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Home My WebLink About01-09-15 (2) J 1505611185 REV-1500 EX(02-11)(FI) PA Department of Revenue OFFICIAL USE ON�Y Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 21 14 0783 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 09292�13 09292013 DecedenYs Last Name Su�x DecedenYs First Name M I DULAM KASIREDDY BABY GIRL (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES 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(date of ❑ 5. Federal Estate Tax Return Required death after 12-12-82) � 6. Decedent Died Testate � 7. Decedent Maintained a Living Trust — 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) � 9. Litigation Proceeds Received ❑ 10. Spousal Poverty Credit(Date of Death ❑ 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number THOMAS F • SMIDA, ESQ 717-232-5000 ,.�, a REGIS�R OF WILLS US£'�ONL� �.. � � G7 r:� --� � G`> ' First Line of Address r s� `T, C"� _� � - e-- � r; 3401 NORTH FRONT STREET � �� ' ` ,, �. ' c Second Line of Address ,- '-D n; " 3 ..,_.� � � PO BOX 5950 = �W ! City or Post Office State ZIP Code ' 7E FILED� �— f C,J � � HARRISBURG PA 171100950 ' � CorrespondenYs e-mail address: T F S M I D A o�M E T T E• C 0 M Under penalties of perjury, I declare that I have examined this retum,inGuding 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 infortnation ofwhich preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING REfURN � ' ��`�� DA�E / BHARATH KASIREDDY ' �v, 4l 08'/2D �S� 16EMEADOW DRIVE '�AMP HIL , PA 7011 SIGNATURE OF PREPARER OTHER THAN REPRESENTATNE L.. DATE � METTE, EVANS & WOODSIDE � /� ADDRESS 3401 N • FRONT STREET, PO BOX 5950 HARRISBURG, PA 17110-0950 PLEASE USE ORIGINAL FORM ONLY Side 1 � 1505611185 OM46473.000 1505611185 � � � � 1505611285 REV-1500 IX(FI) DecedenYs Sociai Security Number �ecedent'sName: DULAM KASIREDDY BABY GIRL RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . � 0 • �� 2. Stocks and Bonds(Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . 2. � •0� 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C), , , , , 3. 0•Q Q 4. Mortgages and Notes Receivable(Schedule D) , , , , , , , , , , , , , , , , , 4. ❑•0� 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) , , , , , 5. 0 • Q Q 6. Jointly Owned Property(Schedule F) � Separate Billing Requested , , , , g. 0•�� 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) � Separate Billing Requested . . . . 7. 0 •0� 8. Total Gross Assets(total Lines 1 through 7) , , , , , , , , , , , , , , , , , , g 0-�0 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . g, �•�Q 1 D. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) , , , , , , , , , �p. 0 • �� 11. Total Deductions(total Lines 9 and 10), , , , , , , , , , , , , , , , , , , , , 11. � • �� 12. Net Value of Estate(Line 8 minus Line 11) , , , , , , , , , , , , , , , , , , , 12, � , �� 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J), , , , , , , , , , , , , , , , �3. 0 •Q 0 14. Net Value Subject to Tax(Line 12 minus Line 13) , , , , . . . . 14. 0 • �� TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers unsier Sec.9116 (a)(1.2)X.OU 0 • �0 15. �-�� 16. Amount of Line 14 xable at�ineal rate X.0 4� 0 •0 0 1 s. 0 • 0 0 17. Amount of Line 14 taxable at sibling rate X.12 0 • �0 17. � •0� 18. Amount of Line 14 taxable at collateral rate X.15 � ,0� �g, � • �� 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. O •�0 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 � 1505611285 1505611285 � OM4648 3.000 REV-1500 EX(FI) Page 3 File Number Decedent's Com lete Address: 21 14 0 7 8 3 DECEDENTS NAME DU K S STREET ADDRESS CUMB R CITY STATE ZIP AMP H L PA 17011- Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) � • �� 2. Credits/Payments A. Prior Payments � •0 0 B. Discount 0•0 0 Total Credits(A+B) (2) � •�0 3. Interest (3) � • �0 4. If Line 2 is greater than Line 1+Line 3,enter the difference.This is the OVERPAYMENT. Fill in box on Page 2,Line 20 to request a refund. (4) � • �� 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) � • �� 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 . . . . . . . . . . . . . . . . . . . . . . . . ❑ 0 b. retain the right to designate who shall use the property transferred 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 individual retirement account,annuity, or other non-probate property,which contains a 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 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 stili 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)(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 Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. OM4671 2.000 � REV-1506 EX+(p612) pennsylvania SCHEDULE E DEPAR'fN�NTOF REVENUE CASH, BANK DEPOSITS�MISC. IRESIDENTDEC ENTNRN PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Babv Girl Dulam Kasireddv 21 14 0783 Include the proceeds of litigation and the date the proceeds were received by the estate. All ro e 'ointl owned with ri ht of survivorshi must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. FOR INFORMATIONAL PURPOS$S ONLY: Proceeds from personal injury litigatioa agaiast Natioawide Iasurance Compaay aad Abraham Aragoa 0 All proceeds were allocated to the wrongful death claim and none to the survival claim and are not subject to inheritaace tax. See attached copy of Order dated November 14, 2014, No. 14-6457, Civil Term (Cumberlaad County C.C.P.) ; also, see attached copy of correspondence from the PA Departmeat of Revenue dated December 3, 2014, approviag the allocation. 2 Proceeds from persoaal iajury litigation against Travco Iasurance Compaay � Al1 proceeds were allocated to the wrongful death claim aad aone to the survival claim aad are not subject to inheritance tax. See attached copy of Order dated May 7, 2014, No. 14-2748, Civil Term (Cumberlaad County C.C.P.) . TOTAL(Also enter on line 5,Recapitulation) $ 0 2wasAD 2.00o If more space is needed,use add'Aional sheets of paper of the same s¢e. REV-1513EX+(01-10) SCHEDULE J pennsylvania DEPARTMENT OF REVENUE BEN EFI C IARI ES INHERITANCE TAX RETURN RESIDENT DECEDEM ESTATE OF: FILE NUMBER: Bab Girl Dulam Kasiredd 21 14 0783 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECENING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1.2).) �. Bharath Kasireddy 416 Meadow Drive Camp Hill, PA 17011 Father 0 2 Mrudula Dulam 416 Meadow Drive Camp Hill, PA 17011 Mother 0 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 OISTRIBUTIONS: 1. TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 0 If more space is needed,use additional sheets of paper of the same size. 9W46AI 2.000 / .. �____,_. Nov t a �o�� 7� fi��l �J•-u��+'��= , Txo�s,THOMAS&HAFER,LLP i�,;' I;iL �sZ�T�G+��Tt�:.�,'': John F.Yaninek,Esquire Attorney LA.No.55741 ��i 1�� (3 �� `�' P.O.Box 999 Harrisburg,PA i�io8-o999 ,I � ti� ��1�� (717)441-3952 Atto�rri�� Ir Ihilam-Kasireddy IN RE: ESTATE OF BA.BY-GIRL DULAM- IN THE COURT OF COMMON PLEAS OF KASIREDDY, Deceased CUMBERLAND COUNTY,PENSYLV.ANIA No. I�- f��#�� iv��Te.�m ORDER �'�' AND NOW,this �� day of � , . 2oi4.,upon consideration of the Petition for Approval of Wrongfui Death and Survival Claims,it is hereby ORDERED AND DECREED that Petitioner, Bharath Kasireddy is authorized to enter into a settlement and sign a release for the Estate of Baby-Girl Dulam-Kasiredd}�s claim with Abraham�ragon and Natibnwide Properry& . , , . �. Casualty Insurance Company in the gross sum o£$100,000 of which$33�333•33 are payable to Bharath Kasireddy,Mrudula Dulam and the Estate of Bab�-Git�l D�lam-Kasireddy. IT IS FiTRTHER ORDER AND DECREED that the settlement of the Estate of Baby-Girl Dulam-Kasireddy should be distributed as follows: � (a} Wrongful Death ioo� $33,333-33 (b) Survival Action -o- Wron�ul Death Action proceeds shall be paid to the�Estate of BABY-GIRL DULAM-KASIREDDY and di.stributed equally to Bharath Kasireddy and Mrudula Dulam. �BY . . � . . d. . Distnbution List John F.Yaninek,Esquire,Thomas,Thomas&Hafer,LLP,305 N.Front Street,Harri::burg,PA i�o8 Shannon E.Baker,Trust Valuation Specialist,PA Aepartrnent of Revenue,I�hez�itance Tax di�ri�ivn,PQ Eox 28o6oi, Harrisburg,PA i�28 � � TRUE COPY FROl11�RECORD U Testirriony whereof,S here unto set n'►Y h&nd �s,� �tid�le�Pa. _ ef � of � P ..._ - � r � . . � �:. . qEC - 8 201� �: :��:::� pennsylvan�a DEPARTMENT OFREVENUE Deccmber 3,2014 John F.Yaninek, Esquire Thomas,Thomas,&Hafer PO BOX 999 Harrisburg,PA 17108 Re: Estate of Baby Girl Dulam Kasireddy File Number 2114-0783 Court of Common Pleas G�mberland County Dear Mr.Yaninek, The Department of Revenue received the Petition for Approval of Settlement Claim to be filed on behalf of the above-referenc�d Estate in regazd to a wrongful death and survival action. It was forwarded to this Bureau for the Commanwealth's approval of the allocation of the proceeds paid to settle the actions. Pursuant to the Petition,the newbom old decedent died as a result of injuries received in a motor veiucle accident. The sole heir to decedent's�tate is her parents. Therefore,any proceeds paid to sett.le the survival action would pass to decedent's parents and would be subj ect to a zero percent inheritance tax rate. 72 P.S. §9116(a)(1.2). Accordingly,regardless of the allocation of the subject proceeds,there would be no inh�ritance tax consequences. Please be advised that based upon these facts and for inheritance tax purposes only,this Department has no objection to the proposed allocation of the gross proceeds of this action,$33,333.00 to the wrongful death claim and$0 to the survival claim. Proceeds of a survival action are an asset included in the decedent's estate and,although subject to the unposition of a zero percent inheritance tax rate in this instance,they must be reported on decedenYs Pecrosylvania inheri,tance tax retum. 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 Departmeut has n�ob,jections to the Petition,an attorney from tlie Department of Revenue will not be attending the hearing regarding it. Please contact me if you ar the Court has any qnestions or requires anything additional frozn this Bureau. Sincer , � .:�� GC�.�6�� ,�� . on E.Bakar Trust Valuation Specialist Inheritance Tax Division .. -------- ...._.....�,�........_..,_...�...r..-.,.�...�.,......_..,��.�w��. .�....._...._...�.�.. Bureau of Indfvidual Taxes � PO Box 280601 j Harrisburg, PA 17128 � 717.783.5824 � shabaker�pa.gov r,�/..,�;:.� I. a7� . ' �' � ` IN T'AE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,PENNSYLVANIA DIVISION . . � ; IN RE: �+state of BABY-GIRL DULAM- : , �� . . NO.: � KASIREDDY, Deceased ORDER � AND NOW,this day of ,2014,upon : consideration of the attached Uncontested Petition to Settle Wrongful Death and Survival Actions,it is hereby ORi3ERED and DECREED that Petitioners are authorized to enter into a settlement with Trayco Insurance Company in the gross sum of$100,000 for Underinsured Motorist Benefits. . It is further ORDERED AND DECREED and that the settlement proceeds shall be distributed as follows: ' GROSS SETTLEMENT: - $ �oo,oaa � Wrongful Death(100%) , $ 100,000 Survival Action (0%) � � The Wrongful Death Action shall be paid as follows: To: Bharath Kasireddy and Mrudula Dulam $ 100,000 Approval of this settlement does not affect Petitioners ability to pursue a claim against Abraham Aragon or any other person or entity responsible for the death of Bahy Crirl Dulam- K.asireddy. _- >- z�i �— BY'THE OURT: . �`' � :.S,=�.. c� �Q :�� ':�i� a� ', c7 � �} _-,:-r_ t �� J. mas A.Placey -'��'L � �=� i'F�E�E CQPY FROM R�CQRD CemmanPisasJudge � -- -�- �,� 1n Testimony whereof,1 here unto set my hand � � and th se I of said Co at Gariisle,Pa. `"' ~ �� This,,�ay of ,20�� Prothohota �• //� J METTE� EVANS �WOODSIDE A PROFESSIONAL CORPORATION ATTORNPYS AT LAW HOWELL C.METTE THOMAS F.SMIDA 3401 NORTH FRONT STREET MARK S.SILVER JAMES W.EVANS ROBERT MOORE PAULA J.LEICHT P.O.BO%5950 BERNADETTE BARATTINI 1926-2008 CHARLES B.ZWALLY TIMOTHY A.HOY AARRTSBURG}�PA 17110-0950 RANDALL G.HURST** PETER J.RESSLER THOMAS A.ARCHER* MELANIE L.VANDERAO JAMES A.ULSH HENRY W.VAN ECK IRS NO. AARON T.DOMOTO "NEW JERSEY BAR JEFFREY A.ERNICO MARK D.HIPP 23-1985005 BRIAN J.HINKLE "''MARYLAND BAR MARY ALICE BUSBY RONALD L.FINCK KEVIN J.HAYES KATHRYN L.SIMPSON HEATHER Z.KELLY TELEPHONE FACSIMILE ERIN L.PENTZ (717)232-3000 (717)236-1816 TOia.FxF:.E: 1-800-962-5097 HTTP�//W W W.METTE.COM Jc1riU�lI'y g, 2�15 Lisa M. Grayson, Esquire Cumberland County Register of Wills VIA CERTIFIED MAIL One Courthouse Square, Room 102 RETURNRECEIPTREQUESTED Carlisle, PA 17013 Re: Estate of Baby Girl Dulam Kasireddy File No.: 2014-00783 ;.,, � � Dear Ms. Grayson: � � � � c-�"i cz� � �za � c� �„� -•�- c� =� t,�� a Enclosed for filing are the following: =`� �-m ��' .--a �`-� �'__ .�, C-r; f,� �,'t . ,;' , � .:�� `� 1. Original and one copy of an Inventory; � ` ''� ��> « _., .. , ,,..,, �-n ..,,r .�,� <._� ...,.� � -� �..._ 2. Original and one copy of a Pennsylvania lnheritance Tax Return,"p��is a cop�of �. � the cover page of the tax return; and _ ' ��-} � � �, � � 3. A self-addressed,postage prepaid envelope for return mail. Please file the original Inventory and Inheritance Tax Return. Please forward a copy of the Inheritance Tax Return to the Pennsylvania Department of Revenue. Please return a date- stamped copy of the Inventory and the cover page of the tax return to my attention in the enclosed envelope. Please do not hesitate to call with any questions. Thank you for your assistance. Very truly yours, .. , �� '��. Lisa J. Kno , Paralegal to Thomas F. Smida Enclosures cc: Bharath Kasireddy, Administrator(w/encls.) John F. Yaninek, Esquire (w/encls.) 762245v1 � � � -a �� i � - ..0 .�.�� ..0 �� ..0 � ..0 �� ..0 = E-' �� O W �� .� � ln - � � � � � �� - y � O � � � r � � �. � � � � c � � . o � � � � a� � �, �, � �i za ° t� �:� a � �. � � b � o � � � o� ° � � �' � � yz � � �"� W � � � b �°co � � �' � � � � � r'~� � coZaoR� �', :� c, � v+ � o �° � o y �3 �i � �.� � � :�;� r�� p �-' C11 r O O ,. � ...� � .:.t {_:r O f.+ � `", o "�3 a p . ;.; c..� �:� �. � o ,� � � d 6�a c� �,, "'ry ..` :� N "--' C��1 � H � .! :7 -�`� � ,�e � � o � z � �:� ,..:, � � � .� � � .. � � .�: �� , 1r . ..._. . � �. -i� �FyF ry�r .I Fi Y. F�.I�,� OON C ON�� O W`2� O � `1, �, � , �� .r� o D � � �' {� m � z � o � � � � m m { N N �' � � � c1� O m �