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HomeMy WebLinkAbout10-01-14 .J REV-1500 EX(02-11) 1505610143 44 PA Department of Revenue OFFICIAL USE ONLY P pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO BOX.280601 INHERITANCE TAX RETURN 21 14 0889 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth `k 07 31 2014 06 09 1924 Decedent's Last Name Suffix Decedent's First Name MI CAMPBELL ELEANOR J (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 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW . 0 1. Original Return ❑ 2. Supplemental Return ❑ 3.Remainder Return(Date of Death Prior to 12-13-82) ❑ 4. Limited Estate ❑ 4a.Future Interest Compromise ❑ 5. Federal Estate Tax Return Required (date of death after 12-12-82) . g Decedent Died Testate7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes ® (Attach Copy of Will) ❑ (Attach Copy of Trust) ❑ 9. Litigation Proceeds Received ❑ 10. Poverty (Date of Death Election to tax under eSec.9113(A) between 91and 1-1-95) Schedule ) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number RICHARD E CONNELL ESQ 717 232 8731 r. REGISTER OF 1 lLIaUSE ONVI :70 Q rri � C7 First Line of Address .1a P'- 2303 MARKET STREET . 01 Second Line of Address DATE FI4ED ► -= c y City or Post Office State ZIP Code f rri CAMP HILL PA 17011 C Correspondent's e-mail address: Connell@bmc-law.net Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. URE OF PERSO RESP SIB OR FILIN RETURN - DATE Donald L. Campbell —/ ADDRESS 708 Bosler Avenue 1 S NATURE OF P RE HAN REPR E T TI DATE Richard E Connell Esq ADDRESS Ball, Murren & Connell 2303 Market Street, Camp Hill, PA 17011 Side 1 1505610143 1505610143 J 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name: CAMPBELL, ELEANOR J. 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&Miscellaneous Personal Property(Schedule E)................ 5. 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6. 37 , 947 . 23 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested............. 7. 8. Total Gross Assets(total Lines 1 through 7).......................................................... 8. 37 , 947 . 23 9. Funeral Expenses and Administrative Costs(Schedule H)..................................... 9. 20 , 447 . 7 0 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................. 10. 3 , 023 . 4 1 11. Total Deductions(total Lines 9 and 10).................................................................. 11. 23 , 471 . 1 1 12• Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 14 , 4. 7.6'.. 1.2 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 Tax(Line 12 minus Line 13)................................................. 14. 14 , 476 . 12 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 14 , 476 . 12 16. 651 . 43 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19: TAX DUE................................................................................................................... 19. 651 . 43 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 i t REV-1500 EX Page 3 File Number 21 - 14 - 0889 Decedent's Complete Address: DECEDENT'S NAME Campbell, Eleanor J. STREET ADDRESS 337 15th Street CITY STATE ZIP New Cumberland PA 17070 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 651.43 2. Credits/Payments A. Prior Payments 618.86 B. Discount 32.57 Total Credits(A +B) (2) 651.43 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) 0.00 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 transferred 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 Dec. 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?......... ❑ ❑x 4. Did decedent own an individual retirement account,annuity,or other non-probate property which contains a beneficiary designation?...................................................................................................................... ❑ ... .❑x . 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)(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 reiiurn 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 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[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,w ether y blood or adoption. REV-1509 EX+(01-10) pennsylvania DEPARTMENT OF REVENUE SCHEDULE F INHERRESIDENT DECEDENT JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF Campbell, Eleanor J. FILE NUMBER 21 - 14-0889 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT Deborah C. Douden Daughter A JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY ITEM LETTER DATE DATE OF DEATH o�OF DATE OF DEATH NUMBER FOR JOINT MADE Include name of financial institution and bank account number(VALUE OF ASSET DECD'S VALUE OF TENANT JOINT similar identifying number.Attach deed for jointly-held real estat . INTEREST DECEDENTS INTEREST 1 March 2006 Belco Community Credit Union 72,499.45 50% 36,249.73 Account No. 0030-Whatever Club 2 March 2006 Belco Community Credit Union 3,306.62 50% 1,653.31 Account No. 0040-Checking 3 March 2006 Belco Community Credit Union 88.37 50% 44.19 Account No.0001-Savings TOTAL(Also enter on line 6, Recapitulation) 37,947.23 REV-1511 EX+(10-09) pennsylvania SCHEDULE DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN RESIDENT DECEDENT wryINSTMWE COM ESTATE OF Campbell, Eleanor J. FILE NUMBER21 - 14-0889 Decedent's debts must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 Parthmore Funeral Home 9,485.12 2 Woodlawn Memorial 5,138.00 3 Funeral Luncheon 1,044.58 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s)Commission Paid 2. Attorney's Fees Ball, Murren &Connell 1,250.00 3,. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Earnest L. Campbell 3,500.00 Street Address 337 South 15th Street City New Cumberland State PA Zip 17070 Relationship of Claimant to Decedent Son 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Cumberland County Register of Wills- Filing of Inheritance Tax Return 30.00 TOTAL(Also enter on line 9, Recapitulation) 20,447.70 penlnsylvania SCHEDULE DEPARTMENT OF AXRET UE RN DEBTS OF DECEDENT INHERITANCE TAX RETURN , MORTGAGE RESIDENT DECEDENT LIABILITIES & LIENS FILE NUMBER ESTATE OF Campbell, Eleanor J. 21 - 14 -0889 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 1 Pinnacle Health 350.00 Account No. 1431030; Date of Service: 01/17/2014 2 EMS Ambulance Service 1,001.41 3 Social Security Recovery 1,592.00 4 Affilia Home Health 80.00 TOTAL(Also enter on Line 10, Recapitulation) 3,023.41 REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Campbell, Eleanor J. 21 - 14-0889 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not ListTrustee(s) ITAXABLE DISTRIBUTIONS[include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 Deborah C. Douden Daughter One-Fifth 309 Hogestown Road Mechanicsburg, PA 17050 2 Earnest L. Campbell Son One-Fifth 337 South 15th Street New Cumberland, PA 17070 3 Sandra L. Elliott Daughter One-Fifth 213 Riverview Road Liverpool, PA 17045 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 REV-1513 EX+(01-10) pennsylvania DEPARTMENT OF REVENUE SCHEDULEJ INHERITANCE TAX RETURN BENEFICIARIES continued RESIDENT DECEDENT ESTATE OF Campbell, Eleanor J. FILE NUMBER 1 21 - 14-0889 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not List Trustee(s) TAXABLE DISTRIBUTIONS[linclude outright spousal distributions,and Fransfers under Sec.9116(a)(1.2)] 4 Carl A. Campbell Son One-Fifth 109 Providence Place Willow Street, PA 17584 5 Donald L. Campbell Son One-Fifth 708 Bosler Avenue Lemoyne, PA 17043 Page 2 of Schedule J LAW OFFICES BALL, MURREN & CONNELL 2303 MARKET STREET CAMP HILL, PENNSYLVANIA 17011 (717)232-8731 PHILIP J. MURREN FACSIMILE(717)232-2142 WILLIAM BENTLEY BALL RICHARD E.CONNELL (1916-1999) TERESA R.McCORMACK DAVID R.DYE September 30, 2014 Lisa M. Grayson, Esquire Cumberland County Register of Wills One Courthouse Square Carlisle, PA 17013 RE: Estate of Eleanor J. Campbell Date of Death: July 31, 2014 Will No. 2014-00889 Our File No. 3053 C=� 6�7 Dear Ms. Grayson: ? ?_� 6 _pr_11 M Enclosed please find, in duplicate,the Inheritance Tax Return for the E'S of Eleanor J. Campbell. No Inventory is necessary for this estate. A copy of thedecedent's r; � 4 ' Will is included, as well. Additionally,please find this firm's check in the am©unt of :t71, $15.00 for the filing of the Return. : `"' rn I'_" cn cJ co 'f1 Please date-stamp the additional copies of the Return for our records. Thank you for your attention to this. Ve S. Richard.E. Connell REC/gjc Enclosures cc: Donald L. Campbell, Executor 06250000722108 e 01LUU) -v co ACL u) ■� LL �■ M% O cc uj f _ w _ ,YF- _ = (n Z U, CM _ W0wM OVWC) I _ r � z 0= Q v, Q � � � � - - - % aYa = W"X (n ■� _s'�Q - < mow IM C,4 i' LL U.J _..1 ' ~ �J . u_ U.. CL,. r� ('i l t? r--� t�J • _E cr pC� CC C 1�') C) C) cv Jm s r�