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Home My WebLink About10-28-14 � 15�561D105 REV-1500�x`°�_�"�F`>%�� OFFICIAL USE ONLY PA Department of Revenue pennsylvania Counry Code Year File Number .,. ,. Bureau of IndividuatTaxes INHERITANCE TAX RETURN PO BOX 28o6oi �t � �� f�� Harrisburg PA 1'7128-o6oi RESIDENT DECEDENT d ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY _ _ 01/10/2013 ' ' 06/30/1988 ' DecedenYs Last Name Suffix Decedent's First Name M� Perry Madison ! (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 FI�L IN APPROPRIATE OVALS BELOW � 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) p 4. Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) ,� CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOtILD BE DIRECTEQI'-�0: � rn Name Daytime Teleph�rte�pmber �-� �'} n _ :�- . ,,:.+_Q __ � � �-� ___ Kari Mellinger, Esq. ' �i �`� � � `. t ,:.� _ .,, _�., - r�i __ _. _ ... _ � � lLLS�USE f?�}.Y : " �� REGISTE(t OF VY -• � � . . �� Y '�1 � , , First Line of Address � '� :^ �� '_'' ;- rn 3513 N. Front St. }—' �— � ' �--, � _.n Second Line of Address _ ___ - � _-- . _ ___ _ _ DATE FIIED City or Post Office State ZIP Code Harrisburg PA 17110 CorrespondenYs e-mail address: Under penalties of perjury,1 declare that I 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 ihe personal representative is based on all information of which preparer has any knowledge. SIGN U ON RES ONSIBLE FOR FILING RETURN DATE � 10/28/2014 ADD ESS 3513 N. Front St., Harrisburg PA 17110 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 � 1505610105 1505610105 � � J150561�205 REV-1500 EX(FI) DecedenYs Social Security Number 186-70-8853 Decedentis Name: MadlSOfl P@ff)/ RECAPITULATION 1. Real Estate(Schedule A). ....... ... 0.00 .................................. 1. ............. 2. 0.00 2. Stocks and Bonds(Schedule B) .......................... _ _ _ 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. 0.0� 4. Mortgages and Notes Receivable(Schedule D)............... ............ 4. 0.00 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 0.00 ' 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 0.00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 0.00 ' (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets total Lines 1 throu h 7 ............. 8. ' 0.00 ' ( 9 )................ 9. Funeral Expenses and Administrative Costs(Schedule H)....... ............ 9. ' 8,839.94 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I)............... 10. 10,901.59 , 11. Total Deductions(total Lines 9 and 10)................................. 11. 19,741.53 12. Net Value of Estate(Line 8 minus Line 11) .............................. 12 ' 0.00 . _._ � � 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 0.00 an election to tax has not been made(Schedule J) ........................ 13. ' 14. Net Value Subject to Tax(Line 12 minus Line 13) ...... ..... ............. 14. 0.00 ' TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or __ _ _ transfers under Sec.9116 �.00 (a)(1.2)X.0_ 15. 16. Amount of Line 14 taxable 0.00 at lineal rate X.0_ ' 16'' 17. Amount of Line 14 taxable 0.00 ' at sibling rate X.12 �7. _ _. 18. Amount of Line 14 taxable 0.00 at collateral rate X.15 18� __ -- 0.00 19. TAX DUE ................ ......................................... 19. _ ' 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Side 2 � 150567,0205 1505610205 J REV-1500 EX(FI) Page 3 File Number Decedent's Compiete Address: DECEDENT'S NAME Madison Perry STREETADDRESS 232 Big Pond Road _ _ _ __ __ _ _ _.... CITY I STATE I Z�P Shippensburg PA 17257 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 0.00 2. CreditslPayments A.Prior Payments --.--.--.—_--_____—...— B.Discount _.—.—.___.....—-.--- 0.00 -- Total Credits(A+B) (2) 3. Interest (3) 0.00 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. 4 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Ditl decedent make a transfer and: Yes No a. retain the use or income of the property transferred.......................................................................................... � � b. retain the right to designate who shall use the properry transferretl or its income ............................................ ❑ � c. retain a reversionary interest .............................................................................................................................. ❑ � d. receive the promise for life of either payments,benefits or care?...................................................................... � � 2. If death occurred after Dec.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?.............. ❑ � 4. Did decedent own an individuai 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 llbefore 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 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 chiltl 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(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, under Section 9102,as an individual who has at least one parent in commo�witn the decedent,whether by blood or adoption. �� Ts�s u` r�'�'�°'� • �� r �� pennsylvan�a �.. DEPARTMENT OF REVENUE September 24,2014 Edward E.Knauss,N,Esquire Metager Wickersham 2321 Paxton Church Rd Harrisburg,PA 17106 Re: Estate of Madison Perry File Number 2113-1039 Court of Common Pleas Cumberland County Dear IvIr.Knauss: The Department of Revenue has received your correspondence. Attached was the petition to approve a compromise settlement to be filed on behalf of the above-referenced estate in regard to a wrongful death and survival action. It was sent to this o�ce for the Commonwealth's approval of the allocation to the proceeds paid to settle the actions. According to the Petition,the 24 year old decedent died as a result of a motor vehicle accident. Decedent is survived by his minor child. Pursuant to the Supreme Court of Pennsylvania,damages recoverable under a suxvival action include those for future earnings,even where those earnings may be difficult to quantify. ICiser v. Schulte,538 Pa.219,648 A.2d 1 (1994). This is supported by the Commonwealth Court. Roberts v.Dungan,574 A.2d 1193 (Cmwlth.Ct. 1990). Therefore,absent any facts to the contrary,a portion of the recovered proceeds must be allocated to the survival action as compensation for decedent's lost earnings. . Aawever as the proceads in this matter are a�minimal net of$4,482.53,this Office has no objection io the . • allocation that you have requested. Please be advised that,based upon these facts and for inheritance tax purposes only,this Department has no objecrion to the proposed allocation of the net proceeds of this action,$4,482.53 to the wrongful death claim and$0 to the survival claim. Proceeds of a survival action are an asset included in the decedenYs estate and are subject to the imposition of Pennsylvania inheritance tax. 42 Pa.C.S.A. §8302; 72 P.S. §9106,9107. Costs and fees must be deducted in the same percentages as the proceeds are allocated. In re Estate of Merrvman,669 A.2d 1059(Pa. Cmwlth. 1995). I trust that this letter is a sufficient representation of the Department's position on this matter. As the Department has no objections to the Petition,an attorney from the Department of Reve_nue will not be attending any -- ____ . _ __ _ hearing regarding it. Please contact me if you or the Court has any questions or requires anything additional from this Bureau. Sinc y, annon E.Balcer Trust Valuation Specialist Inheritance Tax Division .::, . . . ,.... ,... .. _... Bureau of Individual Taxes � PO Box 280601 � Harrisburg, PA 17128 � 717.783.5824 ( shabaker@pa.gov REV-1511 EX+ {08-13) � pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERA� EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Madison Perry Decedent's debts must be reported on Schedule I. ITEM AMOUNT NUMBER DESCRIPTION A. FUNERAL EXPENSES; l. 7,910.40 B, ADMINISTRATIVE COSTS: 1, Personal Representative Commissions: 0.00 Name(s)of Personal Representative(s) __ - - --- Street Address _ City _State .._ _ ZIP __ ......_ _ Year(s)Commission Paid: - -- 660.00 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address –— City_.—.---------------- —__5tate---_ ZIP— — Relationship of Claimant to Decedent_...___.__._ __..___.—._ __—_-.__—..----- 4. Probate Fees: 269.54 5. Accountant Fees: 0.00 6. Tax Return Preparer Fees: 0.00 7. TOTAL(Also enter on Line 9, Recapitulation) $ $,83g.94 If more space is needed, use additionai sheets of paper of the same size. 0 0 0 0 0 o � o � � . . . i . o � �o 0 0 0 � co 00 -- i � �o r� rn rn � � � t�r crr cn� vr «r � �n C N O O O O O O O O O � i� O O O a �t0000 "p�,�+ O U � ,b v c � �v o 0 0 �, r� ooc.iu� y � � Ha � M � � oa o� rn °i � r� � `v '- `" oo � „ � � lY+ ^ � ~ ~ N � ^ F ^ � � O �+ � � N N - •.i .. � � � P+ O � 00 t!� �V} L} V?�t/)-th t?t/r th p Q � � a o v U ,� a � � �• a c, oo a 0 ro a a •� v �n � �O N � ..� . °Q a u •� � C �d �n N •� y •.i �+ •ri v1 c0 � � � N � � � a�i �'�� a� b a C� � cv �,1 u p.., O F+ O aJ s�-i ^ p„ m}.�> � a�l W O' a�i`J_ D .O Z L+' � � .0 3-1 La O 'G � U td �y � � v W v �W "i yx ^� _ � � � O x � .O p �G � td ',�4-i H CJ •.U-1 .p �, � •N � .� o �� U O+ ao•�+ n� G .n m .. ._ � �, �a �n N � o „ 4, � ^ o .� �c � Q Z [L o a`"i � a c"a � �cna °� �p U � rai W ra O � 'u E— a. a` u. u. Q U S�G� (� Z � v F� t� H Q N b ❑ w v �� : � � : 'O y C � ca O „�� W N � � y � 00 � C �p � O 'i7 � U 'C �' 7 N � � � N .� � 'd p . > � U c! `n �., C � Q � G � y � x � '� � � 3 0 � 'n „- C Q p? U Hourlv Billin�for the Estate of Madison Perry KEM 10/22/13 Set up file in computer •2 �12) KEM 10/22/13 Email MW .1 (6) KEM 10/22/13 Advertisement requests .5 (30) KEM 11/7/13 TC to client re: assets/creditors .1 (6) KEM 11/7/13 Set up Estate Accounting .2 (12) KEM 5/30/14 LT Knauss re: status •2 �12) KEM 5.30.14 LT Dept of Rev re: extension •2 (12) KEM 6.2.14 Enter Appearance in Cumb. Cty. .3 (18) KEM 7.30.14 TC w Ted Knauss re: Petition for approval/costs .1 (6) KEM 7.30.14 TC w/ Cumberland Law Journal re: proof of pub .1 (6) KEM 10.21.14 Email Ted Knauss re: status of Petition .1 (6) KEM 10.21.14 TC w PR re: response by creditors .1 (6) KEM 10.21.14 Inheritance Tax Return/Inventory 2 (120) KEM 10.21.14 Final Status Report •2 �12) Totals• ALANCE DUE: 4 hrs 24 min. $150.00/hr = $660.00 3:02 PM R.J. MARZELLA, ESQUIRE AND ASSOCIATES, P.C. 10/21/14 Account QuickReport Accrual Basis All Transactions Type Date Num Name Memo Split Amount Balance Client Prepaids KEM Pe�ry, Est Madison Check 11/25/2013 21148 Cumberland Law... Bank(M&T) ... 75.00 75.00 Check 11/25/2013 21173 The Sentinel Bank(M&� ... 189.54 264.54 Check 09/12/2014 22205 Cumberland Law... Perry estate Bank(M&� ... 5.00 269.54 Total Perry, Est Madison 269.54 269.54 Total KEM 269.5�4 269.54 Total Client Prepaids 269.54 269.54 TOTAL 269.54 269.54 Page 1 REV-1512 EX+ (12-12; � pennsylvania SCHEDULE I DEPARTMENTOFREVENUE DEBT5 OF DECEDENT, INHERITANCETAXREfURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Madison Perry Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. VALUE AT DATE ITEM OF DEATH NUMBER DESCRIPTION 1• Medicaid Lien 10,901.59 TOTAL(Also enter on Line 10, Recapitulation) $ 10,901.59 If more space is needed, insert additional sheets of the same size. �� pennsylvania � DEPARTMENT OF PUBLIC WELFARE October 23, 2013 METZGER WICKERSHAM BRANDY IRVIN GOVERNMENT LIEN PARALEGAL 3211 N FRONT ST P O BOX 5300 HARRISBURG PA 17110-0300 Re: Madison Perry CIS #: 500215730 Incident Date: 12/31/2012 Dear Ms. Irvin: The Department of Public Welfare maintains a claim in the amount of $50.826.21 for the above-referenced incident. After attorney fees and costs, the Department agrees to accept 50% of the client's net settlement. The net payment due is �101901.59. Checks should be made payable to the Department of Public Welfare and sent to my attention at the address listed below. We request that with all transmittal of funds, you provide the Department with a copy of the final distribution sheet. In the event you have already brought or will bring any action resulting in a further recovery, we reserve the right to seek recovery of any unpaid portion of our medical/cash claim. This settlement in no way affects our future rights. Thank you for your cooperation in this matter. If you have any further questions, please contact me. Sincerely, ��- `�'T��-� Tina M. Wise TPL Program Investigator 717-214-1204 717-772-6553 FAX Bureau of Program Integrity � Division of Third Party Liability � Recovery Section PO Box 8486 � Harrisburg, Pennsylvania 17105-8486 �, 3513 NORTH FRONT STREET, HARRISBURG,PLNNSYLVANIA 17110 �� 717.234.7828 866.625.2590 717.234.6883 Fnx : � . _ � �� ARZELLA � �� 1 �: :� �, �y Attorneys � Counselors At Law October 27, 2014 ,.,� �.� �, ca '.s %� rn Cumberland County � � �� C' � � G, __ � Register of Wills � '� —+ r�' `'-; rT� -�- c`7 F �. . 1 Courthouse Square � T.� r:� � ,'., Suite 102 � a-•r Carlisle, PA 17013 y ='-' � 4`' � �:�� ,, - �; � - r,, }_.� {..__ RE: ESTATE OF MADISON PERRY . ''��' �'�� CJ1 FiLE No.2113-1039 To the Register of Wills: Enclosed please find the original and two copies of the Inheritance Tax Return (REV-1500) for the above-referenced estate. Please return one additional time-stamped copy to this office in the envelope provided. Thank you for your attention to this matter. Very truly yours, R..T.MARZELLA 8i ASSOCIATES,P.C. BY: �� -� KARI MELLINGER,ESQUIRE KEM 2 � � � v W N cn Z � � O � c � 3 � + T D � � � y � � , �'^ � J � � � (� (/� rF ^ T /� f"J `1 � j N \/ l'""� �`7'- r-t N <p (� � � n �.-:_ :'7 �Ti �� d C7 `�7 n O (D �37 C J � N � � � CrJ -J --i r;� ''7 O � ,',1 -�� r..t ,,. _, _,._ _ � D � � Q -.�:'i �_�. r.._ E C N 1 (D C � . r ''i CJ � c:-� �I � - � O � tA � �;~S W � -'�) , � ;-_3 -,-; .� _ �, _ .; c� �..� " �"�� ;.� �� o C.rl � �.23 0 rn f� o�� o��A . �n�N . ��DD� � �mN�_ _ I