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Home My WebLink About01-13-09 (2)REV-1500 EX (06-05) 15!156041158 PA Depanment of Revenue OFFICIAL USE ONLY Bureau of Intliddual Tazas County Code Vear File Number Po Box zeoaot INHERITANCE TAX RETURN 21 ~ 9 ' \~ Harrisburg, PA 1 7 7 28-0601 RESIDENT DECEDENT UW ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 161-32-3292 01112008 Decedent's Last Name Suffix Decetlent's First Name M I CAMPBELL, SR• RICHARD (If Applicable) Enter Surviving Spouse's Information Below L 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. Remaintler Return (date of death ^ prior to 12 13 82 4. Limitetl Estate 4a. Future Interest Compromise (date of - ) ^ 5 ^ 6. Decedent Died Testate ^ 7 tleath after 12-12-62) Dec d . Fetleral Estate Tax Return Requiretl (Attach Copy of Will) . e ent Maintained a LiNn Trust (Attach Copy of Trust) 9 - 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death ^ 11 CORRESPONDENT - THIS SECTION MUST BE between 12-31-91 and 1-1-95) . Election to tax under Sec. 9113(A) (Attach SG7. O) Name COMPLETED. ALL CORRESPONDENCE AND CONFID ENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: PETER J. RESSLER, ESQUIRE Daytime Telephone Number Firm Name (If Applicable) METTE, EVANS & WOODSIDE 717-232-500 REGISTER OF N7LLS USE ONLY First line of address 3401 N• FRONT STREET `~--'~ N Second line of address `-r ~~ ~ ~ 1-' ~? PO BOX 5950 ''~ -C J „ City or Post Office n S i W ~~ ` ~ HARRISBURG .;' ~~l State ZIP Code DATE pl.; b' ~ - ` ~ PA 17110-0950 , ~ m toa Correspondent'se-mail address: PJRESSLERaMETTE•C OM v. Under penegias of perjury, 1 tleclare roar 1 have examined this return, includin it is true, correct and complete. Declaration of praparer other than the personal re g accompanying schedules and statements, and to the best of my knowledge and beli f SIGNATURE OF PERSON RESPONSIBLE FOR FILING R resentative is based on all information of which praparer has any knowledge. e , ETURN RICHARD L• CAMPBELL, JR• DnrE ADDRESS ~~ S'-J S' slkiNATURE OF PREPARER OTHER THAN REPRESENTATIVE ` ` "' ~ v I I l 1 I T , I'I ll 21(14 2 PETER J• RESSLER ESQUIRE ~~~~ ~ DATE ADDRESS ~~ ~ _~..~c( -~w ~ ~y, d y 3401 N• FRONT STREET, PO BOX 5950 HARRISBURG, PA 17110-09590 PLEASE USE ORIGINAL FORM ONLY Side 1 ' 15056041158 P BM486]3.000 15056041158 J „~\1~ \V ~~ ,\\ _,~ ~~.~ J 15056042159 REV-1500 EX Decedent's Social Security Number Decedent's Name. 161- 3 2- 3 2 9 2 RECAPITULATION 1. Real estate (Schedule A) ... . .... ..... ... ...1. 2. Stocks and Bonds (Schedule B) ...... Q • Q Q ........... 2, 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3 o.oo , Q•QQ 4. Mortgages R Notes Receivable (Schedule D). , ... .......4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .. 5, Q•QQ 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested 6 8330.22 .. , 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property Q . Q Q (Schedule G) ~ Separate Billing Requested ... 7, 6. Total Gross Assets (total Lines 1-7).. Q • QQ 9 . Funeral Expenses & Atlministrative Costs (Schedule H). . . . ~- . " " ' 9' 8120.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . 10 , 6aoao.oo 11. Total Deductions (total Lines 9 & 10) .... 12. . ~~ Net Value of Estate (Line 8 minus Line 11) ~-•••.. .11. 68120.00 13. .... Charitable and Governmental Bequests/Sec 9113 Trusts for which . 12 -59789.7$ an election to tax has not been made (Schedule J) ... 4. .. . Net Value SubJect to Tax (Line 12 minus Line 13) ... 13. 0.00 ...... TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE . RATES 1a. - 97 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0~ 16. Amount of Line 14 taxable Q . Q Q 15. Q . QQ at lineal rate X .045 17. Amount of Line 14 taxable Q ~ QQ 16. Q • QQ at sibling rate X .12 16. Amount of Line 14 taxable Q ~ Q Q 17. Q . Q Q at collateral rate X .15 Q•QQ 18. Q. QQ 19. TAX DUE .. .. . ..... .. Q. QQ 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505642159 BM4848 2.000 15056042159 REV-1500 EX Page 3 t ax rayments and Credits: 1. Tax Due (Page 2 Line 19) 2. Cretlits/Payments A. Spousal Poverty Credit ~ ~ p B. Prior Payments ~ O O C. Discount ~ • O0 3. InteresVPenalty if applicable D. Interest ^ ~~ E. Penalty Q QO (1) ~. ~0 TotalCretlits (A+g+C) (z) 0 00 Total lnterasVPanaky (D+E) (6) O Oa 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fili in box on Page 2, Line 20 to request a refund. (4) ~ • 0 ~ 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) 0.0 0 B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (se) 0.0 0 Make Check Payable to: REGISTEROFWILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferretl; Yes No b. retain the right to tlesignate who shall use the ro ~ ~ ~ ~ ~ ~ ~ ~ ^ ^ p party transferred or its income; ... ^ c. retain a reversionary interest; or ........ ~ ~ ~ ~ ~ x tl. receive the promise for life of either payments, benefits or care? ............. ^ 2. If death occurred after December 12, 1982, tlid 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? . X 4. Did decedent own an Intlivitlual 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 O AND FILE IT AS PART OF THE RETURN, For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposetl on the net value of transfers to or for the use of the surviving spouse is three (3) percent [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 zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute tloe nol x mot 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 tleceased child twenty-one years of age or younger at death to or for use of a natural parent. an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. the taz rate imposed on the net value of transfers to or for the use of the tlecedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9175(1.2) [72 P.S. §9116(a)(1)]. ~ntleraSe [ioln ~02aas anentlivitlaalwhorhasf at leastronetparent io common weth the dle edent, whethe?by bloodta?atloptio §9116(a)(1.3)]. A sibling is tlefinetl, smae~t i.coo REV-1508 E%+(G99) COMMONWEALTH OF PENNSYLVANIA SCHEDULE E INHERITANCE TAX RETURN CASH, BANK DEPOSITS, & MISC. RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF Richard L. Cam ell Sr. FILE NUMBER Include the proceeds of litigation and the date the proceeds vero receivetl by the estate. 21 D9 All property joindyawned with the right of aurvlvorohlp must be tliaclocetl on Schedule F. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1 Commerce Bank Checking Account #0512085820. Decedent's spouse, Linda J. Campbell, predeceased her husband. (Balance as o£ 9/19/08) 4,305.22 2 2004 Pontiac Bonneville - approximately 60,000 miles in poor conrii tion 4,025.00 - '-•^- ^ ~.. ~~~ ~~ on une o nets I[ula[ion $ 8, 330.22 awasgo t.ooo (It more apace is needed, insen eddRional sheets of the same size) I REV-1511 E%~(1606) I ESTATE SCHEDULE H OF PENNSYLVANIA FUNERAL EXPENSES Hr ~TAx RETURN ADMINISTRATIVE COSTS DECEDENT ~ h =. 1 S FILE NUMBER 2 Debts of decetlent must be reported on Schedule I. 17EM IMBER DESCRIPTION A. FUNERAL EXPENSES: AMOUNT ~, Myers-Harner Funeral Home 4,600.00 2 Funeral Dinner (Theo's) 2,500.00 6. ADMINISTRATIVE COSTS: t~ Personal Representative's Commissions Name of Personal Representative(s) Street Address Ciry State Zip Year(s) Commission Paid: Z~ Attorney Fees 1,000.00 3. Family Exemption: (If decedent's atldress is not the same as claimant's, attach elralanation) Claimant Street Adtlress Ciry State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees S. Tax Return Preparer's Fees 7. 1 Register of Wills - Filing Fee 20.00 i w rar. Iv.iso enter on line 9, R. wasnc 1.000 (If more space is needed, insert atlditional sheets of the same size) REV-1512 EX x(12-03) SCHEDULEI PENNSYLVANIA DEBTS OF DECEDENT, X RETURN :EDENf MORTGAGE LIABILITIES, & L Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE 1. OF DEATH Richard L. Campbell, Jr. - 2007 Rent 15,000.00 2 Richard L. Campbell, Jr. - Credit cards S I+fisc. Debts. 45,000.00 ~~..~ rvso enter on nne 70, Reca itulation) $ 60 000. 0 WABAH 2.000 (If more space is needed, insert additional sheets of the same size) Commerce Ban/~ 0104021NViN0000C020 LINDA J CAMPBELL RICHARD L CAMPBELL 10 ACCENT CIRCLE CAMP HILL, PA 17011 Commerce Bank/Harrisburg N.A. P.O BOX 4999 Harrisburg, Pennsylvania 77111-0999 1-888-937-0004 We're here 7 days a week, 24 hours a day at 1-888-937-0004, 50 PLUS CHECKING 0512085820 Statement Balanceas of 08/20/08 <Plus 1 Deposits and Other Cretlrts $4,304.69 Less 0 Checks and Other Debits $0.53 Statement Balance as of 09/19/08 $0.00 $4,305.22 Transactions By pate Date Description 09/19/08.INTEREST PAYMENT `. Debit Credit Balance $0.53' $4,305.22.:,: Interest Summary Beginning Interest Rate Number of Days in this Statement: Perio Interest Earned this Statement Period Annual Percentage Yield Earnetl this St; Interest Pa1tl Year toDate 0116 Cycle 0.15% SO ant Perod (APY) $0.53 0.15^I° $4:77 NOTE: SEE REVERSE SIDE FOR IMPORTAN7INFORMATION Page t of 1 Member FDIC 2004 Pontiac Bonneville -Trade In Value, blue book value -Official Kelley Blue Book 5... 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