HomeMy WebLinkAbout07-18-14 (2) � 150561D143
REV-1500 �`°2_„' ��
PA De artment of Revenue y OFFICIAL USE ONLY
P penns Ivania co�ncy code Year File Number
Bureau of Individual Taxes �PpRTMENTOFREVENUE
Po Box.z8o6o� INHERITANCE TAX RETURN 21 12 0440
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
03 23 2012 08 15 1979
DecedenYs Last Name Su�x DecedenYs First Name MI
CLEGG LORI A
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1. Original Return � ��� � 3. Remainder Return(Date of Death
Priorto 12-13-82)
� 4. Limited Estate � 4a.Future Interest Compromise � 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
� g Decedent Died Testate � �• (Attach Co a�of Tn�st a Living Trust � 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) PY )
� 9. Litigation Proceeds Received � 10.Spousal PovertY Credit�(Date of Death 11.Election to tax under Sec.9113(A)
between 12-31 91 and -1-95) (Att2Ch SCh2dul8 O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
JAMES T YINGST ESQUIRE 717 632 5315 ,_,
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REGISTER C�j�L, LS US�VLY �- ?`-%
t-�-�-,=c-, •_.. __.- C,
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First Line of Address ��f � ,- '' L��
4;.- _ QD ;-� ':_�
40 YORK STREET `�'C - � `'�; '=�.
:`�c_> _..
Second Line of Address ��== � --- C"�F
�_'�; c..� f. � F-r"1
� W L �
DATE FILED � �
City or Post Office State ZIP Code
HANOVER PA 17331
CorrespondenYs e-mail address: jamesvCc�anyh.com
Under penalties of peryury,I declare that I have examined this return,including accompanying sched�les 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.
SIGNATURE F PERSON SPONSIBLE FOR FILING RETURN DA E
William D. Clegg �
ESS
345 Foxleiqh Drive, Hanover, PA 17331
SI ATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
e�"�� `\ �
James T.Yingst Esquire
RESS
40 York Street, Hanover, PA
Side 1
� 150561D143 1505610143 � �'
�
� 15D561D243
REV-1500 EX
DecedenYs Social Security Number
Decedent'sName: CI@gg� LO�I A.
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 Personai Property(Schedule E)............... 5. 32,7�.8 . 3 4
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous�q Probate Property
(Schedule G) U Separate Billing Requested............ 7,
8, Total Gross Assets(total Lines 1 through 7)........................................................ g. 32,718 . 34
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 3� . 0 0
70. Debts of Decedent,Mortgage Liabilities and Liens(Schedule i)............................ 10.
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 3� . 0 0
12. Net Value of Estate(Line 8 minus Line 11).......................................................... �2. 3Z , 688 . 34
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. 32 , 688 .34
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 15. 0 . ��
(a)(1.2)X.00
16. Amount of Line 14 taxable 32 , 688 . 34 �s. 1,470 . 98
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X.12 � . �� 17. � . ��
18. Amount of Line 14 taxable
at collateral rate X.15 � . �� 18. � . ��
19. TAX DUE................................................................................................................ 19. 1� 470 . 98
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. �
Side 2
� 15U5610243 15U561D243 J
REV-1500 EX Page 3 File Number 21-12-0440
Decedent's Complete Address:
DECEDENT'S NAME
Clegg, Lori A.
STREET ADDRESS
315 B Rosemont Avenue
CITY STATE ZIP
New Cumberland PA 17070
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 1,470.98
2. Credits/Payments
A. Prior Payments
B. Discount
Total Credits(A +B) (2)
3. Interest (3)
4. 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) 'I 470.9$
r
Make Check Payable to� REGISTER OF WILLS, AGENT
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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............................................................................................................... ❑ �
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?.................................................................................................................... ❑ ❑x
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 individuai 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.
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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 retum 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 ftom 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 decedenYs lineaf 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 sibiings 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,whether by blood or adoption.
Rev-1508 EX+(11-10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE p E RSO NAL P RO P E RTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Cle , Lori A. 21-12-0440
Include lhe proceeds of litigation and the date the proceeds were received by the estale.
All property jointlyowned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Estate of Lori Ann Clegg v. Ronald and Josephine Ressler et al.-survival claim benefit 32,018.34
check dated June 27,2014
2 2009 Honda Accord-recovery sale price 700.00
TOTAL(Also enter on Line 5, Recapitulation) 32,718.34
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10)
REV-1571 EX+(�0-09)
pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Clegg, Lori A. 21-12-0440
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zio
Year(s)Commission Paid
2. Attomey's Fees
3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation)
Claimant
Street Address
City State Zio
Relationshi�of Claimant to Decedent
4. Probate Fees 30.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
TOTAL(Also enter on line 9, Recapitulation) 30.00
Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev. 10-09)
REV-1513 EX+(01-70)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Cle , Lori A. 21-12-0440
RELATIONSHIP TO
NUMBER NAME AND ADDRESS OF DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
PERSON(Sl RECEIVING PROPERTY (Words) ($$$)
I� TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116 a 1.2
1 Sharon L.Clegg Mother One-half residue
345 Foxleigh Drive
Hanover, PA 17331
2 William D.Clegg Father One-half residue
345 Foxleigh Drive
Hanover, PA 17331
Total
Enter doliar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet,as a ro riate.
NON-TAXABLE DISTRIBUTIONS:
II. 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
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10)
JUL/15/2014/TUE 01 :51 PM Martz & Gailey, LLP FAX No, 717 852 8268 P, 002
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WII,LIAM T�. CLEGG, A�.dministxatar pf the : IN�`� O��iANS' CO�T OF
Estate of LORZ A. CLECrG : CUMBER.LAND7 CpT TNTY,
: �ENN-S`YLVANIA
: N'O, 21�12-p4�40
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� : AND NO'W,this� day of 2014 u on resenta�i
k � the Petition, it is hereby Ordered and l�e reed as fo�lows: � p �'1O��d cor�siderxtioa af
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f � � 1. . Petitioner ma�execute the Release in favor of Frogxessive T�surauce Company
` ` � ' and disburse proceeds a.s sst forth below:
� � ,
, �
� A. Wrangfi�l T7eath Action;- $ SO,Qp4 (50%)
. $ 32,418.34 Wi�liam a.�d Sharon C1egg ��g t r �
� � m � .�
$ 1,315.00 Martz&Gaile�{54% cQSts) ���� '�
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$ 15,666.66 Martz&G�x�ey(5G%fee) ���� �
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B. Sur'vaval Action- $ SO,OQ4 (50%) � ��� � �
$ 32 OI8.34 � £ �• �
� W�lliam Clegg, Ad.ministrator ���
�H- '�S •
i . ' � $ 1,315.00 Martz& C�ailey(50% costs) d�
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, �
: i ; . $ 16,666.66 Martz 8r Gailey(54%.fee)
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WILLIAM CLEGG, ADMINISTR.ATOR OF THE ESTATE OF LORI CLEGG v.
RONALD AND JOSEPHINE RESSLER, et al.
CLOSING STATEMENT
Amount of Settlement $100,000.00
DISBURSEMENTS:
Attorney's fee:
1/3 of$100,000.00 $ 33,333.32
COSTS:
Patriot-St. Denis Towing $ 1,600.00
Clerk of the Orphans' Court 30.00
ARCCA 1,000.00
TOTAL COSTS $ 2,630.00
TOTAL DISBURSEMENTS $ 35,963.32
CHECKS PAYABLE:
William and Sharon Clegg $ 3 .34
Williain Clegg, Adininistrator of the Estate of Lori Clegg 32,018.34
Martz& Gailey, LLP (costs) , 0.00
Guthrie Nonemaker Yingst & Hart 16,666.66
Martz& Gailey; LLP (fee) 16,666.66
- $100,000.00
By: � �
Herman . Gailey, III, Esquire
The above-captioned matter has been settled to my complete satisfaction and all
disbursements inade with complete approval. I agree that a minimum of ten (10)
business days will be allowed for clearan e of the settlement draft.
Approval this a� �-h day of • �,� , 2014.
�
WILLIAM CLEG
�, ,C�.�„� a
S ARON CLEGG