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Home My WebLink About09-18-15 (2) 1505610105 REV-1500 EX(02-11)(FI) i!j PA Department of Revenue pennsylvania OFFICIAL USE ONLY oEo.a.F.�FwrF�,r 280601 County Code Year. File Number PO BOX 2 Bureau Individual Taxes INHERITANCE TAX RETURN Harrisburg,PA 17128-o6o1 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 11/02/2013 07/16/1948 Decedent's Last Name Suffix Decedent's First Name MI Barrick Dianne E (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 O 1. Original Return 2. Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) Q 4.Limited Estate O 4a. Future Interest Compromise(date of Q 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.) ® 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 SHOULD BE DIRECTED TO: Name Daytime Telephone Number Andrew C. Sheely, Esquire 717-697-7050 REGISTE"F WILLS US&LY �;o J) i First Line of Address r-IJ rnr� ; I 127 South Market Street � - OO 7 Second Line of Address > '-O P.O. Box 95 I C City or Post Office State ZIP Cade DATE FILEDP r Mechanicsburg - PA 17055 c �' o Correspondent's e-mail address:andrewc.sheely@verizon.net 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,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR ILING RETURN DATE / G AD RESS Marilyn J. Willits, Executrix, 435 North Mountain Road, Newville, PA 17245 SIGNA OF PREPARER OTHER EP NTATIVE D/1�E A R Andrew C. Sheely, Esquire, 127 So Market Street, P.O. Box 95, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 1505610205 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: Barrick, Dianne E. RECAPITULATION 1. 'Real Estate(Schedule A). . .. .. .. . . .. .. .. ... . . .. .. .. . . . .. .. .. . .. . . . ... 2. Stocks and Bonds(Schedule B) .. . ... . ... .. .. . ... . . .. .. .... . ... . .. . ... 2. ' 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . .. . . 3. 4. Mortgages and Notes Receivable(Schedule D). . ... .. ... .. . .. .. .. .. ... ... 4. 5.. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). .. . ... 5. ' 84,47.7.73 =: & Jointly Owned Property(Schedule F) O Separate Billing Requested .. . .. .. 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested.. . . .. .. 7. 3 8, Total Gross Assets(total Lines 1 through 7). . . .. ... .... .... .. . ... . .. .. .. 8. 84,477.73 f 9. Funeral Expenses and Administrative Costs(Schedule H). . . .. . .... . .. .. . . .. 9. 265.74 3 I' 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1). .. ..... . .. .. . . 10. 11. Total Deductions(total Lines 9 and 10). .. . ... .. .. . .. . ... .. ... .. .. ... ... 11. 265.74 12. Net Value of Estate(Line 8 minus Line 11) .. .. . . ... . . ..... . .. . :.. . ... .. 12. 84,211.991 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. 84,211.99 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 ; X.0 0. 15, 16. Amount of Line 14 taxable at lineal rate X.0 45 84,211.99 1.6 3,789.53 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. 3,789.53 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side 2 1505610205 1505610205 J s REV-1503 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Dianne E. Barrick ........... .......................... -----.... .................. ......... ................... STREETAIDDRESS 304 Monroe Street ..........................-—---- ...... ....... ....... ------......... CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 3,789.53 2. Credits/Payments A.Prior Payments ....... .......... B.Discount Total Credits(A+B) (2) 3. Interest (3) 4. If Line 2 is greater than Line I +Line 3,enter the difference. This is the OVERPAYMENT. Fill in oval.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) 3,789.53 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.......................................................................................... R M b. retain the right to designate who shall use the property transferred or its income ............................................ El E c. retain a reversionary interest ............................................................................................................................. F-1 0 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?.............. El 0 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 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 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-15o8 DEPARTMENT OF REVENUE CASH, BANK DEPOSITS &MISC. INHEWANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Dianne E. Barrick 21-13-1198 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 VAWE AT DATE NUMBER DESCRIPTION OF DEATH Proceeds from Survival Beneficiary Settlement-received September 10,2015 84,477.73 � TOTAL(Also enter on Line 5, Recapitulation) $ 84,477.73 If more space is needed, use additional sheets of paper of the same size, ` / p ennsyA vania DEPARTMENT OF REVENUE March 2,2015 Matthew Owens,Esquire Law Office 6310 Allentown Blvd,Suite 101 Harrisburg,PA 17112 Re: Estate of Dianne Barrick File Number 2113-1198 Court of Common Pleas Cumberland County Dear Mr.Owens: The Department of Revenue has 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 has been 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 65 year old decedent died as a result of injuries received in a motor vehicle accident. Decedent is survived by her mother. 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 net proceeds of this action,$14,907.84 to the wrongful death claim and$84,477.73 to the survival claim. Proceeds of a survival action are an asset included in the decedent's 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 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 any hearing regarding it. Please contact me if you or the Court has any questions or requires anything additional from this Bureau. Sinc r S on t-.'taker Trust Valuation Specialist Inheritance Tax Division IN RE: Estate of Dianne E. Barrick : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY,, PENNSYLVANIA : NO.: ORPHANS COURT ORDER AND NOW, this day of_ Auqus� , 2015, upon consideration of 1 -0 Petitioner's, Marilynn J. Willits, Petition for Approval of Settlement of Wrongful Death and Survival Claims, it is hereby ORDERED and DECREED that said settlement is APPROVED. The total settlement sum of one hundred fifty thousand dollars ($150,000.00), should be paid to Marilynn J. Willits, as Administratrix of the Estate of Dianne E. Barrick, and distributed as follows: Total Settlement Proceeds.......................................$ 150,000.00 Attorney's Fees.....................................................$ 50,000.00 LegalCosts and Expenses........................................$ 614.43 Estate of Dianne E. Barrick, Survival Beneficiary...........$ 84,477.73 Shirley Earnest,Wrongful Death Beneficiary.................$ 14,907.84 C= C) :Z7 M C7D :Z 70 co CD co Marilynn J.Willits,as Administratrlx of the Estate of Dianne E.Barrick is authorized to sign any and all releases of liability associated with claims against Robert A. Smedley and Yu Sun Smedley under the USAA insurance policy as well as any claims associated with Dianne Barrick's UIM policy through Metropolitan. By the Court, J. Distribution: Matthew L.Owens,Esquire,6310 Allentown Blvd,Suite 101,Harrisburg, PA 17112 John L.Panzarella,United Services Automobile Associates,P.O.Box 33490,San Antonio, TX 78265 Brigid Alford,Esquire,Marshall,Dennehey,et al., 100 Corporate Center Drive,Suite 201 Camp Hill, PA 17011 Joseph D.Buckley,Esquire, 1237 Holly Pike Carlisle,PA 17013 REV-1511 EX+ (10-09) pennsylvania SCHEDULE H - DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Dianne E. Barrick 21-13-1198 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: $0.00 Name(s)of Personal Representative(s) Marilynn U. Willits Street Address 435 North Mountain Road Ci ty__Newville— ___...—__.__...._—... ---State_.._PA ZIP 17245__....-- 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: 100.00 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. Misc.additional costs 150.74 8. Filing fee 15.00 TOTAL(Also enter on Line 9, Recapitulation) $ 265.74 If more space is needed, use additional sheets of paper of the same size. - J sX+ . . - pennsytvania SCHEDULEJ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Dianne Barrick 21-13-1198 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 disVibutions and transfers under 1. Shirley Earnest,c/o Joseph D.Buckley,Attorney at Law,1 237 Holly Pike, Mother 100% rest, residue Carlisle,Pennsylvania, 17013 &remainder of Estate ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS 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 ONLINE 13 OF REV-1500 COVER SHEET, $ If more space is needed,use additional sheets of paper of the same size. � - `