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Home My WebLink About04-17-15 (2) � � pennsylvania 15 0 5 61410 5 DEPFRIMENTOFHEVENUE EX(03-14)(FI) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po aox 2so6oi INHERITANCE TAX RETURN �� O /� ' � Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 11242010 11071962 DecedenYs Last Name Suffix DecedenYs First Name MI Gordon Darrell R (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Gordon Edie C THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1. Original Return p 2. Supplemental Return p 3. Remainder Return(date of death prior to 12-13-82) p 4.Agriculture Exemption(date of p 5. Future Interest Compromise(date of p 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) p 7. Decedent Died Testate p 8. Decedent Maintained a Living Trust _ 9. Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) p 10. Litigation Proceeds Received p 11. Non-Probate Transferee Return p 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) O 13. Business Assets O 14.Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Kari E. Mellinger (717) 234-7828 <� � .� � rn �,--� rri � First Line of Address G o -'D �? � 3513 North Front Street c:a -�v �, � �t � r t _e._ t�. �--' _; c� Second Line of Address � �# r n --J � '} �,� M ;.�, �� n -�rt -. , -� '� -r1 Cit or Post Office State ZIP Code � � � � -� � Y , yl, t � Harrisburg PA 17110 ' � r Q c� �'{ r_.� "`� � Correspondent�s emaii address: kmellinger@rjmarzella.com � REGISTER OF WILLS USE ONLY REGISTER OF WILLS USE ONLY DATE FILED MMDDYYYY DATE FILED STAMP PLEASE USE ORIGINAL FORM ONLY Side 1 � Illillllllllllllllllllllllllllllllllll�IIIIIIIIIIIIIIIIIIII J 15056141 5 ],505614105 � �n ii irc orcn-�• � � 1505614205 REV-1500 EX(FI) DecedenYs Social Security Number I DecedenYs Name: Darrell R. Gordon ' � RECAPITULATION -- _-._ __�--------- 1. Real Estate(Schedule A). .......... .... . ... ....... ....... ..... ... . ... 1. !. 0.00 ( _ . ,��d.� _.. .,,..�,. � .... ._-. , ��,.., _�Q� 2. Stocks and Bonds(Schedule B) ....... ... . ....... ..................... 2. ; 0.00 � 3. Closely Heid Corporation, Partnership or Sole-Proprietorship(Schedule C) ... .. 3. ; 0.00 4. Mort a es and Notes Receivable Schedule D 4. ' 0.00 9 9 � ). ......... . ............... . 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E)..... . . 5. � 109,513 43 � , ,:.... .. ..... _..,._, , ,�m.� ... . ,,��:.n�,i i 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ...... . 6. ; 0.00 � _. ..__,_..._Y....._.__�_.___,_,�__..._____�_._.___�.___.___.._i 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property ; (Schedule G) O Separate Billing Requested... ... . . 7. � 0.00 { 8. Total Gross Assets total Lines 1 throu h 7 8, i 109,513.43 � ( 9 ). ........... . ............... . , � 9. Funeral Expenses and Administrative Costs(Schedule H)... .... ...... .. ... . 9. � 7,290.97 � _... ........... . ........ �_ �____.__ ..�_.�,�__.! 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1)..... .. .. ..... . 10. ; 0.00 � __... ..._,... . . ..._, n_......... _....�.. __.�..._w 11. Total Deductions(total Lines 9 and 10). . . .. ... .. . .. .... . .. ....... ..... . 11. ; 7,290.97 j . �._.. �_er.- .__..,._ w..._..W .r.��..__.�� 12. Net Value of Estate(Line 8 minus Line 11) . ..... ...... .. ... ....... . .. .. . 12. ': 102,222.46 � 13. Charitable and Governmental Bequests/Sec.9113 Trusts for which � � �� ' � �� "' V� � A� µ �'�" I an election to tax has not been made(Schedule J) ........................ 13. 0.00 � 14. Net Value Subject to Tax(Line 12 minus Line 13) 14. 102 222.46 j ............. ........... , i TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 �----�----�----- �---- - � � �� y � (a)(1.2)X .0 00 51,111.23 I 15. 0 00 � � w�.�,.., 16. Amount of Line 14 taxable ; ��'� tl � "�'m T s�� V� � � � � T 3'T � ' � at lineal rate X.0 45 ; 51,111 23 I 16. 2,300.01 � i _ � � , _... �_�.___.., .. .�._ _,,.� � . 17. Amount of Line 14 taxable ; 0 00 ; 17. 0 00 � at sibling rate X.12 , ( _ _._ �_.., ..__ �. .v_ ,._,_. _2.�0.00� . ._�� , . � ... ... �. 0.0�,,.� 18. Amount of Line 14 taxable + at collateral rate X.15 � ( 18. � � �,._ _._""_'_ _._-_-_-___J �'. , -..:... ,. ,,:,. ...-. , .....:._ ., ,.....,.: ,. . ..'_"' 19. TAX DUE .... . ... ................ .. . . . .. ... 2,3��.0� I .. .... ... ... ..... .... . 19. '; I 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Under penalties of perjury,I declare 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 the person responsibie for filing the return is based on all information of which preparer has any knowledge. SIGNA7URE OF PERSO RESPON$IBLE FOR FILING RETURN DATE �E� �-�r�� ADDRESS 332 Doubling Gap Road, Newville, PA 17241 SIG U EPA THER THAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE ADDRESS 3513 N. Front Street, Harrisburg, PA 17110 � ��I�I��I�I��I�� Side 2 � 1 05614205 1505614205 ..A�.„�� ,� rR.��-�� , REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Darrell R. Gordon STREETADDRESS 131 Shippensburg Mobile Estate CITY STATE ZIP Shippensburg PA 17257 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 2,300.01 2. Credits/Payments A.Prior Payments 0.00 B.Discount 0.00 (See instructions.) Total Credits(A+g) (2) 0.00 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) 2,300.01 Make check payabie 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 properry transferred .......................................................................................... ❑ � b. retain the right to designate who shali 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 propefij 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 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 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 step-parent 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(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 common with the decedent,whether by blood or adoption. �.�„�,�_„��..,�. , REV-iso8 EX+(o8-1z) � pennsylvania SCHEDULE E DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Darrell R. Gordon 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 1. Survival Action Settlement(Less 40%for Attorney's fees antl litigation costs of$2,161.57) 109,513.43 TOTAL (Also enter on Line 5, Recapitulation) $ 109,513.43 If more space is needed, use additional sheets of paper of the same size. �. S�A � ;3 p�nnsytvania � OEPARTMEN7 Of REVENUE September 21, 2012 Robin Marzella,Esquire Law Office 3513 North Front StreEt Harrisburg,PA 1�1 t 0 Re: L•state of Darreli Gordon File Number 2I 10-1212 Court of Common Pless Franklin County Dear Attarney Manella: The Department of Revenue has received the Petition for Approval of Settlement Claim to be filed on behajf of the abovc-referenceci Estate in regard to a wrongful death and survivat action. It has been forwarded to this Bureau for the Commonwealth's appravat of the allocatian of the proceeds paid Eo settle the actions. Pursuant to the Petition,the�17 year ald decedent died as a result of inedicai negliger►ce. Decedent is survived by his wife and two children. Please be advised that,based upon these faefs and for inheritance tax purposes oniy,this Department has no objection to the proposed allocation of the net proceeds af this action,$SS8,375.00 to the wrongful death claim ancE$186,125.Q0 to the survival ctaim. Proceeds of a survival action are an asset included in the decedent's estate and are subject tv the irnpasition af Pennsylvania inheritance tax. 42 Pa.C.S.A. §8302;72 P.S. §9105, 9107. Costs and fees must be deducted in the same percentages as the proceeds are allacated. In re Estate of M�an, 659 A.2d 1059{Pa,Cmwlth. l995). I trust that this letter is a sufficient representaEion of the Department's position on thzs matter. As the Department has no objections tv the Petition,an attarney from the Department of Revenue will not be attending any hearing regarding it. Please contact mo if you or the Court lias any questions or requires anything additionat from this Bureau. Sinc ely, , ��. � �annon E.$aker Trust Vatuation Specialist Tnheritance Tax Division . . ._ . ..... ... .. .. ........ . . . .._ ... .. . . . . , . . Bureau of Endividual Taxes � PO Box 280601 � Harrlsburg,PA 17128 �717.783.5824 � shabaker@pa.gov 9:59 AM R.J. MARZELLA, ESQUIRE AND ASSOCIATES, P.C. 01/29/15 Account QuickReport Accrual Basis As of October 28,2012 Type Date Num Name Memo Split Amount Balance Client Prepaids RJM'S Gordon, Est Darrell Check 12/10/2010 18594 Robin M Tillman travel Bank(M&T) ... 41.00 41.00 Check 01/04/2011 18646 Cumberland Cou... Bank(M&T) ... 15.00 56.00 Check 05/05/2011 18934 Register of Wills Bank(M&T) ... 10.00 66.00 Check 08/03/2011 19151 Healthport 0093445187 Bank (M&T) ... 120.27 186.27 Check 09/26/2011 19439 The Sentinel Bank(M&T) ... 189.54 375.81 Check 10/28/2011 19522 Joseph Manley, ... VOID: Bank(M&T) ... 0.00 375.81 Check 05/04/2012 19830 David Hopkins,A... Bank(M&T) ... 700.00 1,075.81 Check 08/21/2012 20124 David Hopkins,A... Bank(M&T) ... 875.00 1,950.81 Check 08/27/2012 20034 Prothonotary of F... Bank(M&T) ... 94.00 2,044.81 Check 08/29/2012 19900 Federal Express Release Bank(M&T) ... 22.22 2,067.03 Check 08/29l2012 20035 Federal Express Writ of Su... Bank(M&� ... 22.22 2,089.25 Check 08/29/2012 20125 Rachel A.Tingler Notary fee Bank(M&T) ... 10.00 2,09925 Check 10/05/2012 20111 Jacqulyn Harris Travel Bank(M&T) ... 43.05 2,142.30 Check 10/22/2012 20231 Jacqulyn Harris Bank(M&T) ... 19.27 2,161.57 - -- . _----_ __ Total Gordon, Est Darrell 2,161.57 2,161.57 Total RJM'S 2,161.57 2,161.57 Total Client Prepaids 2,161.57 2,161.57 --_ _ _ _ TOTAL 2,161.57 2,161.57 ___ _ _. Page 1 REV-1511 EX+ (08-13) � pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCE TAX REfURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Darrell R. Gordon Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1� Funeral Bill 7,29�•97 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) _ Street Address City State ZIP Year(s)Commission Paid: 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent _ 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. TOTAL(Also enter on Line 9, Recapitulation) $ ��290�97 If more space is needed, use additional sheets of paper of the same size. ��:m� �,�. l o/3 y C�o�� -� . . 15 Big Spring Avenue NEWVILLE, PENNSYLVAN�A 17241 F. CHARLES EGGER, Supervisor 717-776-3414 FRANK C. EGGER, Funeral Director December 10, 2010 Funeral Bill for Darrell R. Gordon Date of service November 30, 2010 . Professional Service $3,875.00 Sterling 18 Gauge Casket $2,185.00 1 C� / � Burial Vault $990.00 ��0 � �/ 10 Death Certificates $6.00 a piece $60.00 /� l � Sentinel Obituary day one $80.65 � Sentinel Obituary day two running $40.32 Clergy offering $50.00 Total $7,290.97 REV-1513 EX+ (01-10) � pennsylvania SCHEDULE � DEPARTMENT OF REVENUE gENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Darrell R. Gordon 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. Brooklynn Gordon Daughter 25% 2. Jacqueline Ragan Daughter 25% 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• Edie Gordon 50% B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II - 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. -"*-w'II'll"�'lll�l�ll"'I�' a .,��,� �� ,��,�� COMMONWEALTH OF PENNSYLVANIA SHORT CERTIFICATE COUNTY OF CUMBERLAND �,. pr , �� 6 RiY I, GLENDA FARNER STRASBAUGH Register for the Probate of Wills and Granting Letters of Administration in and for CUMBERLAND County, do hereby certify that on the llth day of May, Two Thousand and Eleve.n, Letters of ADMINISTRATION in common form were granted by tne Register ot said County, on the estate of DARRELL R GORDON , late of SH/PPENSBURG BOROUGH /First,Middle,Last1 in said county, deceased, to EDIE GORDON /FirsL Middle,Lasd and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 11th day of May Two Thousand and Eleven. File No. 20�0- 01212 PA File No. 2�- 90- �212 Da t e of Dea th � �/24/2010 S. S. # � , i n s � .'' r J s -� �� 1%�:: .�� Ls � � Regis r f GViIIs ,�` � 1 �r , .� � �.�y NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL ��.,�„ ,� ,��n,. � � '� .� - - - - _-- ----- - _ REGISTER OF WILLS CERTIFI CUMBERLAND COUNTY _ GRANT OF LETTERS PENNSYLVANIA ADMINISTRATION :.. �:: ,_ _N �o��, No. 20�0- Oy1212 PA No. 21- 10- 12�2 Es ta te Of: DARRELL R GORDON lFirsi,Middle,Lastl Late Of: CUMBERLAN COUNTYGH Deceased Social Security No: 986-58-58�3 �lHEREAS; DAR.RELL R GOR!�nN . (Fi�st,Middle,Last) � late of SHIPPENSBURG BOROUGH CUMBERLAND COUNTY died on the 24th day of November 2010 and, WHEREAS, the grant of Letters of Administration is required for the administration of the estate. THEREFORE, I, GLENDA FARNER STRASBAUGH , Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, have this day granted Letters of Administration to: EDIE GORDON who has duly qualified as ADMINISTRATOR (RIX) of the estate of the above named decedent and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 1 �th day of May 20� 1. � � � , � ��,�. �� ' ��l � �" R gister o i�ls / � � �� .- � � - � Ut ,/,� **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)