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HomeMy WebLinkAbout07-03-12 (3)..,...' 1505610140 REV-1500 EX ~°~-~°~ PA Department of Revenue Bureau of Individual Taxes OFFICIAL USE ONLY PO BOX 280601 INHERITANCE TAX RETURN County Code Year File Number Harrisbur PA 17128-0601 RESIDENT DECEDENT 2 1 1 2 0 5 8 8 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 2 0 6 5 4 9 1 6 6 0 4 1 9 2 0 1 2 0 7 2 6 1 9 6 3 Decedent's Last Name Suffix Decedent's First Name C A M B U R N MI S T E V E N R (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 FILL INAPPROPRIATE OVALS BELO REGISTER OF WILLS 0 W 1. Original Return ^ 2. Supplemental Return ^ 3 R i ^ 4. Limited Estate ^ . ema nder Return (date of death prior to 12-13-82) 4a F t ^ 6. Decedent Died Testate [~ . u ure Interest Compromise date of death after 12-12-82) ( ^ 5. Federal Estate Tax Return Required 7 D [] (Attach Copy of Wiil) 9. Litigation Proceeds Re i . ecedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) ce ved ^ 10. Spousal Poverty Credit (date of death ^ 11 • Election to tax under Sec between 12-31-91 and 1-1-95 9113(A) CORRESP~NOFUT _ Tuie crnr~........__ _ . ) (Attar_h crh n. Name • • •~~ ~~~ ~ wn mu,~ ~ t3E COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: B E N J A M I N Daytime Telephone Number J B U T L E R 7 1 7 3. 6 1~1 8 5 ~. N REGISTE LLS U3~lLY First line of address C~7 1""` ~ ~" 1 0 0 7 M U M M A R O A D v`~'°~'~ ~ Second line of address ~~ ~ : ` 'C ~ ~ S U I T E 1 0 1 ~ ~+ ~ , City or Post Office q w,+ State ZIP Code DATE FILED L E M D Y N E ----- P A 1 7 0 4 3 Correspondent's a-mail address: LAWYERS(a~BUTLERLAWFIRM COM Under penalties of onriurv i ae.,~.,~ .~_.. •_ aeannnea mis return, including accompanying schedules and statements, and to the best of my knowledge and belief, i is e, correct and complete. Declaration of preparer other than the personal representative is based on all information of w SIG~ATURE OF PERSON RESPONCiai c FOR _..__. hich r 1703 WY~DHAM RO SIGNATUR F oeora..~. 1007 MUMMA ROAD, FILING ._ REPRESENTATIVE C A ITE 101 LEMOYNE PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 p eparer has any knowledge. DATE ~~rr ~if -JA. / h LL PA 17011 ~~~ ~~~_ PA 17043 1505610140 J REV-1500 EX Decedent's Name: STEVEN R• C A M B U R N RECAPITULATION 1505610240 1. Real Estate (Schedule A) ................................. . ......... 1. 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, 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous N -Probate Property (Schedule G) ~] Separate Billing Requested ....... 7_ Decedent's Social Security Number 2 0 6 5 4 9 1 6 6 9 3 0 8. 4 7 8. Total Gross Assets (total Lines 1 through 7) ............. •••••••.•••••• 8. 9 3 0 8. 4 7 9. Funeral Expenses and Administrative Costs (Schedule H) ..... . ............ 9. 9 6 4 9. 8 6 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .... • , , , , 10 11. Total Deducttons (total Lines 9 and 10) ............................... 11. 9 6 4 9. 8 6 12. Net Value of Estate (Line 8 minus Line 11) ........ . 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 12 - 3 4 1 . 3 9 an election to tax has not been made (Schedule J) .... • • • , 13 14. Net Value Subject to Tax (Line 12 minus Line 13) . TA ............. X CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RAT ........14. _ 3 4 1. 3 9 15. ES Amount of Line 14 taxable at the spousal tax rate or , transfers under Sec. 9116 16. (a)(1.2)X.0 D . 0 Amount of Line 14 taxable 0 15. D . D 0 at lineal rate X .0 0 . 0 0 17. Amount of Line 14 taxable 16' 0 . D 0 at sibling rate X .12 0 . 0 0 18. Amount of Line 14 taxable 17• 0 . D 0 at collateral rate X .15 D D 0 18 D. o D 19. TAX DUE ..................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 150561024D 1505610240 0. D 0 ._ ._ ....... ,, ..,...a..u REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME 21 12 0588 STEVEN R. CAMBURN STREET ADDRESS 1703 Wyndham Road CITY Camp Hill STATE ZIP PA 17011 Tax Payments and Credits: 1~ Tax Due (Page 2, Line 19) 2. Credits/Payments (1) A. Prior Payments 0.00 B. Discount 3. Interest Total Credits (A + B) (2) 0.00 4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference, This is the TAX DUE. (4) 0.00 (5) 0.00 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROP 1. Did decedent make a transfer and: RIATE BLOCKS a. retain the use or income of the property transferred; ........................ . 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 December 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 securit 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, For dates of death on or after July 1, 1994, and before Jan. 3 percent [72 P.S. §9116 (a) (1.1) (i)]. Yes No a° ^ XQ ~ D 0 a YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse 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)j, 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)j. • 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(1.2) [72 P.S. §9116(a)(1)j. • 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)j. Asibling is defined, unde Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX+ t~ }_~ 0~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT rQTATr .,.~_ SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY STEVEN R. CAMBURN FILE NUMBER: InGude the proceeds of litigation and the date the proceeds were received by the estate, 0588 All property Jointly owned with right of survivorship must be discbsed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE ~ • Citizens Bank -Checking Account No. XXX7CXX8299 OF DEATH 9,208.47 2• 1996 Dodge Dakota 100.00 TOTAL (Also enter on Line 5, Recapitulation) S If more space is needed, insert additional sheets of paper of the same size __. _.. REV 1511 EX+ (10.08) Pennsylvania ~roF NN•ERITAtrCE TAX RETUF01 rt~srnEtrr oECEC3EwT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS DeoedenYs debd roust 4 neeoAed on Schedule L ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: 1 ~ Huff 8t Lakjer Funeral Home, Inc. 2• Funeral Reception 1 AMOUNT 4,332.54 216.04 B• ADMINISTRATIVE COSTS: 1. Pereonal Representative Commissions: Nmrie(s) of Persor-ai Reams) SireetAddresa City ~~ ZIP Year(s) Comrrrr Paid: 2. Atbrney Fees: Butler Law Firm 3. FamNy Exemptlon: (H deoederKs address a rrot the same as olaYrrenCs, attach explarmfion.) Cia6r~err? -Sonia F. Williamson street Address 1703 Wyndham Road ~ ~ Hill Site 1'A ZIP 17011 P ~ CMdrr~arN b Decedent Mother $. Probals Fees: g. Acoountard Fees: 6. Tax Retum Pry Fees: 7• Cumberland Law Journal -Estate Advertising 8• The Sentinel -Estate Advertising 9• Cumberland County Register of Wills -Filing Fees 1,200.00 3,5()0.00 85.50 75.00 210.78 30.00 TOTAL (Also enter on Line 9, Recapitulationl ~ S n move specs is needed, use addNiorral sheets ~ pier d pie scone same. REV-1513 EX+ (01-1b) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMBER: STEVEN R. CAMBURN 21 12 0588 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PEtRnS~ON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Ind Sec. 9116 (ap(1 2)I,distributions and transfers under 1. Insolvent Estate Lineal 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 DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. 15 If more space is needed, use additional sheets of paper of the same size. ~- .•.. _ _ ~~^ ~y ~,E' ~ ~ ~ ~ ~ ~ f ~ ~: ~r ~ Y y1 ^, k ~~ }. j~',` ,, CERTIFICATE OF TITLE FOR A VET ~~LE ~ ~ - ~ .1.. ~ ---~- -_----_-------- ------~__..:__ o ray ~ • ' 7 3 ,k,.~ 4x- _ ~. ~ I y' r II ww~ = ,~~. r r _:nT '.tR-r I ., , I _ I u `3 T ~ ~ I ~ --~ ~ ~~ ~ Z .. -.-. .._- ~ ~~ rx , ~ 4 ~- __ ,- - r ;; ., . - ~ ~ 4 - ~4-~ I ~ ~;~~ _ ~ __ C4T A • i AEU I rTE OF ISSUE ~ ~ ~ ~ ~~ '~ _. _ U^]LADEN WEIGHT ~ ®VWR ,. ~ ~,._ _ G ~ w . i .._ -_ __ '-J ~ n.. ~ i CfMEf t i x ~ N.F~'E ~ ~~~yV i 1 r -'EEC TI t1=~ F•~ (~ ! "±C 1'r(E ACTUAL MILE>GE: F« ' v ' .r 11E ACTUPt MLE GF_ M1 ~ ~~ -. ~' '41 a RINGVE.7 F ^ I 3r 7~ ~ C7{. ~,` Ex MPT :M L UM rl ~ j fir G _ I 9L E? J.NERtS~ ~ ~ J tZ I -_~ (ii > Y ~ 74 ~E B PNJS '~ (1 ~ i ? AN 7Jl' VE O,,E A ~I U[ t,LE _ r rll~^I t1 ~ gyp, rh ,1.~ ~t,.... Ir,,,• ~~ -` T ' f 7 `+- f1 C ~ - ~ ~ `l y ~ ? f - BLE VEHt Lc _ 77 r ~1 /'~ p {~ {` (y 7' I F - t'C:1N ftY ~ M ' b ! ~ ~ ~J ? •nZ t } h U .? T ITT T T ~? .. C _ ORI(~ L. Ff`p CA rlOrJ . Qf ZIB 'FOI t. H CU TL"R E P = S .NkS A POL l,F V. r.,. _ '~ = - _ ECONSTP,UC,T_D ; :3 i ~ = n~REET AGD ~ isY ~i ~ _ ~ = 9ECOVEREG TnEF~ VE ~! . E JEHIGLE COA AINE RE.S~~EC'. ~ ~~ - W - FLOOC VEHIC _ ~ .~ u Z- : Df'. OF'. _.. ,( 7 SANAS A TA% VF.C _ ['~ rA'JVR OF: ~ F_w f a If a secorLtl Ilenhoider s Ilsted upo of < a 1 ieo ,t e f,r~t • penholder must forward th s 7be, to . _:,. ,- H,_ ~meh ,he FIR LIEN RELC.' ~_~ ' `. appropriate farm and tee - I , DATE c I 2 EY SECOND LIEN REL =ASEU i AUTHORIZED RE~RESENTATI'1E ----"- -'-_-- +, CATS MAILING ADDRESS 0 ~ B - ___ ~ ~ ~ ~ ~ ~ A' N_ , rR -SENTA -`IVE C. +[~T ;y p~ ,t i~1I ~~ ~Y ,~ ~ 6~1 BR~At~ ST APT ~; != ~ LA~S~At.~ PA ~;°j~#46 z -- __ -_ ._ - - _ .E -:. ~ ~ ~~' ~ • ~~ K I. certify as of the' date of issue, the official records of the Pennsylvania Department ~4 ~ ~ ~ ~ ~ ~ C ~ ~ ~ ~ l ~",°a, ; • .• of Transportation reflect that the person(s) or cnmpar.y named herein is the lawful owner 37~ ' •• of the said vefiicle. °~ - - I - -~ '~ ~ Secretary of Transportation ~ .. ~ Y- ~L ~=_n AND sr~oav If a co-purchase other than you pose Is listed anc you wan' Y rite to rr, e ~~ ft- be listed as "Joint Tenanis WI h -1 g,t of Su[vi~.--rsh p (On dean of cne ~~:. ~~- j°~ mo cnv vEnn owner, title goes to surviving: owne ~ SHE tE NEFlE C Ot-;arwis he ttip 7 • will-beissued as "Tenants in CJr for i0 ,fe;. n` cre cwrer .,L ~1 of - s = ~ ~3 • deceased owner goes to hislhe F_Ir:, .:r e .ate __ „r~'~ - ~. AGMINISTERING OAiH - -~7-~7 `~`. ~ 1ST LIEN DATE --~ 'L FN C.sECK Ctl. ! "• 1ST LIENHOLDER If STREET I ___ _ ______ ~ '.,~ . CIT. G - S'4TE Zl_____._.- i 1 F)NAN~CIA~ INSTITUTION NUMBER r ~7~. 2ND Lit E^J DATE _.-~• - NQ EN ,. i ~ -M~~ 1e nd2 ttr .. i, dOF _-~ 1 rtt t -.e 1.~ the vel'icle ..escrtetl _.._- "_'_ kC-`y seo.e s:,t o~oinen¢gal cla ms set anrtnere. 2ND LIENHOLDER -. ~"°i .. r STREET .. __-_-~.__ j '" ~ ~ ~..~ PIICANT OG AIITHORiZrC Sr_NGa -_ _ _ __-__~__ ~~' -- clTV = -~-E ~I '"' -- - - - -- -- --- - ~ ~3 ~~~ ~ i., RE OF c -.. au^~~-T ~ nF A Za zeo s Gnerv FINANCI' fNST ThTION ^.L MBER F , `~ C i t i z e n s B a n k® Customer Receipt Please be sure to enter this transaction in your records. Transaction Date Amount Description Account Number J~E~U ~~?~C~I~u'~'U4 JVr1h Jb~6ti1~L' ~.;~1~'?i~ Funds from your deposit may not be available for immediate withdrawal. All transactions are subject to 2208x-BUNKER 8/06 1M/PK verification as outlined in the rules and regulations of the Bank. Member FDIC 1007 Mumma Road Suite 101 Lemoyne, PA 17043 Mailing Address: Post Office Box 1305 Camp Hill, PA 17001.1305 Rorudd D. Butler Jana Butler Taole June 29, 2012 Benjamin J. Butler Suzanne M. Butler Register of Wills Cumberland County Courthouse 1 Courthouse Square Room 102 Carlisle, PA 17013 Re: Estate of Steven R. Camburn 2012-00588 Tel: 717.236.1485 Fax: 717.236.7777 lawyers®buderlawfirm.com Dear Sir or Madam: I have enclosed two originals and one copy of a Pennsylvania Inheritance Tax return, one original and one copy of an Inventory and one original and one copy of a Status Report Under Rule 6.12 for the above referenced estate. Please time stamp the enclosed copies and return them to me in the enclosed self-addressed stamped envelope. I have also enclosed a check for $30.00 made payable to Register of Wills for filing fees. Your cooperation in this matter is appreciated. Very truly yours, Benjamin J. Butler BJB/mot Enclosure tr m ~ ~,? _ ~ Ci ~ ' T o~ ~ ~; ~~ © `~ L `~{ r `" ' 4 ~ <[ a ~` ~.j ~~~ r_. - - •,, _ ~ _~ ~~~ ,°, r~ ~' ~ ~ ..~ + ~ ~- ~ . . ~~ d _; ~ - rl Y z z ~. !_ U: d- ~, ~ - ._. •~ .,. ~„ c w ~ c ~: ~ r ~ ~~ .. ~, r ~ ~. ~ ~ C1 .~ ~~ ~: U +'