HomeMy WebLinkAbout08-06-14 � REV-1500 �``°'�'°' 1505610143
� OFFICIAL USE ONLY
PA Department of Revenue pennsylvania coumy coda Year File Number
Bureau of Individual Taxes DEPARTMENTOFREVENUE
Po sox.2soso� INHERITANCE TAX RETURN 2 1 13 0 0 8 7 5
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
07 26 2013 O1 31 1932
DecedenYs Last Name Suffix DecedenYs First Name MI
CAMPBELL JOHN L
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
CAMPBELL CHRISTABELLL M
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1. Original Retum ❑ 2. Supplemental Retum � 3.Remainder Retum(date of death
priorto 12-13-82)
� 4. Limited Estate � 4a.Fucure interest Compromise � 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
� 6 Decedent Died Teslate ❑ �• qC�h Co��of Trust a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy M Will) � pY �
� 9. Litigation Proceeds Received � 10.��e�P2���Ca d�il'(d;1�e5,f death � ��.Election to tax under Sec.9113(A)
(Attach Sch.O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
SAMUEL L ANDFSS 717 761 5361
REGISTER OF WILLS US�Y3NLY
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First line of address �-� �—�- � . ,r�>
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525 NORTH 12TH STREET � , i -;
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cn ,.} � �
Second line of address cJ�-;;,- , .� �; ., �:;
£�"j C;` . , �. -r
DA�E.#�LED '"�� �
City or Post Office State ZIP Code � � ` �7
LEMOYNE PA 17043 �
Correspondent's e-mail address: �a W a n d@ S(�1 O 1.C O f17
Under penalties of perjury,I declare that I have examined this retum,including accompanyi,ng schedules and statements,and to the best of my knowledge and belief,
it is we,correct and complete.Declaration of preparer other than the personal representatrve is based on all information of which preparer has any knowledge.
SIGNATU OF PERSON RES NSIBLE FIIING RETU DATE
� , ' tabelle M. Campbell
ADDRESS
1067 Oyster Mill Road, Camp Hill, PA 17011
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
Samuel L Andes
ADDRESS
525 North 12th Street, Lemoyne, PA 17043
Side 1
� 1505610143 1505610143 � ' `�
' � 1505610243
REV-1500 EX
DecedenYs Social Security Number
DecedenYs Name: C A M P B E L L� J O H N L.
RECAPITULATION
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&Notes Receivable(Schedule D).......................................................... 4.
5• Cash,Bank Deposits 8 Miscellaneous Personai Property(Schedule E)................ 5. 1 6 , 7 4 0 . 0 1
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6. 1 , 8 3 7 . 0 7
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
(Schedule G) � Separate Biiling Requested............. 7.
8. Totai Gross Assets(total Lines 1-7)....................................................................... 8. 1 8 . 5 7 7 . 0 8
9. Funeral Expenses&Administrative Costs(Schedule H)......................................... 9. 2 . 9 0 6 . 1 8
10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule I)................................ 10. 1 , 5 7 5 . 0 6
11. Total Deductions(total Lines 9&10)...................................................................... 11. 4 , 4 8 1 . 2 4
12. Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 1 4 , 0 9 5 . 8 4
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J)................................................. �3, 1 4 , 0 9 5 . 8 4
14. Net Value Subject to Tax(Line 12 minus Line 13)................................................. 14. 0 . 0 0
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 ta�ble
at the spousal tax rate,or
transfers under Sec.9116
(a)(�.2)x.o0 14 , 0 9 5 . 8 4 15. O . 0 0
16. Amount of Line 14 taxable
at lineal rate X .045 16•
17. Amount of Line 14 taxable
at sibling rate X .�2 ��•
18. Amount of Line 14 ta�ble
at collateral rate X .15 �$•
19. Tax Due..................................................................................................................... 19. 0 . 0 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑
Side 2
� 1505610243 1505610243 J
� REV-1500 EX Page 3 File Number 21 - 13 - 00875
Decedent's Complete Address:
E EDENT'S NAME
Campbell, John L.
STREET ADDRESS
13 Randi Road
CITY STATE ZIP
Enola PA 17025
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0.0 0
2. Credits/Payments
A• Prior Payments
B. Discount
Total Credits(A +B) (2) 0.00
3. Interest (3) 0.00
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4)
Check box 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. �5) �.0�
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:.................................................................................. ❑ x�
b. retain the right to designate who shall use the property transferced or its income:.................................... � x�
c. retain a reversionary interest;or.................................................................................................................. ❑ x❑
d. receive the promise for life of either payments,benefits or care?.............................................................. � x❑
2. If death occurred after December 12, 1982,did decedent transfer property within one year of death without
receiving adequate consideration?....................................................................................................................... ❑ X❑
3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?......... � x0
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 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.§9116(a)(1.1)(u)]. 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 retum 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 decedenPs lineal beneficiaries is 4.5 percent,except as noted in
72 P.S.§9116 1.2)[72 P.S.§9116(a)(1)�.
•The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S.§9116(a)(1.3)1. A
sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,wfiether by blood or adoption.
SCHEDULE E
CASH, BANK DEPOSITS, 8� MISC.
COMMONWEALTMOFPENNSYLVANIA PERSONAL PROPERTY
NJHERRANCE TAX RETURN
RESIDENT OECEDENT
FILE NUMBER
ESTATE OF Campbell, John L. 21 - 13-00875
Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointly-owned with the right of
. survivorship must be disclosed on schedule F.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
8 Miscellaneous items of clothing, personal ornament, and other personal effects 300.00
9 Sovereign Bank Money Market Account No. 924089520 10,020.01
10 1998 Ford Explorer(in poor condition and need of repairs) 6,000.00
11 Health insurance refund from Capital Blue Cross 420.00
TOTAL(Also enter on Line 5, Recapitulation) 16,740.01
SCHEDULEF
COMMONWEALTHOFPENNSYLVANIA �OINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Cam bell, John L. FILE NUMBER
P 21 - 13-00875
If an asset was made joint within one year of the decedenYs date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
Christabelle M. Campbell 1067 Oyster Mill Road Wife
q Camp Hill, PA 17011
JOINTLY OWNED PROPERTY:
LETTER DATE C�F�SCRIPT.IO�C�F PROd'ERT�Y %OF DATE OF DEATH
ITEM FOR JOINT MADE �nclude name o mancial ins i u ion an ban account numbe OATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT or similar identifying number.Attach deed for jointly-held real VALUE OF ASSET INTEREST DECEDENTS INTEREST
estate.
A 2009 Account No. 921718659 at Santander Bank 3,674.13 50% 1,837.07
TOTAL(Also enter on line 6, Recapitulation) 1,837.07
St�EDU�H
F1INERAL D�ES 8�
COMMONWEALTH OF PENNSYLVANIA �w w/�
INHERRANGE TAX RETURN �'N�RMTIYL��
RESIDENT DEGEDENT
FILE NUMBER
ESTATE OF Campbell, John L. 21 - 13-00875
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1
B. ADMINISTRATIVE COSTS:
�. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s)Commission paid
2. attorney's Fees Samuel L.Andes 2,500.00
3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of W ills 158.50
Register of Wills 15.00
5. AccountanYs Fees
6. Tax Retum Preparer's Fees
7. Other Administrative Costs
8 Cumberland Law Journal (advertising) 75.00
TOTAL(Also enter on line 9, Recapitulation) 2,906.18
Sdied�l�H
F�neral E�er�ses 8�
COMMONWEALTH OF PENNSYLVANIA ��M w , �
INHERITANCE TAX RETURN u c��v�tA6LS
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Campbell, John L. 21 - 13-00875
9 The Sentinel (advertising) 157.68
10
Page 2 of Schedule H
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
COMMONWEALTHOFPENNSVLVANIA LIABILITIES, & LIENS
INHERRANCETAXRETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Campbell, John L. 21 - 13-00875
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM DESCRIPTION AMOUNT
NUMBER
8 PPSL Electric 8�7•49
9 East Pennsboro Township(sewer and trash) 138.00
10 Sovereign Bank(Visa bill) 269.57
11 Schultz Landscaping 290.00
TOTAL(Also enter on Line 10, Recapitulation) 1,575.06
� REV-1513 EX*(11-08)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN �
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Campbell, John L. 21 - 13-00875
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY DoNotustTrustee(s)
I. TAXABLE DISTRIBUTIONS[include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
1 Christabelle M. Campbell Spouse residue
1067 Oyster Mill Road
Camp Hill, PA 17011
2
Enter dollar amounts for distributions shown above on lines 15 through 18 on 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 All assets listed above left to decedenYs spouse, Christabelle M. Campbell 14,095.84
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTR►BUTIONS ON LINE 13 OF REV-1500 COVER SHEET 14,095.84
SAMUEL L. ANDES
ATTORNEY AT LAW
525 NORTH TWELF'TH STREET
P.O. BOX 168
LEMOYNE,PENNSYLVANIA 17043
MAILING ADDRESS: TELEPHONE
r.o.sox i6s �n��6i-s�i
LEMOYNE,PA 17043-0168
FAX
E-MAIL:LawAndes�aol.com (71�761-1435
31 July 2014 � '
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Pennsylvania Department of Revenue ��'�`� °' ;`� �
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Harrisburg, PA • -�-� ., r- rr
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RE: Estate of John L. Campbell �
Cumberland County No. 21-13-00875
Ladies & Gentlemen:
I represent Christabelle M. Campbell, the widow of John L. Campbell, a resident of
Cumberland county who died on 26 July 2013. His Will named his wife and his daughter by a
prior marriage, Tammy A. Powers, his personal representatives and the court subsequently
appointed the two of them as Co-Executrixes of the Estate.
I have worked with Christabelle Campbell to collect information about the assets and
expenses of the Estate so I could prepare an file an inheritance tax return. Unfortunately, Tammy
Powers, who resides in Maple Valley, Washington has not cooperated. She has failed to
provide the information that Ms. Campbell and I have requested and failed to respond to any of
my efforts to obtain this information from her.
I had prepared a Pennsylvania inheritance tax return for Christabelle Campbell listing the
assets that have passed to her as a result of her husband's death. We believe there may be other
assets that passed to Tammy Powers,but we have no information about those assets because Ms.
Powers has refused to cooperate. Under the circumstances, I concluded it was better to file this
return, to report the assets that came to Christabelle Campbell, rather than simply to fail to file a
return.
If you have any questions about this, or about the return itself, please feel free to contact
my office directly. Thank you for your anticipated cooperation.
Sincerely,
uel L. Andes
amh/Enclosure