HomeMy WebLinkAbout01-0389
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of Brandon S. Seidle
also known as
No.
,;}J -OJ - rS ~
, Deceased
Social Security No. 170 - 72 - 6354
George Seidle, Jr. and Marion Wagner
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW;)
D A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut_named in the last Will of
the Decedent, dated and codicil(s) dated
State relevant circumstances, e.g., renunciation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents
offered for probate; was not the victim of a killing and was never adjudicated incompetent
em B. Grant of Letters of Administration
r
!
(c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and
heirs:
I Name Relationship Residence I
George Seidle, Jr. Father 813 Wertzville Road, Enola, PA 17025
Marion Wagner Mother 148 Henry Road, Enola, PA 17025
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumber land
County, Pennsylvania with his/her last family
or principal residence at 813 Wertzville Road, East Pennsboro Township
(list street, number, and municipality)
Decedent, then ~years of age, died 09/26/2000 at Hershey Medical Center, Hershey, PA
(Location)
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property
(If not domiciled in PAl Personal property in Pennsylvania
(It not domiciled in PAl Personal property in County
Value of real estate in Pennsylvania
10,000.00
$
$
$
$
situated as follows:
Wherefore. Petitioner{s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of
letters in the a riate form to the undersi ned:
Si nature
George Seidle,
813 Wertzville
Marion Wagner
148 Henr Road, Enola, PA
Typed or printed name and residence
Jr.
Road, Enola, PA 17025
17025
) &-;).:1 c..f - i 0
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, Inc.
Form RW-1 (1991)
21-01-389
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumber land
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true
and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of
the Decedent. Petitioner(s) will well and truly administer the state according to law.
APRIlJ
2001
Sworn to or affirmed and subscribed
before me this 17tJaay of
/j J 0"
n ;'),
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I..k- .
1: For the Register
\
No.
21-01-389
Estate of Brandon S. Seidle
Deceased
Social Security No: 170 - 72 - 6354
Date of Death: 09/26/2000
AND NOW.
APRIL 18, 2001
, in consideration
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters D Testamentary ~ Of Administration
(c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
are hereby granted to
George Seidle, Jr. and Marion Wagner
in the above estate and that the instrument(s) dated
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters.
$
40.00
Ina:, C--
.,L}. n,)(\ 1::
rf~-<-V-<-l p-:-::: 'V tJ. ',; ~M .
Register of Wills ,
Short Certificate(s). .3. $
Renunciation. $
Affidavits ( $
Extra Pages ( ) . $
Codicil. $
JCP Fee. $
Inventory. $
Other $
TOTAL. $
9.00
Attorney:
John DeLorenzo, Esquire
1.0. No:
72190
Goldberg, Katzman & Shipman, PC
320 Market Street
P.O. Box 1268
Harrisburg, PA 17108-1268
Address:
5.00
Telephone: 717/234-4161
54.00
FILED: APRIL 18,2001
Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc.
Form RW-1 (1991)
'rhis is to cercify that the information here given is correctly copied fron: an original c~l~rificate of death du~~ filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records othce for permanent hlmg.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
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/7?( Gj"&~6~~
Local Registrar
tz-...-..--
Fee for this certificate, $2.00
p
6763462
SEP 2 '{ 2000
Date
Rev, 1/91
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
Brandon S. Seidle
SEX
2. Male
STATE FILE NUMBER
SOCIAL SECURITY NUMBER
1.
3. 170
72
6354
DATE OF DEATH (Month, Day, Year)
~September 26 2000
NAME OF DECEDENT (Flfst Middle, Lasl)
AGE (Last Slfthday)
UNDER 1 YEAR
Months Days
UNDER 1 DAY
Hours Minutes
BIRTHPLACE (Clly arid
Slate Of ForeIgn Country)
10 YIS
=ity) 0
~
,.5.
--:COUNTY Of DEATH
..
..
~Ib.
.- DECEDENT'S USUAL OCCUPATION
i (~;';:~i~'u;.,~r~d~eu~r;~r~Jr
::-"11.. Student 11b.
DECEDENT'S MAILING ADDRESS (Street CilyfTown Stale. Zip Code)
RACE, American Indian, Black, White. elc
(Specify)
Dauphin
8C.Derry Twp.
DECEDENT'S
ACTUAL
RESIDENCE
(See Instructions
on OIher side)
17.. State
Prt
MARITAL STMUS . Married
Never Married, Widowed.
Divorced (Specify)
1.. Single
17cKJ Yes, deCedenllived in F?c; t
White
SURVIVING SPOUSE
(II wile, gIve maiden name)
WAS DECEDENT EVER IN
U.S, ARMED FORCES?
Yea 0 No ex
Hi.
17b. Coun
Did
deCedent
"vein.
r. nnhpr 1 ;:mn townShip?, 17d.O :h~~~t~~\i~:: of
MOTHER'S NAME (First, Middle, Maiden Surname)
Marion pfadenhauer
?ennsboro
twp
city/bora
22b.
To the beat ot my knowledge. dealh occurred allheli..... dale and place .tated
(Signalure and Tille)
er
DATE OF DISPOSITION
(Monltl, Day, Year)
o 21b~ptanber 29, 2000
LICENSE NUMBER
011654-L
14 B HenrY Bead
. Pa 170~Enola~Pa 17025
lOCATION, C"ylTown. SIll', Zip Cod.
/'
21c.
Rolling Green Cemetery
NAME AND ADDRESS OF FACILITY
ers-Harner Funeral
LICENSE NUM3EA
hems 24-26 must be completed by
poIrliOn wllO pronounces dealh,
238.
TIME OF DEATH
DATE PRONOUNCED DEAD (Month. Day, Year)
23b. 230.
WAS CASE REFERRED TO MEDICAL EXAMINER/CORONER?
Yes I&J No 0
2.. 6:40 p.m. M 25. September 26, 2000
27. PART I: Enler lhe dIs8aa8s. injuries or complications which cauaed tile dealll, 00 nol,nler Ihe mode 01 dying. aucR as cardiac Of respiratory arrest, SIlock or heart laUure
List only one causa on each line
IIIMEOIATE CAUSE (Final
disease or conidition
reauhlng In death)-
Closed head trauma
DUE TO (OR AS A CONSEQUENCE OF):
MVA
DUE TO (OR AS A CONSEQUENCE OF)'
21.
I Approxlmat.
: int.rval belween
lon...t and dealh
!
PART II: CIne, signifICant condlllons conlributing 10 dealh. but
not resulting in the underlying cause given in PART I.
Sequentially list conditions
K any. leading to immediate
causa Ent.r UNDERLYING
CAUSE (Diseaae or injury
!hat ir\l1ialed evenla
r-.lling in deall1) LAST
DUE TO (OR AS A CONSEQUENCE OF):
~ AN AUTOPSY
PERFORMED?
d
WERE AUTOPSY FINDINGS
A"'ILAaLE PRIOR TO
COMPLETION OF CAUSE
OF OEi\TH?
MANNER OF DEATH
DME OF INJURY
(Month, Day, Year)
TIME OF tNJURY
INJURY AT WORK?
DESCRIBE HOW INJURY OCCURRED,
Yes 0
No[)l
Ye.O
No 0
Accident
Pending Investigation
Could not be determined
o Sept. 21,200 4:45 p.m.
o 308. b M. 300.
o PLACE OF INJURY, Al home. farm, Ilreet. leclory, olfica
~~j~~~lecll~enn Dr. at Magnolia
SIGNATURE AND TIT
Yes 0
No iCe
bicycle VB. vehicle
Nstural
o
~
o
Homicide
33.
'S SlGNi\TUR~~NU~~
4t.-1t/ /"'(' %..z..t..~~
~I/~I ( I
o
Cumber-
Cty. PA
2... 21b.
CERTIFIER (Check only one)
'CERTIFYING PHVSICIAN (PhYSICian certifYing cause 01 dealh wilen anolher phySICian has p",,,,,,,need death and compleled nern 23)
To lite...., of my knowledge, c1a.lh occurred due \0 the ~uaa(.).nd mann..... .lated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Suicide
21.
'~=~~::y'i.~=~~::~=~:~~':;' =~~~~':~~ =~=:o"=~=~':'do~~'::r"'lated.... . ..... . . ......... .. . . . 0
'MEDICAL EXAMINER/CORONER
On the buIa of .umlnatlon and/or Inve.tlllatlon,ln my opinIon, death occurr.t.t the time, date, and place, and due to the cauM{a) and
manner.. ...t.too . . . . . . . . .. . . . . . . . . . . . . . . . . . .. .. .. . . . . . . . . . . . .. . . . . .. .. . . . . . . . . . .. . .. . . . . . . . . .. . .. . . . .. . .. .. .. . . .
31..
REGIS
PA 17111
-
~POO
/1
E
-
Deceased
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
: No. 2001-00389
IN RE: ESTATE OF
BRANDON S. SETDLE,
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
Date of Death:
\Vill No.
Brandon S. Seidle, deceased
September 26, 2000
Admin. No.
2001-00389
To the Register:
1 certify that notice of estate administration required by Rule 5 .6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on April 23,2001:
George Seidle, Jr.
Marion Wagner
813 Wertzville Road, Enola, PA 17025
148 Henry Road, Enola, P A 17025
Date
'f/nlo\
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except N/A.
10~
60hn DeLorenzo, Esquire
\./
Goldberg, Katzman & Shipman, P.C.
P.O. Box 1268
Harrisburg, P A 17108-1268
(717) 234-4161
Signature
Name
Address
Telephone
Capacity:
_ Personal Representative
~ Counsel for personal
representative
C/
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPARTMENT 280601
HARRISBURG, PA 17128-0601
Telephone
7/27/2001
Thomas E Brenner, Esquire
Goldberg, Katzman & Shipman
PO Box 1268
Harrisburg, PA 17108-1268
, . I :;: (\JCj
:J /-'() I .,,:~ .Y /
717-793-0972
Re: Estate of Brandon Seidle
File Number 2101-0389
Court Number: Cumberland County
CCP 01-3284
Dear Mr. Brenner:
The Department of Revenue received the Petition for Approval of
Settlement Claim to be filed on behalf of the above-referenced Estate in
regard to a wrongful death and survival action. It was forwarded to this
Bureau for the Commonwealth's approval of the allocation of the proceeds paid
to settle the actions.
Pursuant to the Petition, the 10 year old decedent died as a result of
Bicycle / motor vehicle accident. The sole heirs to decedent's estate are
his parents. Therefore, any proceeds paid to settle the survival action would
pass to decedent's parents and would be subject 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 inheritance 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, $ 40,000.00 to the wrongful death claim
and $ 10,000.00 to the survival claim. Proceeds of a survival action are an
asset included in the decedent's estate and, although subject to the
imposition of a zero percent inheritance tax rate in this instance, they must
be reported on decedent's Pennsylvania inheritance tax return. 42 Pa.C.S.A.
s8302; 72 P.S. ss9106, 9107. Costs and fees must be deducted in the same
percentages as the proceeds are allocated. In re Estate of Merryman, 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 Revenue will not be
attending the hearing regarding it. Please contact me if you or the Court
has any questions or requires anything additional from this Bureau. Finally,
the approval of this allocation is limited to this estate and does not
reflect the position that the Department may take in any other proposed
distribution of proceeds of a wrongful death / survival action.
cc: Cumberland County Clerk of Courts ~
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
REV-1tJOO EX +(6-00)
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL)
Seid1e Brandon S.
DATE of DEATH (MM-DD-YEAR)
.- 02;J. </ - / ()
5;(
c:..
IRST,
OM DOLE INITIAL
OFFICIAL USE OHL Y
FILE NUMBER
21-01-0389
COUNTYCODE
YEAR
NUMBER
X 1. OrIgInal Return
4. LImited Estate
6. Decedent Died Testate
(Attach copy of Will)
IT] 9. LItIgatIon Proceeds RKelved 0 10.
rt~\tHi~i,$~~tfQ"::M(j.!l:tBijei~-'"
NAME
John DeLorenzo, Es ire
FI AM NAM E (If Applicable)
Goldber , Katzman & Shi man
TELEPHONE NUMBER
SOCIAL SECURITY NUMBER
170-72-6354
THIS RETURN MUST BE FILED IN DUPUCATEWlTH THE
REGISTER OF WILLS
SIAL SE AllY NUM ER
o
3 date 0 death
. RemaInder Return prIor \0 \2-13-82)
5. Federal Estate Tax Return Required
8. Tota.l Number of $a:fe Deposit Boxes
o
320 Market Street
P.O. Box 1268
Harrisburg, PA 17108-1268
4-4
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or
Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
S. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent Mortgage Liabilities, & Liens (Schedule l) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Une 13)
Copyright (c) 2000 farm software only The Lackner Group, Inc.
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(3)
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(4)
(5)
None
None
None
OFFICIAL USE ONLY
(6)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 tax.able at the spousalta:x
rate, or transfers under Sec. 9116(aX1.2)
16. Amount of line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of line 14 taxable at collateral rate
19. Tax Due
20.
671.00
0.00
0.00
0.00
None
10,000.00
None
None
9,329.00
None
(8) 10,000.00
(11) 9.329.00
(12) 671. 00
(13)
(14) 671. 00
X
X
X
X
.0 0
.0 45
.12
.15
(15)
(16)
(17)
(18)
(19)
0.00
0.00
0.00
0.00
0.00
Form REV-1SOO EX (Rev. 6.00)
Decedent's Complete Address:
STREET ADDRESS
813 Wertzvi11e Road
CITY I STATE I ZIP
Eno1a PA 17025
Tax Payments and Credits:
1. To< Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
0.00
Total Credits ( A + B + C) (z)
0.00
TotallnlerestlPenalty ( D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line ZO 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)
A. Enter the interest on the tax due. (SA)
B. Enter the tolal of Line 5 + SA. This is the BALANCE DUE. (5B)
Make Check Payable 10: . .. REGISTER OF WILLS, Ac:;ENT.. . ........
~:~:~;~~~~:~m:!:~:;::;;::;:;"l\mm"m\\\\\\\\m!!mmmlll1!\\\\I!!lllm\\\\\\!\\\\\I\\\\\\\\\\\\\\\l\I\\mmmmmmmmmmmmmmmmmimmmmmmmml!111l11)j1mmmmmmm\\mmmnm1l1mmmmrmmmmmmmmmmml)Ll1mm;:;~i::::;~),:i:!;;);;;:
m:u;;;:m!:L:~::::!::"::;
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; .
c. retain a reversionarylnterest;or. , , . .. ........ ..........
d. receive the promise for life of either payments. benefits or care?, .......
Z. If death occurred atter Oecember 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.
3. Interest/Penalty if applicable
O. Interest
E. Penalty
0.00
0.00
0.00
0.00
0.00
H!:;iii;;;
o
o
o
IT]
IT]
IT]
Under penalties of perJury, I declare that I have examined this return, IncludIng accompanyIng schedules and statements, and to the best of my knowledge and belief, It Is true,
coned and complete. Dec:laratlon of preparer other than the personal representative is based on afllnformatlon of which preparer has any knowledge.
SIGNATURE OF PER N RESPONSIBLE FOR FILING RETURN
Marion Wagner
"'~':>?, ,I!~~!.Y, J.l.5',":~", u''''''' "m,"""'"
Enola. PA 17025
Goldberg, Katzman & Shipman
320 Market Street, P.O. Box 1268
. 'H,,;:'i-'{sb;;':'" 'PA" 'ijiiia ~ ii6S'" -- m"""""
DATE
For death on or atter July 1, 1994 and before January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. 9116 (a) (1.1) (;)J.
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or far the use of the surviving spouse is 0%
[72 P.S. 9116 (a) (1.1) (ii)]. The statute does not exemot 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 twenty-one 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 00/0 [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%, except as noted in 72 P.S. 9116(1.2)
[72 PS. 9116(aXl)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(aX1.3)]. 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.
Copyright (c) 2000 form software only The Laclcner Group, Inc. Form REV...1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
813 Wertzville Road
CITY I STATE I ZIP
Enola PA 17025
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Povertj Credit
B. Prior Payments
C. Discount
(1)
0.00
Total Credits ( A + B + C) (2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 .to line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line S + SA. This is the BALANCE DUE. (SB)
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.
0.00
0.00
0.00
0.00
0.00
Did decedent make a transfer and:
a. retain the use or income of the property transferred; . .
b. retain the right to designate who shall use the property transferred or its income; .
c. retain a reversionary interest; or . . . . . . . . . .. .........
d. receive the promise for life of either payments, benefits or care? . . . . .
2. If death occurred after Oecember 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .. ....,.
3. Did decedent own an Win trust forw 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.
Yes No
~~
o
o
o
[KJ
[KJ
[KJ
Under penalties of perjury, I declare that I have oxamined this return, Including accompanying schedules and statements, and to the best of my knowledge and belief, it Is true,
correct and complete. Decl.aratlon of preparer other than the personal representatIve Is based on all Information of which preparer has any knowledge.
SIGNATURE OF PERSON FtESPONSl8LE FOR FILING ETURN
SIGNATURE OF P
George Seidle, Jr.
813 Wertzville Road
--~~ol-a;-jiA--l-i625-------------------------------
Goldberg, Katzman & Shipman
320 Market Street, P.O. Box 1268
- - -Ba;:';'-is});'-': - - - -PA - - -:e jicfs: fi68 - - - - - - - - - - - - - - - - --
DATE
9.\ 1d.\0\
DATE
For dates of ath on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [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%
[72 P.S. 9116 (a) (1.1) on). 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 twenty-one years of age or younger at death to or iOf the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0"10 [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<'10, except as noted in 72 P.S. 9116(1.2)
[72 PS. 9116(aX1l].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(a)(1.3)J. 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.
Copyright (cl 2000 form software only The Lackner Group, Inc:.
Form REV-1500 EX (Rev. 6-00)
REV.1508 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERfTANCETAX RETURN
RESIDENT DECEOENT
ESTATE OF FILE NUMBER
Brandon S. Seidle SS# 170-72-6354 09/26/2000 21-01-0389
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.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ITEM
NUMBER
1
DESCRIPTION
Settlement of civil action docketed to Cumberland County Court or
Common Pleas at civil action number 01-3284, amount allocated tc
survival action (copies of Court Order dated August 7, 2001,
Petition for Approval of Settlement, and letter dated July 27,
2001 from the Department of Revenue are attached to death tax
return only)
VALUE AT DATE
OF DEATH
10,000.00
TOTAL (Also enter on line 5, Recapitulation) $ 10,000.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems,lnc. Form REV-1S08 EX (Rev. 1.97)
REV-1511 EX + (1-97)
COMMONWEALTH OF PENNSYLVA.NIA
INHERITANCET/4X RETURN
RESIDENT DEC~DENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Brandon S. Seidle
SSjl 170 - 72 - 6354
09/26/2000
FILE NUMBER
21-01-0389
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1
FUNERAL EXPENSES,
Myers-Harner Funeral Home, Inc. - funeral services
5,189.00
2
Rolling Green Cemetery Company - cemetery plot & memorial
4,140.00
B.
ADMINISTRATIVE COSTS,
1. Personal Representative's Commissions
Name of Personal Representative{s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney's Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
State
Zip
City
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
TOTAL (Also enter on line 9, Recapitulation) $ 9,329.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97)
,REV.1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERJTANCETAX RETURN
RESIDENT DECEDENT
ESTATE OF
Brandon S. Seid1e
SCHEDULE J
BENEFICIARIES
SS{f 170-72-6354
09/26/2000
FILE NUMBER
21-01-0389
RELATIONSHIP TO DEC~qENT AMOUN I OH SHARE
Do Not List Tr.stee(s) OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS [lnc\udeoutrlght spousal dIstributions, and
transfers under Sec. 9116{a)(1.ZlJ
1 George Seid1e, Jr.
813 Wertzvi11e Road
Eno1a, PA 17025
Father 1/2 of Residue
2
Marion Wagner
148 Henry Road
Eno1a, PA 17025
Mother
1/2 of Residue
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON- TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
0.00
"'___ Or:U_1J:1'1 cv "'_" ... ",,\
Index to Exhibits
Pennsylvania Inheritance Tax Return
Estate of Brandon S. Seidle, deceased
Exhibit A: Grant of Letters of Administration
Exhibit B: Copy of Court Order dated 817/01, along with copy of Petition for Approval of
Settlement and copy of Department of Revenue letter dated 7/27/01 approving
allocation
67135.1
Register of Wills of CUMBERLAND County, Pennsylvania
Certificate of Grant of Letters
....-..-................
~~. .~: . .""
.". "
~.' .'l' ",
. .~ . .
// \" \
~ 4 \ ,,)
No. 2001-00389 PA No. 21-01-0389
ESTATE OF SEIDLE BRANDON S
(LAbl, ~lKbl, M1UUL~i
'(: ""
Late of
EAST PENNSBORO TOWNSHIP
~UM~~KLANU CUU~lY,
0"
Deceased
Social Security No. 170-72-6354
WHEREAS, SEIDLE BRANDON S
(LA~l, ~~Kbl, M1UULb)
CUMBERLAND COUNTY , died on the
and
, late of
EAST PENNSBORO TOWNSHIP
26th day of
September
2000;
WHEREAS, the grant of letters of administration
is required for the administration of the estate.
THEREFORE, I, MARY C. LEWIS
in and for the County of CUMBERLAND
Commonwealth of Pennsylvania, have this day granted
to GEORGE SEIDLE JR
(LAbl, ~lKbl, M1UUL~)
, Register of Wills
, in the
Letters of Administration
and
MARION WAGNER
who have duly qualified as administrator (rix) of the estate
of the above named decedent and have agreed to administer the estate according
to law, all of which fully appears of record in my Office at CUMBERLAND
COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my Office on the 18th day of April 2001.
mQ,~ c".~, ,(k.Pt3~t
I eg~sCler of ~ s-\
**NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE)
GEORGE SEIDLE, JR, and
MARION WAGNER, Co-
Administrators of the Estate of
Brandon Seidle,
: IN THE COURT OF COMMON PLEAS
:CUMBERLANDCOUNT~
PENNSYLVANIA
Plaintiff
: No. 01-3284 Civil Term
v.
: Civil Action - Law
ROBERT W. ZEIGLER,
Defendant
ORDER
AND NOW, This
? ~ day of August, 2001 this Court approves the
settlement as set forth in the petition and directs that $50,000 be paid in settlement in this
claim with $40,000 allocated to the wrongful death claim and $10,000 to the survivor
action.
.~
'6'<&
BY THE COURT
J.
GEORGE SEIDLE, JR, and MARlON
WAGNER, Co-Administrators of the
Estate of Brandon Seidle,
Plaintiff
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYL VANIA
No. 01-3284 Civil Term
v.
Civil Action - Law
ROBERT W. ZEIGLER,
Defendant
PETITION FOR APPROVAL OF SETILEMENT
AND NOW, come the parties who state:
1. George Seidle, Jr., and Marion Wagner, are the parents and co-Administrators of the
Estate of Brandon Seidle.
2. Decedent, Brandon Seidle, was a 10 year old child who died as a result of a bicycle-
motor vehicle accident that occurred at the intersection of Magnolia Drive and East Penn Drive in
East Pennsboro Township, Cumberland County, Pennsylvania, on September 21, 2000. Brandon
Seidle was operating a bicycle traveling from Magnolia Drive onto East Penn Drive at a point in time
when the bicycle and a vehicle operated by Defendant, Robert W. Zeigler, collided. Brandon Seidle
sustained fatal injuries as a result of this accident.
3. The Plaintiffs, as parents and co-administrators of the Estate, have negotiated to
resolve their claims with Erie Insurance Company, the liability insurance carrier for Defendant Zeigler,
with Erie agreeing to pay $50,000 in settlement ofthis claim.
4. The claim is to be allocated between the wrongful death and survival claims as follows:
Wrongful Death
$40,000.00
Survival Action
$10,000.00
5. Approval of the allocation of this settlement has been obtained from the
Commonwealth of Pennsylvania, Department of Revenue, as reflected in the letter attached hereto
as Exhibit "A!'.
WHEREFORE, the parties request that the Court approve the settlement involving the
minor's estate.
Date: 1/1 ~ J 0 /
Date:/- ) Lf - 0 }
Date: c{ / '/0 I
65182.1
GOLDBERG, KATZMAN & SHIPMAN, P.C
~L,
om ---: ._.~, E",rnre
I.D. #: 32085
P.O. Box 1268
Harrisburg, PA 17108-1268
Attorneys for Defendant
2
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPARTMENT 280601
HARRISBURG, PA 17128-0601
Telephone
7/27/2001
Thomas E Brenner, Esquire
Goldberg, Katzman & Shipman
PO Box 1268
Harrisburg, PA 17108-1268
717-793-0972
Re: Estate of Brandon Seidle
File Number 2101-0389
Court Number: Cumberland County
CCP 01-3284
Dear Mr. Brenner:
The Department of Revenue received the Petition for Approval of
Settlement Claim to be filed on behalf of the above-referenced Estate in
regard to a wrongful death and survival action. It was forwarded to this
Bureau for the Commonwealth's approval of the allocation of the proceeds paid
to settle the actions.
Pursuant to the Petition, the 10 year old decedent died as a result of
Bicycle / motor vehicle accident. The sole heirs to decedent's estate are
his parents. Therefore, any proceeds paid to settle the survival action would
pass to decedent's parents and would be subject 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 inheritance 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, $ 40,000.00 to the wrongful death claim
and $ 10,000.00 to the survival claim. Proceeds of a survival action are an
asset included in the decedent's estate and, although subject to the
imposition of a zero percent inheritance tax rate in this instance, they must
be reported on decedent's Pennsylvania inheritance tax return. 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 Merryman, 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 Revenue will not be
attending the hearing regarding it. Please contact me if you or the Court
has any questions or requires anything additional from this Bureau. FinallYt
the approval of this allocation is limited to this estate and does not
reflect the position that the Department may take in any other proposed
distribution of proceeds of a wrongful death / survival action.
au Dl.bert
Inheritance Tax Division
Bureau of Individual Taxes
cc: Cumberland County Clerk of Courts
l
,
Register of Wills of Cumberland County, Pennsylvania
)L
<-
Estate of Brandon S. Seidle
also known as
INVENTORY
No. 21-2001-0389
Date of Death September 26. 2000
,Deceased Social Security No. 170-72-6354
Personal Representative(s) ofthe above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets
wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said
Inventory represents its fair value as ofthe date ofthe Decedent's death, and that Decedent owned no real estate outside ofthe Commonwealth of
Pennsylvania except that which appears in a memorandum at the end of this inventory. IlWe verify that the statements made in this Inventory are true
and correct. IM/e understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification
to authorities.
Personal Representative:
Name of
Attorney: John DeLorenzo, ESQ.
I.D. No.: 72190
Address: Goldberg, Katzman & Shipman. P.C.. 320 Market Street.
P.O. Box 1268. Harrisburg. PA 17108-1268
Telephone:
717-234-4161
Description
Value
1. Settlement of civil action docketed to Cumberland County Court of Common Pleas at civil
action number 01-6284, amount allocated to survival action
$10,000.00
(Attach Additional Sheets if necessary)
Total:
$10,000.00
NOTE: The Memorandum of real eslateoutside the CanrTJOrlV\.eCllth of Pennsylvania may, attheeleclion of the personal representative, include the value of each item, but such
figures should not be extended into the total of the Inventory.
Register of Wills of Cumberland County, Pennsylvania
,.
Estate of BrandonS. Seidle
also known as
INVENTORY
No. 21-2001-0389
Date of Death September 26. 2000
,Deceased Social Security No. 170-72-6354
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets
wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said
Inventory represents its fair value as ofthe date of the Decedent's death, and that Decedent owned no real estate outside ofthe Commonwealth of
Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We verify that the statements made in this Inventory are true
and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification
to authorities.
1.0. No.: 72190
George Seidle, Jr\, CO.Vdministrator
Dated Q 8 ~\
Name of
Attorney: John DeLorenzo, Esq.
Address: GoldberQ. Katzman & Shipman. P.C.. 320 Market Street.
P.O. Box 1268. Harrisbun:J. PA 17108-1268
Telephone:
717-234-4161
Description
Value
1. Settlement of civil action docketed to Cumberland County Court of Common Pleas at civil
action number 01-6284, amount allocated to survival action
$10,000.00
(Attach Additional Sheets if necessary)
Total:
$10,000.00
NOTE: The NIemorandum of real esIaleoulsidelheCanr'norMealthofPennsyNania rrraf. atlheeledion of the personal representative, include the value of each item, but such
figures should not be extended into the total of the Invento'Y.
'v / b - cQ c:-:2..c,/- / CJ
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG. PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT" ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
JOHN DELORENZO ESQ
GOLDBERG ETAL
PO BOX 1268
HBG PA,17108
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
10-29-2001
SEIDLE
09-26-2000
21 01-0389
CUMBERLAND
101
.
REV-1547 EX AFP H2-00)
BRANDON
S
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE" PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV =is'4j-ix--AFP--fi'2-:oo1--NoTlci-oF-.rNHEifliANcE-TAx-A-PPRA-ISEMENT~--AiioWAN-CE-OR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SEIDLE BRANDON S FILE NO. 21 01-0389 ACN 101 DATE 10-29-2001
TAX RETURN WAS: (X) ACCEPTED AS FILED
CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
n)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
10.000.00
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
nO)
9,,329.00
.00
nl)
(2)
(3)
(4)
NOTE: I~ an assessment was issued previously. lines
re~lect ~igures that include the total o~ ~
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
10,,000.00
g.~?g 00
671.00
.00
671.00
14. 15 and/or 16. 17. 18 and 19 will
returns assessed to date.
671.00 X 00 =
. 00 X 045 =
.00 X 12 =
.00 X 15 =
(9)=
.00
.00
.00
.00
.00
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
· IF PAID AFTER DATE INDICATED" SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
(
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
BRANDON S. SEIDLE
Date of Death:
September 26. 2000
Will No.
Admin.
2001-00389
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes X No
2. If the answer is No, state when the personal representative reasonably
believes that the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes No X
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the
parties in interest?
Yes X No
d.
Copies of receipts, releases, joinders and approvals of formal or
information accounts may be filed with the Clerk of the Orphans'
Court and may be attached t thi pO;Z---
I
Date: (1/1 0 (
John DeLorenzo. Esquire
Goldberg. Katzman & Shipman. P.C.
320 Market Street. P.O. Box 1268
Harrisburg. PA 17108-1268
(717) 234-4161
Capacity:
Personal Representative
X Counsel for personal representative