HomeMy WebLinkAbout10-10-13 (3) 15�5610143
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OFFICIAL USE ONLY
PA Department of Revenue pennsylvania cw,my crwe vea� Faa Numea
I 8ureau of IrWividuai Ta�s ^�^^'A"�
�o aaxs$oso� INHERITAMCE TAX R£TURN 21 13 0 901
Harrisburg,PA 17126-0601 RESIDENT DECEDENT ���
ENTE DECEDENT INFORMATION BELOW - �
Saciai rity.Number Date pf Death Date of Birth
07 18 20I3 04 19 1927
Dece nfs Last Name Suffx DecedenYs First Name M�
BLLL KATHERINE R
(If Ap Icable)EMer Surviving Spouse's Informatibn Belpw
Spou 's Last Name Suffuc Spouse's First Name MI
Spous 's Soctal Security Number
THIS RETURN MUST 8E FII.ED tN DUPUCATE WITH THE
REGISTER OF W1�.LS
Fl44 I APPROPRIATE OVALS BELOW �
� t. OriginaiReWm � 2. SupplementeiRefum � 3. �r�nder'�(Dsleof0ealh
� 4. Limited Estate . � 4a.Fu�ure Imarest Canpromlu 5. Federei Estete Tax Retum Requiretl
�anaaaeem.�iz-�zax) ❑
� g' {�C�`�W�y ❑ 7' t+��MYU1°i��nneew7e tivtnn Tn,at � a. Tote4 Ntenber of Safe Deposit Boxes
� � 9. LlHpadqn Proceeda ReCeNetl � 10.�P�������� � 11.Electlon m taz under Sec.8713(A)
� (Attach Schetlule O)
C DENT-TNtS SECTION MUST 8E COF��ETED.ALt,CpRRE&PONDENCE AND C#iF7DEN71At TAX�ORMA77Wi SIi0RN.4 BE DIRECTED T4:
Nam � Daytime Telephorre Numbsr
VREN E BOGAR 717 737 8761
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3B RENIl4NST0f�PN PA 1?011 �" �
pondenC's amall address: ��98r�bogarlaw.com
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� R DATE
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7 J hn M r Cou Mech k�bu PA 17058
W" RE 6F PREPARER OTHER THAN REpRESENTATNE pA�
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OR SS
#? e Weat Mafn Stree Shiremanstawn, PA 17011
Side 1
15D561U143 15�5610143 „�J
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�I
�, PA Inheritance Tax Return
� Signature of Additional Fiduciaries
EST TE OF FILE NUMBER
Ca pWll, KatheHne R. 21-13-0901
U er penaltles of pe�ury,I dedara that I have examined this rctum,induding accompenyfng acheduks and eWtements,snd to tlre beet of
m knoxdedge aiW belief,it fs true,corrod and complete.Dedaretlon ot preperer Wber than the personal reprasentatNe ia beaetl on all
in atfo�of which preparer has any knowledge.
Sig ature A2 ��y/ (6d�/1!
���.r
Ne e (iail C.Skeele
Ad ressl �zzoa t�.-�eor urivs
Ad �s2
C ,State.Zip wooabr�aa0.vn 2s�9s --
Dat
_ . _. . . _. _ . _ . . _. ._ _. _. _... _. . .
� 1505610243
I REV-1500 EX
' . . � DecedenYs Social Security Number
o�m,N�,»: Campbeil, Katherine R.
� RE APITULATION
1. Real Estate(Schedule A)....................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................. 2. �
3. Closely Held Corporetion,Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages&Notes Receivable(Schedule D)........................................................ 4.
� 5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 6� 8 90 .2 9
6. Jointly Owned Property(Schedule F) ❑ Separete Billing Requested............ 6.
7. Inter-Yrvos Transfers&Miscallaneous t�oq Probate Property
(Schedule G) U Saparete Billing Requested............ 7, , 311 , 921. 04
8. Total Gross Assets(toWl Lines 1 through 7)........................................................ 8. 318 ,�811 .33
9. Funeral�Expenses and Administretive Costs(SChedule H).................................... 9. 9, 6 64 . 8 9
10. Debts of Decedent,Mortgage LiabilRies and Liens(SChedule I)............................ 10.
11. Total Deductlons(total Lines 9 and 10)................................................................ 11. 9, 664 . 89
12. Net Value of Estate(Line 8 minus Line 11).......................................................... �p. 30 9,14 6. 44 �
�3. Charitable and Govemmental Bequests/Sac 9113 Trusts for which �
an eladion to tax has not been made(Schedule J)............................................... 13. � �
14. Net Value SubJect to Tax(Line 12 minus Line 13)............................................... 14. 30 9,14 6. 44
TA COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RA'fES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 �g 0 . 0 Q
(a)(12)X.00 . �
18. AmountofLinel4taxable 309� 146. 44 �s. 13� 911 .59
at lineal rete X .045
17. Amount of Line 14 taxable
at sibling ra�e X.12 0 . 00 17. 0 . 00
16. Amount of Line 14 taxable
at collaterel rate X.15 0 . 00 18. 0 . 00
79. TAXDUE................................................................................................................ 19. 13 , 911 . 59
20. PILL IN THE OVAL IF YOU ARE REOUESTING A REFUND OP AN OVERPAYMENT. �
Side 2
1505610243 15U5610243 �
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REV-1500 E Page 3 File Number 21-13-0901
Deceden 's Complete Address:
DECEDE S NAME .
Ca pbell, Katherine R.
STREETA DRESS �
Go den Living Center
46 rford Road
CITY STA'fE ZIP
Ca p Hill PA 17011
Tax Pay ents and Credits:
1. Tax Du (Page 2,Line 19) (1) 13,917.59
2. Credit ayments
A. Prio Payments 5,770.19
B. Dis unt 695.58
Total Credits(A +B) (2) 6,465.77
3. Interest (3)
4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4)
Cheek ox on Page 2,Line 20 to request a refund
5, If Line 1 +Line 3 is g2ater than Lina 2,enter the d'ifference. This is the TAX DUE. (5) 7��rJ.$2
Make Check Pa able to: REGISTER OF WILLS AGENT.
PL SE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: � Yes No
a. retain the uae or income of the property Vansferred:............................................................................... x
b. retain the right to designate wF�o shall use the property transferred or its income:..................................
c. retain a reversionary interest;or...................................�............................................................................ x
d. receive the promix for life of eRher payments�benefits or care?............................................................
2. If death occurted after Dec. 12, 1982, did decedent transfer proparty within one year of death vrithout
receiving adequate consideration?.................................................................................................................... ❑ �
3. Did decedent own an°in trust for' or payable upon deaN bank account or security at his�or her death7....... Q ❑
4. Did decedent own an individual retirement account annuity,or other non-probate property which
containsa ben�ciary designation7.................................................................................................................. ❑x ❑
IF THE WER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For datea o death on or aftar Juty 1,t894 and before Jan. t, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving
spouse is 3 percanl�72 P.S.§9176(a)(1.1)(i)1.
For dates o death on or afler January 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.§9 16(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 iling a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates o death on or after July t,2000:
• Tha tax ate imposed on the nat value of trensfars from a deceased child 21 years of age or younger at death to or for the use of a naturel parent,an
adoptiv paront,or a atepparent of the ehiM is 0 pereent[72 P.S.§9116(a)(12)]. �
. The tax te imposed on the net value of trensfers fo or for the use of the decedenPs lineal beneficiaries is 4.5 percent,except as noted in
[72 P.S.§9116(a)(1)].
. The tax te imposed on the net value of transfers to or for the use of the decedenPS siblings is 12 percent[72 P.S.§9116(a)(1.3)]. A
sibling i defined under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
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Rev-0508 E%+�1140)
SCHEDULE E
p nnsylvania CASH, BANK DEPOSITS, 8 MISC.
DE TMENTOFR�N�E �pERSONAL PROPERTY
INH RITANCETAXRETURN
RE IDENTDECEDENT
ESTATE F FILE NUMBER
Cam bell Katherine R. 21-13-0907
InrJWe the qocaetlaof litigatian antl Ne tlale the proceetle vrere receiveC bY the estele.
1111 prope�ty pintlyownW wIN Ns NpM M�uMVOnhip musl be dbclosatl on schadula F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Members 1at Federal Credit Union-Savings Account No.16443-00. Principal balance at date 3,029.19
of death E3,028.98;accrued interest$0.21.
2 Golden Living Centers-Refund 3.860.26
3 Highmark Blue Shield-Refund �•�
TOTAL(Also enter on Line 5, Recapitulatfon) 6,890.29
(H more apace is needed,atltlbonal pages of the seme aize)
Copyright( 2010 fortn sofivare oniy The Lackner Group, Inc. Fortn PA-7500 Schedule E(Rev.17-10)
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_ I S�
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i �
� II MEMBERS lst
I FIDERALCREDITUMON
I
RE ULAR SAVINGS ACCOUNT:
Acc unt Number/Suffix 168443-00
Dat Account Established 06/11/1997
Pri cipal Balance at Date of Death $3,028.98
Acc ued Interest to Date of Death $0.21
Tot I Principal and Accrued Interest $3,029.19
Na e of Joint Owner None
CH CKING ACCOUNT:
i�.cc unt NumberlSuffiz 168443-71
Dat Account Established O6111/1997
Pri cipal Balance at Date of Death $0.00
Acc ued Interest to Date of Death $0.00
Tot I Principal and Accrued Interest $0.00
Na e of Joint Owner None
VIS CREDIT CARD ACCOUNT
Ac unt Number 4672090000141911
Dat Account Established 07103/2009
Bal nce at Date of Death $0.00
Joi t Cardholder None
MEMBERS 15T FEDERAL CREDIT UNION
Tessa L KIuJ��(/
Lending Insurance Support Specialist
August 20, 2013
Es te of: KATHERINE R CAMPBELL
Da of Death: 07/18/2013
So ial Security Number: 203-18-3618
5000 L.o 'se Drive • P.O. Box 40 • Mechanicsburg,Pennsylvania 17055 • (800) 283-2328 • w�v�umemberslst.org
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Rsv�1510 E%�(p8-09)
, SCHEDULE G
�nnsylvania lNTER-VIVOS TRANSFERS AND
DE ARTMENTOPREVENUE MISC. NON-PROBATE PROPERTY
INH RRANCETAXRETURN .
RE IDENTDECEU�M
ESTATE F PILE NUMBER
Cam bell, Katherine R. 21-73-0901
- This achedule must be complele0 and fleE i(Ure answx W any of questions 1 Mrough 4 on pepe ihree of Me REV-1500 is yas.
ITEM ��p� DESC�qRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S �c�us�on TAXABLE
NUMBER TryE�DA�7E OF iRANSF�ERSATfACN A COPV OF THE DE�ED FOREREEN�.ESTATE. VALUE OF ASSET INTEftEST (IF MPIiCABLE) VALUE
1 Merrill Lynch-IRA Account No.872-77911. Gail C. 709.456.67 109,456.67
Skeele,Richard E.Campbell and Diane C. Noll are the
named beneficiaries of this account
2 Mertiil Lynch-Investment Account No.87234097. 202,464.37 202,464.37
Gail C.Skeele,Richard E.Campbell and Diane C.Noll
are the named ben�ciaries of this account.
TOTAL(Also enter on Line 7,Recapitulatlon) 3���92�•04
(If more space is neetled,aCAttional pa8es of the same sae)
Copyright( )2009 form soflware only The Lackner Group,Inc. Fortn PA-1500 Schedule G(Rev.0&09)
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REV-15t1 EX+{70-09) .
p�nnsylvania '�+NEDULE H
oe na��eroFR�NU� FUNERAL EXPENSE$ AND
INH RITANCETAXRETURN ADMINISTRATIYE GOSTS
RE IDENT DEGEDEM
ESTATE F FtLE NUMBER
� Cam bell, Katherine R. 21-13-0901
DecedenYs debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
A. FUNERAL EXpENSES: '
'
See corrtlnus#iart sshedule{s)a#tashed 2,2s7.82
B. ADMtNISSRATIVE COSTS:
1. ParsonalRepresentative'sCommissians . .
Name of Personal Represontative(s)
Street Addrese �
Ciry State Zm �
Vear(s)Commission Paid �
2. Attomev's Feas Bogar�}Iipp Law Offices 4.2d0.00
g. Family E�nption: (tf dscedtnPs address is not the same as ciaimaM's,attach e�lanat400}
. Claimant �
Street Address
City Stafe Zi0
Relationshio of Claimant to Decedent
4. Probate Feea
� B. AccoantanYs Fees
6. Tax Retum Preperer's Fees
7. Other Administrative Costs 3,167.d7
See continuation schedule(s)attached
TOTAL(Also enter on line 9,Reoapitulation) 9,664.88
Capyright{ )2049 frsnn software oniy The�adcner C�roup,ina Fam PA-1500 Schedule H{Rev. 10-09}
_ �
_ _ _ _
__ __ _ _
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
I continued
ESTATE F FILE NUMBER
Cam bell, Katherine R. 21-13-0901
ITEM
NUMBER DESCRIPTION AMOUNT
Funsral F�coenses
1 Giant-foodforwakeluncheon �Z�•�6
2 Hetrick-Bitnerfunerel Home 96.00
3 HeMck-Bitner Funerel Home-balance of bill 6.00
4 Rolling Green Cemetery-intertnent fees 1,650.00
5 T J Rockwells-Wake dinner 2�8��
H-A 2.297.82
Ofher Administrative Cosffi
6 Alizia RX 7.00
7 Country Meadows 977.26
8 Diamond Phartnacy 63.60
9 RESERVES:-Costs to conclude administrafion of Estate,including filing PA Inherltance Tax , 800.00
Retum and Inventory,preparatlon and flling of Fiduciary Income Tax Returns
10 West Shore EMS-ambulance fee for July 7,2013 984.62
11 West Shore EMS -ambulance fee for July 8,2013 767.53
12 West Shore EMS-ambulance fee for July 15,2013 167.06
H-B7 3,167.07
Copyright( )2002 form software only The Lackner Group,Inc. Fortn PA-1500 Schedule H(Rev.6-98)
.
_ _ .
REV45t7 EX� 7-00)
p nnsylvania SCHEDULE J
OE ARTMENTOPREVENUE
INH RRANCETAXRETURN - BENEFICIARIES
RE IDENTDECEDENT
ESTATE F FILE NUMBER
Cam bell, Katherine R. 27-13-0901
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE MOUNT OF ESTATE
NUMBE PERSON(Sl RECEIVING PROPERTY DECEDENT �o�g� �$$$�
- I TAXABLE DISTRIBUTIONS [include outright spousal
distnbut�ons,and trensfers
under Sec.9116 a 12
See attached schedule
Total
EMer dd r emoWb for dbhibutions shown�above on linas 15 Nrou h 18 on Rev 7 500 cover aheet as a r ' te.
NON-TAXABLE DIS7RIBUTIONS: -
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
OTAI OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE
Copyright( )2010 fortn sofhvare only The Lackner Group, Inc. Fortn PA-1500 Schedule J(Rev.01-10)
_ _ . _ _
_ _
I
!, SCHEDULE J
! BENEFICIARIES
' (Part I,Taxable Distributions)
I
,
ESTATE F:
Katheri e R.Campbell 07N8I2013 203-18-3618
Item ame and Address of Person(s) Share of Estate Amount of Estate
Number eceiving Property Relationship (Words) (SS$)
1 Richard E.Campbell Son One-third of rest,
7 John Mar Court residue and remainder
Mechanicaburg, PA 17055
2 Kelly N. Dert Granddaughter 1H2th of rest,residue
4 Betty Circle and remainder
Reedsvilie, PA 1T084
3 Diane C.Noll Daughter 1/12th of rest,residue
1273 Ridge Avenue and remainder
Columbia, PA 17513
4 Laura Noll Grenddaughter 7N2th of rest,residue
919 Spruce Street and remainder
Columbla, PA 17512
5 Gail C.Skeele Daughter One-Third of rest,
12205 Harbor Drive residue and remainder
Woodbridge,VA 22192
6 Krista N.Tischler Granddaughter 12th of rest,residue
339 Westview Drive and remainder
Hampton,VA 23666
1
r ti. I
I
LAST WILL AND TESTAMENT
o�
KATHE1tINE R. CAMPBELL
2, KATHERINE R. CAMPBELL, o£ Mechanicsburg, Cumberland
County, Pennsylvania, make, gublish and declare this as and far
my Last Will ancl Testament, hereby revoking a11 other Wills ancl
i Codicils heretofare made by me.
F=RST: I devise and bequeath all the rest, residue and
( �, remainder of my estate of whatever nature ancl wherever situate,
including any property over which I hold power of appointment and
�together with any insurance policias therean, as follows :
� (A) Four-"Pwelfths (4/12) thereof to my daughCer, GAIL
� C. SKEELE, provided, however, that shouZd she predecease me then
to her issue par stirpes 3�y representation.
� {B) Four-Twelfths (411.2) thereof to my son, RICHART� E.
� C�BELL, prova,ded, hawever, that should he preclecease me then to
his issue per stirpes by representatian.
t�? One-Twelfth {1t12) thereof ta my daughter, DIANE
C. NOLL, provided, hawever, that should she predecease me then to
�.. her issue per stirpes by representation.
(D) qne-Twelfth (1/12 ) thereof to my granddaughter,
�KRISTA N. TISCFiZ,ER, provided, that shauld she gredecease me then,
in equal shares to KELLY N. DERR, LAURA NOLL and DIANE C , NOLL.
{E) One-Twelfth (1112} thereof to my gran8daughter,
KELLY N. DERR, provicled, that shav.ld she prec3ecease me Chen, in
egual shares ta LAURA NOLL, KRISTA N. TSSCHLER and DSANE C. NQLL.
(F) One-Twelfth (1/12} thereof to my granddaughter,
LAURA NOLL, pravided, that should she predecease me then, in
equal shares to KRISTA N. fiISCHLER, KELLY N. DERR and DIANE C.
NOLL.
_ , __ _ __ _ _ _ __
I
I
I
i
SECOND: In addition to a11 powers granted to them by
law and by other provisions of this Will, I give the fiduciaries
acting hereunder the following powers, applicable to all proper-
ty, exercisable without court approval and effective until actual
distribution of all property:
(A) To sell at public or private sale, or to lease,
for any period of time, any real or personal property and to give
options for sales, exchanges or leases, for such prices and upon
such terms (including credit, with or without security) or
conditions as are deemed proper. This includes the power to give
.. legally sufficient instruments for transfer of the property and
to receive the proceeds of any disposition of it.
(B) To partition, subdivide, or improve real estate
and to -enter into agreements concerning the partition, subdivi-
sion, improvement, zoning or management of real estate and to
,. impose or extinguish restrictions on real estate.
(C) To compromise any claim or controversy and to
abandon any property which is of little or no value. _
(D) To invest in all forms of property, including
stocks, common trust funds and mortgage investment funds, without
restriction to investments authorized for Pennsylvania fiduci-
aries, as are deemed proper, without regard to any principle of
diversification, risk or productivity.
(E) To exercise any option, right or privilege granted
in insurance policies or in other investments.
(F) To exercise any election or privilege given by the
Federal and other tax laws, including, but not necessarily being
limited to, personal income, gift and estate or inheritance tax
laws .
(G) To make distributions to my herein named benefici-
aries in cash or in kind or partly in each.
2
__ _ _ _ _ _ _ __ _ _ _ _
I
(H) To borrow money from themselves or others in order
to pay debts, taxes, or estate or trust administration expenses,
to protect or improve any property held under my will, and for
investment purposes .
(I) To select a mode of payment under any qualified
retirement plan (pension plan, profit sharing plan, employee
stock ownership plan, or any other type of qualified plan) to the
extent the plan or the law permits them to do so, and to exercise
r- any other rights which they may have under the plan, in whatever
manner they consider advisable.
TBIRD: I direct that all inheritance, estate, trans-
r fer, succession and death taxes, of any kind whatsoever, which
may be payable by reason of my death, whether or not with respect
. to property passing under this Will, shall be paid out of the
principal of my residuary estate.
FOIIRTH: All interests hereunder, whether principal or
' income, which are undistributed and in the possession of the
fiduciaries acting hereunder, even though vested or distribut-
able, shall not be subject to attachinent, execution or sequestra-
tion for any debt, contract, obligation or liability of any
beneficiary, and furthermore, shall not be subject to pledge,
assignment, conveyance or anticipation.
FIFTH: I nominate and appoint my children, RICHARD E.
CAMPBELL and GAIL C. SKEELE, Co-Executors of this, my Last Will
and Testament . I direct that my Co-Executors and their succes-
sors, sha11 not be required to post security or a bond for the
performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal to this, my Last Will and Testament, thisi � �� day of
2008 .
.-jc,�n w�.,L� � ,, _ �
�/ � J
i1 rr�f �IY,%L�nY.� '1� ���rn w�/(SEAL)
KATHERINE R. CAMPBELL
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� _ _ , _ _ .
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Signed, sealed, published and declared by the above-
named Testatrix as and for her Last Wi11 and Testament in our
presence, who, at her request, in her presence and in the
presence of each other, have hereunto subscribed our names as
attesting witnesses.
Address �
/
Address
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