HomeMy WebLinkAbout01-08-131505610105
REV-1500 ex"'-'z'f"'~
PA Department of Revenue Pennsylvania OFFICIAL USE ONLY
Bureau of lndividuaL Tazes ~ County Code Year FileN ber
PO BOX x80601 INHERITANCE TAX RETURN~1 I~ ~~~
Harrisbur0 PA 17128-06ot RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW '
Social Secunty Number Date of Death MMDDYYVV Date of Birth MMDDVYYY
105012012 08051930
Decedent's Last Name Sufix Decedent's First Name MI
Callen Matthew
(If Applicable) Enter Surviving Spouse's Information Below
Spouse s Last Name Suffix Spouse's Fvst Name.. MI
Spouses Socal Security Number
THIS RETURN MUST BE FILED tN DUPLICATE WITH THE
REGISTER OF WILLS
FILL INAPPROPRIATE OVALS BELOW
m 1. Original Return O 2. Supplemental Return
O 3. Remainder Return (date of death
O 4. Agriculture Exemption
(date of death after 7-1
2012
O 5. Future Interest Compromise (tlate of Prior to 12-13-82)
O 6. Federal Estate lax Return Required
-
) death after 12-72-82)
t~ 7. Decedent Died Testate
(Attach cop
of will
) O 8. Decedent Maintained a Living Trust 0 9. Total Number of Safe Deposit Boxes
y
. (Attach copy of trust.)
O 10. Litigation Proceeds Received O 11. No Taxable Asset Return O 12. Election [o Tax under Sec. 9113(A)
(Atach Schedule O.)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE ANDCONFlDENTIAL TAl( INF
Name ORMATION SHOULD BE DIRECTED TO:
Daytime Telephone Number
Shaun E. O'Toole (717) 69389 =s
C. ~.. ~ .~
Tn
REG~EI~F WILLS O$E ON
'D
~ U
First Llne of Address i
~ D r
.220 Pine Street _... _... _...
' t- i rn C r a h'
a ~ ,.a ~ 1 ~: J
Second Line of Address r.~ cy `i7 „ -~~
' ..
.. .
::], c-
~..
Qty or Post Office
_. i
-._ __ State ZIP Code ~ ~ z~ H... ;
'"iY ATE FILED F r.
~.
'. Harrisburg PA 17101 `~ -n
Correspondent's email address: SOtOOIe otoolelawoffice.com
Untler penalties of perjury, I declare I have examined this return, induding accompanying schedules and statements, antl to the best of my knowledge and belief, it
is true, correct and complete. Declaration of preparer other than the personal representative is basetl on all information of whi pre arer has any knowledge.
SIGNATURE OF PERSON RESPON. GFlR rail' iur wn.o..
7637 Bland Drive, Manassas, Virginia 20109 ~ r
SIGN E OF P~ARF3i,pR{bry THAN REPRESENTATIVE GATE
DRESS .r~, l ~ .rf~ ~Z/I I ~1Z
ZZO riY1G ~J~... ~~Ayaw~ rr+ ~'lI0\
PLEASE OSE ORIGINAL FORM ONLY
Side 1
L 1505610105 1505610105 J
"l.:'
J 1505610205
REV-1500 EX (FI)
Decedent's Social Security Number
oecadenrs Name: Matthew Callen, III 201-16-4946
RECAPITULATION
1. Real Estate (Schedule A) ........................................... 1 _
2. Stocks and Bonds (Schedule B) ..... ......... ........ 2 278,734 82
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. ' ',
4. Mortgages and Notes Receivable (Schedule D) ... _ .... _ . , .. q ', ',.
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. ' 30,448.19 '.
6. Jointly Owned Property (Schetlule F) m Separate Billing Requested .... ... 6. 151
335
00
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property ~" ,
.
---- ----
(Schedule G) O Separate Billing Requested..... ... 7.
8. Total Gross Assets (total Lines 1 through 7) ...... .... ....... .. 8 ~ 309,183.01
9. Funeral Expenses and Administrative Costs (Schedule H).... _ .......... ... 9. ', 37,196.56 ',
10. Debts of Decedent, Mortgage Liabilities and Liens (Schetlule I) ... ........ .. 10 28,618.32
11. Total Deductions (total Lines 9 and 10) .................... ........ .. t1 65,814.88
12. Net Value of Estate (Line 8 minus Line 11) ....... ................... .. 12 - -~~.- 243
368 13
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 lax (Line 12 minus Line 13) . ....... ....... ... 74. ~ 243,388.13
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116 ---- -- - ---- _...
(a)(i.2)X.o45 243,368.13 t5 10
951
56''
16. Amount of line 14 taxable .~~.~ ... __ ,.,_.._ _. ._.. _. ,
.
_. ...__
a[ lineal rate X .0 _
i6 ..
'..
17. Amount of Line 14 taxable .~.~~ - -.._. _. _. __. _ ___. _. ___.
at sibling rate X .72 17 '.
18. Amount of Line 14 taxable -'..__... .' . .......... ..___..._ ..
_..
at collateral rate X .15 18
ts. TAx DuE .. ......... 1s. _ 10,951.56 :
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L 1505610205 1505610205
G~
REV-7500 EX (FI) Page 3
Decedent's Complete Address:
Flle Number
DECEDENTS NAME
Matthew Callen, III
STREET ADDRESS
36 Lee Ann Court
clrv
EnOla STATE 21P
PA 17025
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) 10,951.56
2. CreditslPayments
A. Prior Payments __.___ _ . _____ 14,000.00
- - ---
B. Discount _ 736.82
3. Interest Total Credits (A+ g) (2) 14,736.82
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. (4)
3,785.26
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE 15)
Make check payable to REGISTER OF WILLS, AGENT
,.
- `.s ,,s1.°~s Milt iC(is, ~s+,~, iiFe4 ,x vi 4~s s'~'ss Ssl il6nav;ilia:; 6ssi j,}~. °>::'d3h~ ?. ~:;0.1 .; i ,
,. ,p: . .. .,,,. ..,tin..,.. „~:hs , .. {i., i
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
i. Dld decedent make a transfer and: Yes No
a. retain the use or income of the property transferred ................................................................................... ....... ^ ^
b. retain the right to designate who shall use the property transfened or its income ..................................... ....... ^
c. retain a reversionary interest ........................................................................................................................ ...... ^
d. receive the promise for life of either payments, benefts or care? ......................._ ........
2. If death occurred after Dec. 12, 1982, did decedent transfer property wtthin one year of death
without receiving adequate consideration? .............
3. Did decedent own an "in trust for" orpayable-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 bene0ciary 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
'. ,: ,,,,;; s ,. .n..ri':i '{{i s. ~.~~.1 ~;: i .,v~ n ', ,; ~;. I#1~Ip,; ;M{;,..' jd, ti. ,ltintl-l i.S, i a,.I,',h.,{:NSSrrvul a .i '~~i;14 ,dl, ., ,. ''! ~5; +1,,;4 u,`t°,,..`.'i'~pq zl IItsG,i i,(i~;t;,)i}
For dates of death on or after July 1,1994, and before Jan 1, 1995, the fax 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. i, 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 172 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 172 P.S. §9116(a)(1.3)]. Asibling is defined,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
ESTATE OF
Callen, III, Matthew
FILE NUMBER
21-12-0652
The Estate is seeking a refund of an overpayment. The Estate made a payment toward
the Inheritance Tax liability during the discount period in the amount of $14,000.00. At the time
of the payment, the Executor estimated the estate's tax liability on the assumption that the
Decedent was the sole owner of the real estate included on Schedule F of the Return. The
Executor subsequently learned that Decedent was not the sole owner of either property. Each
property was jointly owned with a joint owner as joint tenants with right of survivorship.
REV-~SO3 EX+ (8-13)
Pennsylvania
L7 ~EPgRTMENT OF FEVENUE
INRERRANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
Callen, III, Matthew
21-12-0659
. _ _- -_____~ ....,_.. ,.,.,,~.,,,~~o~ >~ icccu of me same sze
,Fide/it~r
July 19,2012
Mr. Kevin Callen, Executor
Estate of Matthew Callen III
7637 Bland Drive
Manassas, VA 20109-6246
Reference Number: W149753-17JUL12
Account Number: 618515381
Dear Mr. Callen
We have established the estate account on behalf of the late Matthew Callen III. Please
accept our condolences. The transfer and redemption are pending.
On the date of death, May 1, 2012, the account held $3,856.369 shares of our Fund # 258,
FA High Income Advantage -Class A; the price per share was $9.95 and the account
valuation was $38,370.87.
We are returning your legal documents; scanned copies remain on file. If you have questions,
please contact a Fidelity representative at 877-208-0098, Monday through Friday, between
8:30 a.m. and 7:00 p.m. Eastern time. Please provide the reference number above during
your call. You may also write to:
Regular Mail: Fidelity Investments Institutional Operations Company, Inc.
PO Box 770002
Cincinnati, OH 45277-0081
Overnight Mail: Fidelity Investments Institutional Operations Company, Inc.
100 Crosby Pazkway, KC1G
Covington, KY 41015
Sincerely,
Peter F. Ross
Fidelity Investments Institutional Operations Company, Inc.
Enc. Legal documents
431133.3.0
Fidelity Investments P.O. Box 770002
Institutional Operations Company, Inc. Cincinnati, OH 45277-0085
JOa Nuah Gan be Sum
Surtc 00
Yurk. PA l i'4111
ml 't' dS4 >559
Ltx 'i'S~397n1
ro9 free NUn 3aI 5235
August 10, 2012
Kevin T. Callen
7637 Bland Drive
Manassas VA 20109-6246
RE: Estate Matthew Callen
Dear Kevin:
MorganStantey
SmithBarney
Enclosed please find the information you requested to establish the value of the
Estate account for Matthew Calten lll. The prices are as of May 1, 2012 and you
may use these values for estate valuation purposes.
1. Date opened: 08!27/1990
2. Account Number: 916-896509-566
3. Registration: Matthew Callen
4. Date of Death Values: SEE ATTACHED WORKSHEET
If I can be of additional service to you, please call.
Sincerely,
~~'~)VV4~UZ>.Y
Kristie L. Snyder
Senior Client Services Associate to
Michael N. Washburn
Financial Advisor
Financial Planning Associate
Encl
This information antl data is being provided at your request and is from sources consitlered reliable, but their
accuracy and completeness is not guaranteed. It has been prepared for Illustrative purposes only and is not
intended to be used as a substitute for the transaction statements you receive from Morgan Stanley Smith
Barney LLC. Please compare the data on this document carefully with your transaction statements to verify its
accuracy. This information is based upon the market value of your account as of the close of business on
May 1, 2012, and is subject to daily market Auduation.
B7mp:u, ycn Jam. Sna C:: iinrsc LLC. Nrndsr JIYC
Estate of Matthew Callen III
Date of Death 05/01/2012
Account a 916-010288-566
Security quanti Date Acquired Date Sold Total Cost ($ Adjusted Cost $) Proceeds ($) G/L Amount ($) Hdding Period
American Cap Inc Builder A Position:4 G/L Amount: $182.64
Dividend Reinvestment
Dividend Reinvestment
Dividend Reinvestment
Sub Total 3.81
7.87
195.695
2.551
209.934 7 5/1/201
1 5/1/201
5/1/2012
5/1/2012 2 8/3/201
2 8/3/201
8/3/201
8/3/201 2 197.7
2 407.7
2 10,137.0
2 132.14
$10,874.58 2 197.72
2 407.72
0 10,137.00
132.14
$10,874.58 201.0
414.5
10,307.25
134.36
$11,057.22 4 3.3
7 6.85
170.25
2.22
$182.64 2 long
long
long
long
American Inc Fd O f America A Position:7 G/L Amount: $310.69
Dividend Reinvestment
Dividend Reinvestment 37.981
44.741 5/1/2012
5/1/2012 8/3/2012
8/3/2012 668.09
786.99 668.09
786.49 673.78
793.71 5.69
6.72 long
long
Dividend Reinvestment
Dividend Reinvestment 87.093
13.614 5/1/2012
5/1/2012 8/3/2012
8/3/2012 1,531.97
239.47 1,531.97
239.47 1,545.03
241.51 13.06
2.04 long
long
Dividend Reinvestment
Dividend Reinvestment
Sub Total 1,884.72
0.341
2.796
2,071.28 5/1/2012
5/1/2012
5/1/2012 8/3/2012
8/3/2012
8/3/2012 33,152.19
6
49.18
$36,433.89 33,152.19
6
49.18
$36,433.89 33,434.90
6.05
49.6
$36,74a.58 282.71
0.05
0.42
$310.69 long
long
long
Bristd Myers S quibb Co Positional G/L Amount: -$506.35
400 5/1/2012 8/3/2012 13,428.00 13,428.00 12,919.65 -508.35 long adj 2012-08-07
titigroup Inc New Positional G/L Amount: -$93.66
10 5/1/2012 8/3/2012 333.3 333.3 239.64 -93.66 long adj 2012-08-07
Covidfen Plc New Positlon:2 G/L Amount: -$59.92
37.405 5/1/2012 8/3/2012 2,071.86 2,071.86 2,026.12 -45.74 long adj 2012-08-08
Sub Total 11.595
49 5/1/2012 8/3/2012 642.25
$2,714.11 642.25
$2,714.11 628.07
$2,654.19 -14.18
($59.92) long adj 2012-08-07
Express Scripts Hidg Co Com Position:! G/L Amount: -$58.96
155 5/1/2012 8/3/2012 8,720.30 8,720.30 8,661.34 -58.96 long adj 2012-08-08
General Electric Co Positional G/L Amount: $47654
600 5/1/2012 8/3/2012 11,826.00 11,826.00 12,302.54 476.54 long adj 2012-OS-07
Genl Elec Cap 6 5/8 6.28-32 Positional G/L Amount: $207.32
800 5/1/2012 8/3/2012 20,832.00 20,832.00 21,039.32 207.32 long adj 2012-08-O1
Johnson & Johnson Positional G/L Amount: $499.20
200 5/1/2012 8/3/2012 13,016.00 13,016.00 13,515.20 499.2 long adj 2012-OS-08
Jpmorgan Chase & Co Posftian:2 G/L Amount: -$1,999.90
132 5/1/2012 8/3/2012 5,755.20 5,755.20 4,617.33 -1137.87 long adJ 2012-08-07
Sub Total 100
232 5/1/2012 8/3/2012 4,360.00
$10,115.20 4,360.00
$10,115.20 3,497.97
$8,115.30 -862.03
($1,999.90) long adj 2012-08-07
Lsi Corp Positions G/L Amount: •$13.39
4 5/1/2012 5/3/2012 32.44 32.44 19.05 -13.39 long adj 2012-08-07
Merck & Co Inc New Com Positional G/L Amount: $3,703.31
800 5/1/2012 8/3/2012 31,344.00 31,344.00 35,047.31 3,703.31 long adj 2012-08-07
Oracle Corp Positional G/L Amount: $37.13
200 5/1/2012 8/3/2012 5,908.00 5,908.00 5,945.13 37.13 long adj 2012-08-08
Pfizer Inc Positional G/L Amount: $253.31
300 5/1/2012 8/3/2012 6,831.00 6,831.00 7,084.31 253.31 long adj 2012-08-07
ub Total
37.405
11.595
49 Te Co
5/1/2012
5/1/2012 nnectivity L
8/3/2012
8/3/2012 td New Poskion:2 G/L Amount: -$291.76
1,369.77 1,369.77 1,147.05 -222.72 long adj 2012-OB-07
424.61 424.61 355.57 -69.04 Ion adj 2012-OS-07
$1,794.38 $1,794.38 $1,502.62 ($291.76)
Tyco International Ltd New Position:2 G/L Amount: -$ 117.35
11.595 5/1/2012 8/3/2012 651.29 651.29 623.52 -27.77 T ong adj 2012-08-07
Sub Total 37.405
49 5/1/2012 8/3/2012 2,101.04
$2,752.33 2,101.04
$2,752.33 2,011.46
$2,634.98 -89.58 T
($117.35) ong adj 2012-08-07
Western Asset Managed Muni A Position:9 G/L Amoum: $1,054.28
Dividend Reinvestment 1.166 5/1/2012 8/3/2012 19.64 19.64 19.96 0.32 long
,vidend Reinvestment 0.849 5/1/2012 8/3/2012 14.3 14.3 14.53 0.23 long
Dividend Reinvestment 18.974 5/1/2012 8/3/2012 319.52 319.52 324.83 5.31 long
Dividend Reinvestment 10.637 5/1/2012 5/3/2012 179.13 179.13 182.11 2.98 long
Dividend Reinvestment 0.822 5/1/2012 8/3/2012 13.84 13
84 14
07
1,440.72
5/1/2012
5/3/2012
24,261.71 .
24,261.71 .
24,665.11 0.23
403.4 long
long
787.402 5/1/2012 8/3/2012 13,259.85 13,259.55 13,480.32 220.47 long
Dividend Reinvestment 0.564 5/1/2012 8/3/2012 9
5
. 9.5 9.66 0.16 Ion
1,504.21 5/1/2012 8/3/2012 25,330.93 25,330.93 25,752.11 421.18 long
Sub Total 3,765.35 $63,408.42 $63,408.42 $64,462.70 $1,054.28
Long Term Total $240,363.95 $240,363.95 $243,945.08 $3,582.13
Grand Total $240,363.95 $240,363.95
$243,945.08
$3
581
13
Disclaimer ,
.
The gain and loss information is provided for informational purposes only, is not a substitute 1099 form (or any other appropriate tax form), and should not be
used for tax preparation. Unrealized gain and loss values are estimates and should be independently verified. We recommend that you contact your tax
advisor to determine the appropriate use of this information. Past performance does not guarantee future returns. Gain and loss information is calculated
based upon uniform standards and does not account for each individual client's particular circumstances such as the existence of hedging transactions or
constructive sales. Although we make every effort to adjust the cost basis for securities' capital changes, we do not adjust the cost basis for all events. Contact
your Financial Advisor for guidance on particular questions.FOraccounts-with Choice Select pricing, the commissions paid on your eligible equity and option
purchases and sales are applied to the Total Cost on a monthly basis. With respect to estimated gains and losses for listed equity options, we have taken into
account option premiums paid or received and, in respect to multiple purchases and/or sales, calculated cost using an average unit price for all like positions.
We are not responsible for any gain and loss information provided by you or another financial institution; you are responsible for ensuring the accuracy of such
information. Whether provided by you, another financial institution or MS58, it is your responsibility to ensure the accuracy of all of the Estimated Gain and
Loss informatlon.Forciients wishing to make versus purchase sales that Information needs to be conveyed at the time of the sale. Unless you tell us otherwise,
we use first in first out (FIFO) accounting.
A -Priced Assets calculation includes all assets excluding Cash, MMF & Deposits. This aggregate number is not duplicated in Total Account Value calculation.
REV-s5o8 EX+ (o8-iz)
~ Pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
aES oENr oECeoerRirTURN PERSONAL PROPERTY
ESTATE OF:
Callen, III, Matthew FILE NUMBER:
21-i2-0652
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
NUMBER nocroronnni VALUE AT DATE
1. Bank, P.O. Box 609, Pittsburgh
PA 15230; Account # 51-1378-1598
, 1,005.18
2. PNC Bank, P.O. Box 609, Pittsburgh, PA 15230; Account # 51-1269-0512
340.01
3, 2008 Chevrolet Impala
10,500.00
4. 2003 Buick Rendevous
3,500.00
5. Personal property -household items
15,103.00
'Automobiles and personal property valued at price items sold at estate auction.
_ TOTAL (Also enter on Line 5 Recapitulation) S 130 448.19
If more space is needed, use additional sheets of paper of the same size.
Account Statement
4" ` ' Fhimary account number: 61-137&1595
.. 4th ,
nu,.. For the Period 94106@012 to 95N412012
- Page t of 3
Numberof encloaurea: 0
fira# '...
.,
a~', '_ MATTHEW CALLEN III CI For241wur banking, antl lranaec6on ar
B
3 6 LEE ANN CT lnarea late Infarmetlon, sign on to
PNC Clank Dnliro Barking at pnc.com,
err ENOLA PA 17025-I949 'Q Forcustomer aeMCe call t-886-PNC-0AN(
b`~S;r, nwr#ay - Fdday: 7 AM -10 PM ET
~~ ,. ,
,n&::a:. 8aamay8 Sunday: 8 AM - 5 PM ET
ti~.j;: ~- ' Para serviUO en espano7, 7.866-NOtA-PNC
^~'~ I Moving? Please contact us at 1.868-PNGBANK
® Wrile to: Customer Serviw
PO9oz 609
Pitlstwryr PA 152349738
Vsit us et Pnc.com
® TDD terminal: l-BOOS37-1648
For hmNq gnoehed Claus artly
Enroll in online statements today through online banking, and have access to your checking and saving statements for up to 6 years. Enroll
today by visiting the (.ltstomer Service Tab in online banking.
Performance Checking MatBrew Callen to
Interest Checking Account Summary
Account numt»c 51-1378-1698
OvereraR Proactlon ProWded By: XXX%XXXXXX%X6738
To teem more, Nag us online a pnc.corNoverdreflsolullons
Balance Summary
Begmirq DeposBSeM Cheeks and eater EMmg
b9arCe aarxeddtlexre dedudbrm Iwlence
1,643.90 3,730.35 2,675.87 2,698.38
Austere manlhry Chpges
baberra acrd fees
1,483.98 to.Do
Transaction Summary
ClreGapalW Chatlr Card POS CherkCWHwkcad
v4tlrenwW riPnd aeMaetlarb PO6 PIN 199arlip5
12 0 0
TobI ATM PNC Beret phrBeret
aarnaatlaro A7M baaastlal6 ATM aanascrare
0 0 0
Interest Summary As of 05/04, a total of 5.11 in inrerea was
AreWlPeraNage Ntmbaafdey9 Avenge Wleded Inhragt Paid Pad Nia yeaf.
Ylea Earned tAPYE) In aIPoIMt Prdal baerKa krAPYE the Patod
O.OOa 29 1,398.47 .W
ncslrity Damon
Deposits etld ~ttlef AddkiOtla Tharo wan 3 Deposits and OtherAddiBOns
Oats Artwua l>escrptlern lataling {3,730$5
04/10 1,204.69 Deposit Reference No. 523495065
tlepocits ae# Otlrer Addrtlons cmtlnued on ne# page
Checking Account Statement
sign on to PNC Bank Dnllrte BaMcing
continued
For the period 01/08!2012 to OSI04/2072
MATTHEW CALLEN III
Primary account number. 61-1378.1598
Page 2 d 3
. nmuaK Desutpeon
$i
'.
,-
,
~~' 872,48 D
h eppslt Reference N0. 521486740
1,653.20 Direct Deposit - Xxsoc Sec
c „~„ US Treasury 303 XXXXX4946A
t
~~and Substitute Chacks
{
D~
Ra~tlKe
~
.t,lk Amount
wio run4ter
~30. 200
00 04/27 a `
cumber Dab RMwerce
AmgaN Paid number
.
.
s64stea2
s5a 20.00 OM09 Oneeo+3e 428'
427 173.00 04/17 Osses5e,15
-'-358 28.75 04/09 oe+eaaste
42.1 ` 294
30 04108 a
z
429' 285.15 04117 oewstsaz
83.77 04/17 oeae~a7B1
.
e3o
aers
422. 232.00 04/11 oesvtstf 430
431 70.00 04125 093e55962
424' 80.39 04!78 sz1s35tra
432 188.00 .04/17 oesatzt3
100
00 04!25
.
o73.7eez5
' Gap in check sequence
There were t2 checks listed k»aling
Si 751.38
Oniltle and Electronic Banking Deductions Th
ere were 5 Online or ~ectmnic Benkirg
Dale Amgey payer
Dernrctbns tofallrtg E974.51
04+06 250.00 Twh Auht Transfer To 5112690.512
ON12 50.00 Payment,E-Check Checkpaymt Hsbc Credo Svc2 423
0425 380.00 Payment,E-Check Check Pyml Chase 0433
ON26 233,00 PaymenLE-Chetlc Chedcpaymt PNC 435
0427 21.51 PaymenLE-Check Checkpaymt LovreslGemD 0438
Other Deductions
There was 1 other Oetlrntlon totaling
Deb Amount DeablpYori
sto.oo .
05/04 10.00 CalcWaled Service Charge Type DD
Daily t3alartce Detail
Dab Belerre Dab 8aleri~ peq
04/D6 1,099.80 04!11 2,025.54 04!18
04109 1
052
85
/ Belerue
1,167.23 Dab 881ance
04/27 1,055.18
,
.
04
12 1,975.54 04/25
04/10 2,257.54 04/17 1
247
62 1,509.69 05/03 2,708.38
,
.
0428 1,278.89 05/04 2,898.38
PERFORMANCE CHECKING -Service Charge Explanation
Agoura type Aocda41earlbef e/encebne Aad BBbIY.a
Interest Cheddng XX-XXXX•1598 This CyGe Avg Balance 05!05 1,464.30 T~~ ~O11nN'Ne'e rewovrod m meet
the balance requirements d your
PedormanCB Checkpp Account, Sirtca
balance rerptkemems were not mef this
monM, a $10.00 fee was deducted from
this account.
Account TYansaction Detail Report
Page 1 of I
https://www.cct.pncbank.comlesimsglsb/EaiMessageS ervlet?SOURCE-CHANNEL=LINK... 7/ 13/2012
t"N_'IMIN(iLR AUf.11i~N4GRS
SING 1936
.3557 FLMEkFON AYENIif
HARRISBURG, PA 17104
71765?-4111 roC~ertCdCNSAtIMi:kS r7r*
St?tClttt'F_!ft ~P1IC'f 1
Rdti,7e: 11
item DeSC n p[ron l"arm
._ - - - - - P nce CLY Total
41r' ~~HA a A5S1S' ~ ~-. - '
430
l:E1Gt'T~ l :D 14 :~
I :i:
431
kEIGHT) c i L~J9 '.; :21 :2v
448
t~AIER CO: OR 7 1 1_i~1 14 :21 :4i
441
RAKE ICE CHIPPER
fTC 1 1,00 14 :22 :1
~2 ,
4FEICE SUpPLlES ? i 1.U0 74 :22 :30
443
°ICiCTtF
' 3.fi0 14 :23 OA
444 P7CTL~tE 1 ^.'1J 74 :2 + :~
447 P>t.TURE ~ U'~ 14: 24 :1+
445 atiTl-iREEZE ~ ` ~ ~'i7 IQ= 2 :32
447 P0T11 ~3 SOIL ' - C'"~ 14 : 2t 52
a49 BOR LOT '.00 14. 25 :21
44'3 hgPS AND SUCH 1 •3 l~q 14'. 25 :01
450 W4O0EN EL[PHa'iT
t)OGG1E ~ 'TJ :4: 26 ;24
451 .
VARTCfliS UEPtS 4 qU ;": 25: 0`'
.152 S?EF' iAOOER '
~ `~UU 14: 29: 19
45,-f SHOE RACK
~ 1 9,r,-~. 14 3D; C'1
454 HEP,AL STAND I I.CU 1.: 30: 2]
45a HARDWrU2E 1 12-G4 14 31 ~, Of}
45b SU11CaSES 1 G.~.il 'a= 31: 21
457 .
BAG LOT j 1 1 C0 14: 31: 5.9
X59 M1?(ER 1 a 1 CO i~+: 32: 1'
459 PILE ~ %,i,0 14: 32: 45
460 CANE ~~ 1 2.UO 14: 33: 42
1 I ;1^ 14 34 14
1tem5 452 Artr..runt_ 29, 103.3"~
%amgM Ra[e Items Total Comns
- --
12.5000 145 S.UOO.U+)
575
00
15.QOUC 172 5.000.00 .
i50 0U
1 10.0000 139 S.lU3.U0 .
510 3~i
~- 5.oaor, 2 ,4.a~o.oa .
1co. a1;
451 29.103.00 1.585,30
REV-1509 E%+ (oi-iD)
' B Pennsylvania SCHEpULE F
D[PAHTMENT OE REVENUE
INHERiTAncE rAx RETURN JOINTLY-OWNED PROPERTY
RESIDENT DECEDENT
ESTATE OF:
Callen, III, Matthew FILE NUMBER:
21-12-0652
If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING ]DINT TENANT(S) NAME(S) ADDRESS RElATI0NSHIP TO DECEDENT
A• Doris Garland 36 Lee Ann Ct.
Enola, PA 17025 Friend
e' Chistopher P. Callen 124 Fifth Street Son
Hanover, Pennsylvania
C.
JOINTLY OWNED PROPERTY:
ITEM
NUMBER
1. LETTER
FOR JOIN
TENANT
A. DATE
T MADE
IOINT
05/15/02 DESCRIPTION OF PROPERTY
INCLUDE NAME OF FlNANCIAI INSTITlRION AND BANK ACCOUNT NUMBER OR SIMIUR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HElO REAL ESTATE.
Residence: 36 Lee Ann Ct., Enola, PA 17025; owned as'/tlr/s
1
DATE OF DFATR
VALUE OF ASSEr
177,200.00
DE E ENT'S
INTEREST
°
50 /0
DA p0 EDOFTN
DECEDENT51Nni0.E5T
88,600.00
2. B. 04/19/02 House: 124 Fiflh Street, Hanover, PA 17331; owned as j/Nrls 125,470.00 50%
62, 735.00
TOTAL (Also enter on Line 6 Recapitulation) I; 151,335.00
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ ;.LO-09)
~ . pennsylvania SCHEDULE H
oEaARrmaer or REVENUe FUNERAL EXPENSES AND
INHERRANCE TAx RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Callen, III, Matthew 21-12-0652
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
I' Malpezzi Funeral Home
9,102.77
z. Paxtang Cemetary -burial and headstone 4,704.00
3. Subway Cafe -funeral reception 1,907.00
a. Eric Sheafter - design of funaral cards 261.02
5. Staples - pdnting of photos and funeral cards 150.39
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
6,000.00
Name(s) of Personal Representative(s) Kevin Callen
Street Address 7637 Bland Drive
C;ry Manassas state VA zIP 20109
Year(s) Commission Paid: 2012
Z~ Attorney Fees: 7,947.50
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 [o Decedent
4. Probate Fees: 509.50
S. Accountant Fees:
S. Tax Return Preparer Fees:
~ PNC Bank -service charges
20.00
B. PPL - electricity at residence
269.45
s. Pennsylvania Amedcan Water - water at residence
34 79
to Duty's Locksmiths -change locks on residence
123.56
t ~ Callen/Kinback Goodyear - inspection of vehicle
37.90
t2. Fromaltached
6,128.68
TOTAL (Also enter on Line 9, Recapitulation) # 37,196.56
If more space is needed, use additional sheets of paper of the same size
Administration Exoeses
Callen/Kinback Goodyear -battery for vehicle
Staples -overnight deliveries (3 deliveries)
Fedex -overnight deliveries (2 deliveries)
Suntrust -banking fee -check printing
Suntrust - Fedwire -transfer funds fromk Fidelity
U.S. Postal Service -postage
Donegal Insurance -auto policy premium
U.S. Postal Service -stamps
Eric Sheaffer -labor -clean out house
Kevin Callen -reimbrse Executor for printer ink
Kevin Callen -reimbrse Executor for travel (4 trips)
Kevin Callen -reimburse for expenses preying for auction
Matthew Callen -reimbrse for travel/exp. To buy car battery
Ensminger Auctioneers - comm/exp sale of personalty
$ 100.7(
$ 98.23
S 51.15
$ 24.45
$ 15.00
$ 13.40
$ 301.00
$ 9.00
$ 625.00
$ 24.14
$ 598.85
$ 178.11
$ 196.65
$ 3,893.00
$ 6,128.68
REV-1512 EX+ it2-08)
'.,~F' Pennsylvania SCHEDULE I
°`°^RTrnE"T°`"`°E"°E DEBTS OF DECEDENT,
'""ERrr""`ET"xReT°R" MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Callen, III, Matthew 21-1-0652
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1' PNC Bank -credit card debt
9,105.36
2. Chase Bank -credit card debt 15,977.71
3. East Pennsboro Twp. -property taxes (paid before date of death, check cleared after DOD) 521.31
4. PNC Bank -line of credit -overdraft protection 394.63
5. Pennsylvania American Water Co. - final water bill 2 O 1
s. Crystal Spring Water
20.74
7. Shaun E. O'Toole, Esq. -legal fees -estate planning documents 650.00
8. Bon Ton -credit card debt 363.00
9. Butler Medical Transport -ambulance service 75.00
10. Stambough Tax Preparation -tax preparation for prior year 425.00
11. Butler Medical Transport -ambulance service 81 86
12. HCR Manor Care -Nursing home care 239.50
13. White Rose Ambulance Service -ambulance service 234.08
14. American Home Patient -wheel chair rental
28.42
15. Verizon -phone, cable, intemet 424.70
16. East Pennsboro Ambulance Service - ambulance service
75.00
TOTAL (Also enter on Line 10, Recapitulation) I; 28,618.32
If more space is needed, insert additional sheets of thesame size.
REV-1513 E%+ (D1-10)
}_ ~ ~~`pennsylvania SCHEDULE 7
DEPARTMENT OF REVENUE
INHERITANCE TA% RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF:
FILE NUMBER:
Callen, III, Matthew 21-12-0652
NUMBER NAME AND ADDRESS OF PERSON 5 RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
() Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (11).]
1, Michael Callen, 637 W. Philadelphia St., York, PA 17401 Son
2. Matthew Callen, 8526 Maple Grove Rd., Spring Grove, PA 17362 Son
3. Christopher Callen, 124 Fifth St., Hanover, PA 17331 Son
4. Kevin Callen, 7637 Bland Drive, Manassas, VA 20109 Son
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON L[NES IS 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:
1.
8. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
1/4
1/4
1/4
1 /4
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET IS
If more space is needed, use additional sheets of paper of the same size.
- 9 _ ~.~n' ~ ~ r
~` t + , ~ ,# t.v ,fit°A~,....:
~ `~, ~
~ q :.., n ~ i ",~'n hf,~r
fic
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MATTHEW CALLEN, III
---.,.
:a v
t ~~ ."~. v ., .. V
wa i
[, MATTHEW CALLEN, III, declare this to be my Last Will and Testament and hereby
revoke all prior wills and codicils made by me.
FIRST: At the time of the execution of this, my Last Will and Testament, I am a
widower. My wife, Etta I. Callen passed away in 1990 and 1 never remarried. [have four (4)
sons, Michael J. Callen, Matthew Callen, IV, Christopher P. Callen, and Kevin T. Callen. Any
reference in this Will to "my children" is a reference to these four sons.
SECOND: My Executor shall pay from the residue of my estate all my debts, funeral
and administration expenses and all estate, inheritance, succession and transfer taxes imposed by
the United States or any state, territory or possession which shall become payable by reason of
my death. It shall not be necessary to file any claims therefore, nor to have them allowed by any
court.
THIRD: I give and bequeath such of my tangible personal property as is set forth in a
separate, dated and unsigned Letter of Instruction, which I shall place with my Will, to the
persons therein designated. If [have not left a Letter of Instruction or for those articles of
property not distributed under this Letter of Instruction, t direct that such items be distributed to
m} children, in equal shares, all of my tangible personal property which I own and insurance
thereon, to be divided among them as they may select in as nearly equal shares as is practical. If
there is any disagreement as to distribution, [direct my Executor to make such distribution. The
decision of my Executor shall lie final and binding. Any items not selected may be sold or
distributed in the sole discretion of my Executor and if sold, the net proceeds therefrom shall be
added to the residue of my estate.
FOURTH: I give and devise the reside of my estate, real, personal and mixed, of
whatever kind and nature, and wherever situate at the time of my death, including any property
over which I now have or hereafter acquire a power of appointment, unto my issue, per stirpes,
provided that should any beneficiary have not yet attained the age oftwenty-five (22), his or her
share of the estate shall be distributed to the Trustee hereinafter named to be held and
administered, CN TRUST, for the benefit of said beneficiary pursuant to the terms of Item
FIFTH.
FIFTH: The Trustee shall administer the share of any beneficiary who has not yet
attained the age oftwenty-two (22), [N TRUST, for the benefit of said beneficiary, as set forth
herein:
A. Trustee shall accumulate the net income and expend and apply so much of the net
income, accumulated income, and principal of this trust as the Trustee, in its sole and
absolute discretion, deems advisable For the health, maintenance, support and education
(including vocational and college education, both undergraduate and graduate) of the
beneficiary, after taking into consideration the beneficiary's other readily available assets and
sources of income, or during illness or emergency. The Trustee may apply the net income,
accumulated income, and principal of this trust for the health, maintenance, support and
education of the beneficiary, should the beneficiary, by reason of age, illness, or any other
cause, in the opinion of the Trustee, be incapable of disbursing it.
B. When the beneficiary attains the age of twenty-two (22) years, the Trustee shall
distribute to the beneficiary all of the principal and accumulated income of the trust to the
beneficiary.
C. [n the event that any beneficiary shall predecease the complete termination of the
beneficiary's mist, the remaining principal and accumulated income of such beneficiary's
trust shall be distributed to such beneficiary's surviving issue, if any, in equal shares; or if
such beneficiary shall have nu issue then living, then to such beneficiary's siblings, per
stirpes, provided that if any such issue or siblings at such time have not attained the age of
twenty-two (22), his or her share shall be distributed to the Trustee hereinafter named to be
held and administered, [N TRUST, for the benefit of said issue or sibling pursuant to the
terms of this Item F[F'fH.
SINTH: [nominate, constitute and appoint my sun, KEVIN T. CALLEN, as the
Executor of this my Last Wiil and Testament, to serve without bond or security, and to make
distribution of my estate in cash or in kind, or partly in cash and partly in kind, and in such
manner as he may determine. f authorize, empower and direct my Executor to sell and convey,
by good and sufficient deed, in tee simple estate, any and all of my real estate, at public or
private sale, for such price or prices, upon such terms and conditions, as in his judgment is best
for my estate, and to that end to sign, seal, execute, acknowledge and deliver all deeds or other
instruments necessary therefore, as effectively as [could do if [were personally present.
[n the event my son, KEVIN T. CALLEN, does not survive me. or refuses to act as
Executor or does not complete the duties of Executor, then I nominate, constitute and appoint my
son, MICHAEL .I. CALLEN, as the alternate Executor, [o serve without bond or security. iVly
alternate Executor shall have all of the powers, privileges, duties and immunities granted to my
Executor as provided herein.
SEVENTH: [hereby nominate, constitute and appoint my sons, b[[CHAEL J.
CALLEN and iv[ATTHEW CALLEN, IV, as Co-Trustees of any Trust created herein, to
exercise all of the powers conferred upon trustees by law, and all of the discretionary powers
granted herein. The Co-Trustee and any successor trustee shall be entitled to compensation for
services from time to time during the period in which [hey are performed.
[f and in the event that either Co-Trustee refuses or is unable to act as Trustee,
predeceases me or dies before the termination of any trusts herein created, the other Co-Trustee
shall serve as the sole Trustee.
EIGHTH: My Trustee is authorized to invest, reinvest and keep the trust assets invested
in such real and personal estate as a prudent man of intelligence and discretion would do for
himself, for investment and not for speculation, giving due regard to the safety of the principal
and the adequacy of the income, without being limited to the so-called "legal investment" in [he
Commonwealth of Pennsylvania.
NINTH: No beneficiary shall have the power to anticipate, encumber or transfer his or
her interest in my estate or any trust created herein in any manner other than by the valid exercise
of a Power of Appointment. No part of my estate or any trust created herein, shall be liable for
or charged with any debts, contracts, liabilities or torts of a beneficiary or subject to seizure or
other process by any creditor of a beneficiary.
4
IN WITNESS WHEREOF, [, MATTHEW CALLEN, [II, the Testator, have to this
my Last Will and Testament, set my hand and seal this Z`-~ day of F~/~y ~0t2.
~-
~~
~.
~~~~
~t t ~ (SEAL)
iVIATTHE CALL ,
Signed, sealed, and published and declared by the above named Testator, as and for his
Last Will and Testament, in the presence of us, w!io have hereunto subscribed our names at his
request, as witnesses hereto, in the presence of the said Testator, and of each other. The
preceding document consists of this and four (4) other consecutively numbered typewritten
pages.
residing at `'
u ~~ L' ~j~esiding at /-I /J ~~OG ~ f ' /
-~
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA )
SS.:
COUNTY OF DAUPHIN )
[, MATTHEW CALLEN [II, the Testator whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I
signed and executed the instrument as my Last WiIL and that I signed it willingly and as my free
and voluntary act for the purposes therein expressed.
Sworn to or affirmed and acknowledged before me by MATTHEW CALLEN, 1[I, the
Testator, this ZS day of Feb.w..,~ ~O12.
- ~-, _
~,~ ;~-
~~ : ~,
IiI~ ,.,,`I ,,~,~ i~~~.~~
Testator
~.~.C" "" ~r~'~-_ (SEAL)
f--Notary Public or Attorney
AFF[DAVI'C
COMMONWEALTH OF PENNSYLVAN[A
SS.:
COUNTY OF Dr\UPH[N )~
~'"e. ~ and ~/ "~ ~ GhhL ~ G /`P~
,the
Witnesses who a name are si med to the attached or Foregoing instrument, being duly qualified
according to law, do depose and say that we were present and saw the "Cestator sign and execute
the instrument as his Last Will; that the "testator signed willingly and executed it as his Free and
voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and
sight of the "Cestator signed the will as a witness; and that to the best of our knowledge the
Testator was at the time 18 or more years oFage, of sound mind and under no constraint or undue
inFluence.
Swom to or aftitTrt d and acknowledged before me by ,and
SU L Gbii ~~?~jP ''7 ,witnesses, this zS daY f "'r 2012.
~V
' es //~
Wita ss
~8~h~-~ °~v~/`-'~Z, (SEAL)
Notary Public or Attorney
ATTORNEY AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA )
SS.:
COUNTY OF DAUPHIN ~
>'
On this, the ~~3~ day of ~~ ~ 2012, before me, the undersigned ofticer,
personally appeared Shaun E. O'Toole, kn n to me or satisfactorily proven to be a member of
the bar of the highest court oY' Pennsylvania, and, being fully aware of the criminal penalties
relating to unsworn falsification [o authorities, certified that he was personally present when the
foregoing acknowledgment and affidavit were signed by the Testatrix and witnesses.
[N WITNESS WHEREOF, [have hereunto set my hand and ofticial seal.
COQ I~AUNWEALTN U^ !'ERIN SYLVANIA
~'lOU1RIAL. .A!.
;7 ~ D4 L. Lr, J ; N•Itary Public
phin County
~ E spires August 9, 2012
l l-
~~,t6.1t~4~ !~ /Sri,-~ -SEAL)
'Votary Public