death of Kenneth R.Logan., deceased
Plaintiff/Petitianer 2012 Civil Term ��S �
vs
State Farm Mutual Automobile Civil Action—Law
Insurance Company Petition for Approval of Settlement
Defenc�ant/Respondent and Distribution.
Petition for A�vroval of Payment of
Liabilifv Insurance Proceeds and Distribution
1. The petitioner, Susan B. Logan, Individually and Administratrix of the
Estate of Kenneth R. Logan, deceased and Trustee Ad Litem for all
individuals entitled to share in the proceeds for the wrongful death of
Kenneth R. Logan, deceased, is an adult individual currently residing at
3I20 Naamans Road, Apt.Q12, Wilmington,DE 19810.
2. The respondent, State Farm Mutual Automobile Insurance Company, is a
business entity licensed to and doing business in the Commonwealth of
Pennsylvania, wi.th a place of business located at One State Farm Plaza,
Bloomington, Illinois, 61710. The claim is being handled by Teena
Robinson, State Farm Mutual Automobile Insurance Company, Qaim
Central - Complex, PO Box 106114, Atlanta, GA 30348 - 6114. Said
respondenfi is hereinafter referred fio as'State Farm'.
3. Qn or about December 5�', 2010, at approximately 2:35 am the decedent,
Kenneth R. Logan, age 33, was a passenger in a vehide being operated by
Leroy Johnson, III of 1$12 Iverson Street, O�con Hill, MD 20745.
4. On the aforesaid date, Mr. Johnson, was operating the deceden�s motor
vehicle in eastbound lanes of Interstate Route 68 in the vicinity of milepost
14.70 in Morgantown, Monongalia County, West Virginia. At said time
and place he lost control of the vehide and struck the center highway
divider causing Kenneth R. Logan to be ejected from the vehicle and
killed.
5. At the time of his death Kenneth R. Logan was single and had never
married nor had children. He rnsided with his parents, Raymond and
Susan Logan in East Pennsboro Township, Cumberland County, at 50
Circle Drive, Camp Hill,Pennsylvania.
6. Kenneth R. Logan died a single man with no children o#his own. His sole
intestate heir is his mother Susan B. Logan. His father died on April 1Q,
2011. His mofiher was appointed Administratrix of his Es�tate by the
Register of Will of Cumberland County, Pennsylvania at docket 2010 -
1255.
7. The vehicle that was being operated by Leroy Johnson, III was owned by
Kenneth R. Logan and insured by Kenneth Logan through State Farm
Mutual Aufomobile Insurance Company.
8. Kenneth R. Logan maintained a policy of insurance with State Farm
Mutual Automobile Insurance Company (policy number 107 7223 - 38A}
that extended iiability coverage to the permissive drivers in fhe amount of
$100,000.00.
° 9. State Farm has now tendered their$100,000.00 Iiability policy limit.
10. There are no minor heirs involved in this matter.
11. All sums set forth above constihzte damages on account of personal
injury/wrongful death, arising fram the occurrence, within the meaning
of�104(a)(2) of the Internal Revenue Code of 1986, as amended.
12. Susan B. LQgan entered into a one-third contingent fee agreement with
Douglas Law Office and Coyne and Coyne.
13. The petitioner respect�ully requests that the settiement in the amount of
$100,OOQ.00 be approved and the distribution of the proceeds be approved.
14. The petitioner respectfiiily requests that payment of the a€oresaid
proceeds be paid to Susan B. Logan, Administratrix of the Estate of
Kenneth R. Logan, deceased, and fihe distribution of the proceeds be
approved.
15. State Farm Mutual Automobile Insurance Company concurs in the request
to approve the settlement.
16. Distribution:
Susan B.Logan, Administratrix $66,666.67
of the Estate of Kenneth R.Logan, deceased
William P.Douglas $33,333.33
Douglas Law Office and
Coyne and Coyne
Total: $100,0OO.OQ
WHEREFORE, your Petitioner prays that the payment of Iiability insurance
proceeds and distribution be approved in accordance with the aforesaid.
W� �
.
William P.Dougl Esq.
Douglas Law fice
43 W. Sou St.
Carlisle, Pennsylvania
Tel (717)243-179Q
Fax 717)243-8955
douglasiaw@earthlink.net
December 11,2012 Attorney for petitioner
Susan B. Logan,individually;Susan B. In the Court of Common Pleas of
Logan, Administratrix of the Estate of Cumberland County,Pennsylvania
Kenneth R. Logan, deceased;and
Susan B.Logan Trustee Ad Litem on
behalf of all individuals entitled ta
share in fihe proceeds for the wrongfial
death of Kenneth R. Logan, deceased
Plaintifj�'/Petitioner 2012 Civil Term � �'f`S�
vs
State Farm Mutual Automobi.le Civil Action-Law
Insurance Company Petition for Approval of Settlement
Defendunt/RespQndent and I}istribution
AFFIDAVIT
I hereby swear or affirm that fhe Foregoing is true and correct to the best of my
knowledge and/or information and belief.
'T�.is is made subject to the penalties of 18 Pa.C.S. �4904 reiafiing to unsworn
falsification to authoriti.es.
. � t `
� . �
William P.Dougla
for Susan B.Logan
December 11, 2012
REV-1b11 EX+(10-09)
��_�� ��� pennsylvania �p��p�/�� �yp����`
�� DEPARTMENT OF REVENUE rV1�JY��+� �+�+'—`+�
INHERITANCE TAX RETURN ��`T�1��'�'
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Logan, Kenneth R. 21 - 10- 1255
Decedent's debts must be reported on Schedule I.
ITEM i DESCRIPTION AMOUNT
NUMBER I. FUNERAL EXPENSES: —
A. �
,
I
�I
�, I
,I il
I
I
I
I
B, i ADMINISTRATIVE COSTS: ,
�, i Personal Representative's Commissions
I Name of Personal Representative(s)
I
I� Street Address II
iCi� State Z�p I
i, Year(s)Commission Paid
j 600.00
2. ! Attomey's Fees Coyne&Coyne, P.C.
3. � Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation) '
Claimant
�I
Street Address
City State Zip 'll
�
I'� Relationship of Claimant to Decedent
4. i Probate Fees '
� III
� I
5. �I AccountanYs Fees
i
6, 'I Tax Retum Preparer's Fees
� I�
7. II Other Administrative Costs
j ' 15.00
Filin Fee
for Su lemental Return
1 Pp
�
9 II
� �
I
�
� I
TOTAL(Also enter on line 9, Recapitulation) 19,085.50
' Sct�edule H
Funeral E�s&
COMMONWEALTH OF PENNSYLVANIA �n����nued
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Logan, Kenneth R. 21 - 10- 1255
2 'i Court Costs for Wrongful Death Litigation i 103.50
3 ' Fiducia lncome Tax Return 2013 800.00
ry
�
400.00
4 � Additional Prob
ate Fees �
5 �� William P. Douglas, Esq. and Coyne&Coyne, P.C.--Contingency Fee Proceeds from I�; 16,667.00
!, Settlement Proceeds Subject to Suvival Action Note: Total Atty Fees were$33,333.33 �;
i 500.00
6 � Reserves '.
, �I
il
I
I �
��
�
I
� I
,,
, II
�
� i
;
�
i I
�
i
i
� �i
I
I
I
I
�
�
�i
, ,
,
�I
�
i
i
,
�
i
II
Page 2 of Schedule H
REV-1613 EX+(07-10)
���°� pennsylvania SCHEDULE J
DEPARTMENT OFREVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Logan, Kenneth R.
21 - 10 - 1255
I RELATIONSHIP TO SHARE OF ESTATE 'AMOUNT OF ESTATE
NUMBER '; NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY oo Not ust rrustee(s)
�
I, ;TAXABLE DISTRIBUTIONS[include outright spousal
, distributions,and transfers
li under Sec.9116(a)(1.2)] , ,
1 �', Susan B. Logan '�, Mother Sole Intestate Heir 100.00
I 2501 Wigmaw Parkway '' ,
, Apt. 221 ,
' Henderson, NV 89074-6272 ,
i
!,
', ,
i
i
�
, ,
i �
� '
�
I Enter dollar amounts for distributions shown above on lines 15 through 18 on 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
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00