HomeMy WebLinkAbout06-08-15 .-
J '�i pennsylvania 15 0 5 614],0 5
cecnar.:en,or�n�veHuc EX(03-14)(FI)
REV-1500 oFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
INHERITANCE TAX RETURN � ' -
PO BOX 280601 i r�I��� � � � �
Harrisburg, PA 17128-0601 RESIDENT DECEDENT � "' { ; � i ��
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
__. ...�..,__._ _. __ __
� February 27, 2015 � March 16, 1942 '
,
_.. . .._.. . __.: �. . ..._._. ___ _._.. ; i _ _ _,
Decedent's Last Name Su�x DecedenPs First Name MI
_ __... _... _ _. __ , .___ __. _
Campbell � ; Eugene H;
� ,
_ _ _. . _..._. ..__.__.-- - -- -- ._ _ _. _- � .. ._. _ . _ _ _ _ _
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Su�x Spouse's First Name MI
_._ _____ __...._ ._. . .._._ --, ---� _, _ _ _... _...._
_....__.
Campbell i I � Shirley �;
_ _ _.._.----- ____----_-_____- _____.... _. _ , . _J � ____ __
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVA�S BELOW
p 1.Original Retum p 2.Supplemental Return p 3. Remainder Retum(date of death
prior to 12-13-82)
p 4.Agriculture Exemption(date of 0 5.Future interesi Compromise(date of � 6 Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
� 7.Decedent Died Testate p 8.Decedent Maintained a Living Trust _� 9 Total Number of Safe Deposit Boxes
(Attach copy o(will.) (Attach copy of trust.)
p 10.Litigation Proceeds Received O 11.Non-Probate Transferee Return O 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
O 13.Business Assets � 14.Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
_ _ ___ __ _.___.. �_..._----------------._._.._._i _ __ _ . __...___ __ ._ _
David A. Baric, Esquire � ' (717)249-6873
_.. __._..... ____ __ __ _..___ _, _. . _ __ _ _.
First Line of Address
_ __. ...------- _______ __ _ _..... .._ _...._.__.. __...... _._......_____�
Baric Scherer LLC 3
_ __..._.__.______--------.___.__. __ __. __ _ __ ;
Second Line of Address
' 19 West South Street '
.._..___ _ ...__._._ ..___.._..___.----__ __.— ._. _. _ _._._.. _..
City or Post Office State ZIP Code
_ .___ _ _....
__. . __..._..
-- _. .
Carlisle PA 17013
_... ._.__.. .. _ ..__ .._...... . .......... . .._ _'_ __._... ..._._..__.... _ . ...__... .__ _.... . .... : ���..7
_... r.._' �
CorrespondenYs emaii adaress: dbaric@baricscherer.com n � -�� 1"�l
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REGISTER OF;V�ILI=$USE ONL'S� - �.--�
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£ REGISTEROFWILLS�USEONLY =z �� �"���' . � ���
s OATE FILED MI�A4DYYYY i 3 ? C7J
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DATE FILED STAMP � ', .—
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PLEASE USE ORIGINAL FORM ONLY
Side 1
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� ],505614205
REV-1500 EX(FI)
De:cedenYs Social Security Number
� __ _
172-32-2358
oe�ede�,rs Name: Eugene H. Campbell
RECAPITULATION
, _ __
1. Reai Estate(Schedule A). ....................................... ..... 1. i '
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.
,-_. ... .... ......M .
5. Cash,Bank Deposits and Miscelianeous Personai Property(Schedule E)......, 5, 100,095.45
��...____---�_..___..�__�._.____._...._.. . . .....__ .. ,
�
6. Jointiy Owned Property(Schedule F) O Separate Biliing Requested ....... 6. ; '
;...._.. _..._. .._...__ _ __
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 3
(Schedule G) O Separate Billing Requested........ 7. ;
i.,_. _.. �.___...._. ._..____��___ .__...__ _._. . -
8. Total Gross Assets total Lines 1 throu h 7 . g, i 100,095.45
� 9 )...... .................... ..
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9 ; 4,039.18 ;
i..... � __...._ . �.r..,�_. �.. .. . __
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............... 10. ' '
_..... __._______..�-_.._� . . ..,__ _ ...
11. Totai Deductions(totai Lines 9 and 10). ... ........................... .. 11. 4,039.18
! _..._..�.._......._.._.W. _.
�.._---..._.__._.__.___. _
12. Net Value of Estate(Line 8 minus Line 11) ............... .......... .... . 12. � 96,056.27
__ ._______ __ . ._.
13. Charitabie and Governmental Bequests/Sec.9113 Trusts for which � �� �
an election to tax has not been made(Schedule J) ......... .............. . 13 �I
_.. �r.._.._ ..__. ...��_...__ . .�_._ .
14. Net Value Subject to Tax(Line 12 minus Line 13) .......... ....... ...... 14 ';
96 056.27
TAX CALCUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount ot Line 14 taxable
at the spousai tax rate,or
._..__. _ ._..._. __...._ _
transfers und�r Sec.9116 ' g6,056.27 � 0 00
(a)(1.2)X.0_ � 15.�
�...___ . _...._.�.__.�.�.___--._e__..._._....._...�...._. �.�..._ �_,_._._v. .______ ._... ,_. ... �
16. Amount of Line 14 taxable i
at lineal rate X.0_ �6�I
. ...._... � �7.E . ......___.___..__...___ __.______._. ...._.
___._�._____.___..__...._�_.____._..._..__ �.. i
17. Amount oi Line 14 taxable
at sibling rate X.12 l.._ _. _.,.._,_.._._._._..v._._ ,_..� ..__
__.._._._.�._��«w._..._.._..�.��_..�. _._._.{ .
18. Amount of Line 14 taxabie
at collateral rate X.15 � _ � 18
_..._. _ __ _ _.. _... ,__...
_. _ (
19. TAX DUE ........ ............... ...................... .
......... 19.� 000
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0
Under penalties of perjury,1 declare I have examined this return,induding accompanying schedules and statements,and to the best of iny knowledge and beiief,
it is Vue,correct and complete. Declaration of preparer other than the person responsible for filing the relurn is based on all informalion of which preparer has
any knowledge.
SIGNATURE P R$ON RESPONS lE FOR FILING RETURN
ADDRESS
21 G nn View, Ca sle, Pen s Ivania 17013
SIGNAT E PRE� ER T TH ERSON RESPONSIBLE FOR FILING THE RETURN � I1�
(V
ADDR �
1 est South Street, Ca ' le, Pennsylvania 17013
� i iaiii iiiii iiiii i�iii�ii��i�iiii�i�i�iiiii iiiii iiii iiii Side 2 J
15 4 15�56142�5
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'SNAME Eugene H. Campbell
_...----------- ---- -- ---------__ _--------------...___
STREETADDRESS
21 Glenn View
cirv sT�7E__ PA Z1P-^17013
Carlisle
Tax Payments and Credits: 0.00
1. Tax Due(Page 2,Line 19) ���
2. CreditslPayments
A,Prior Payments __.
B.Discount �.�0
(See instructions.) Total Credits(A+B) (2)
3. Interest
(3)
4. If Line 2 is greater than Line 1+Line 3,enter ihe difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (d1 _....
5. If Line 1 +Line 3 is grealer than Line 2,enter the difference.This is the TAX DUE. �5� 0.0�
Make check payable to: REGISTER OF WILLS, AGENT.
4t
' �o�y��
��'3,-,._ H, s,� .�3 .�.,.���v �, �,� . � .�F ,�. � �
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................................................................................••.•.•.•• � �
b. retain the right to designate who shall use ihe properly transferred 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 within one year o(death
without receiving adequate consideration?.............................................................................................................. ❑ �
3. Did decedent own an"in trust for"or payable-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
containsa beneficiary designation? ........................................................................................................................ ❑ �
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,Y4U MUST COMPI.ETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
, , � , �, �� ��
., �� A �' r " a . �., �,3 �., I. � , „ ,. �
, ��s. ,
__... _... ,.. �_ ,_a � �. �.. �.r .
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 tlates of death on or after Jan. 1, 1995, the tax rate imposetl on the net value of transfers to or for the use of the surviving spouse is 0 perceni
[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
atloptive parent or a step-parent 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(a)(1)j.
. 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)).A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
REV-i5o8 EX+(o8-iz)
�pennsylvania SCHEDULE E
���,� OEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: Eu ene H. Cam bell FILE NUMBER; �
9 P 21-15-0359
Indude the proceeds of litigation and the date the proceeds were received by the estate.
AII property jointly owned with right of survivorship must be disclosed on Schedule F.
[TEM VALUE AT DATE
NUPIBER DESCRIPTION OF DEATH
1. Members First Federal Credit Union 100,095.45
Certificate of Deposit
Account#220925-40
TOTAL(Rlso enter on Line 5, Recapitulation) $ 100,095.45
If more space is needed,use additional sheets of paper of the same size
y REV-1511 EX+(02-15)
� pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INtiERITANCE TAX RETURN AD M I N ISTRATIVE COSTS
RES[DENT DECEDENT
ESTATE OF FILE NUMBER
Eugene H. Campbell 21-15-0359
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUi�T
A. FUNERAL EXPENSES;
1,
e, AOMINISTRATIVE COSTS:
1. Personal Representative Commissions: 0.00
Name(s)of Personal Representative(s) Shirley Campbell _______ _
Street Address 21 Glenn View _____
_...---
c�ty Carlisle _____scare_PA_zlP_17013
Year(s)Commission Paid: _
None
3,500.00
z, nttorney Fees: Baric Scherer LLC
3. Family Exemption: (If decedent's address is not the same as daimant's,attach explanation,)
Claimant -----
Street Address ----
City_ State--._..___.ZIP ._.—__---._
Relationship of Claimant to Decedent ___--__- -----
305.50
4. Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees:
158.68
�. The Sentinel: legal advertising 75.00
$� Cumberland Law Journal: legal advertising
TOTAL(Also enter on Line 9, Recapitulation) $ 4,039.18
If more space is needed,use additional sheets of paper of the same size.
REV-1513 EX+(02-15)
�pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BEN EFICIARIES
INHEfttTANCE TAX RE7URN
RESIDENT DECEDENT
......___`_.' ,_._..._
ESTATE OF: FILE NUMBER:
Eugene H. Campbell 21-15-0359
RELATI0NSNIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not list Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a}(1.2),]
1� Shirley J. Campbell spouse 100%
21 Glenn View
Carlisle, Pennsylvania 17013
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON L[NES 15 THROUGH 18 OF REV-IS00 COVER SHEET,AS APPROPRfATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKE�:
1,
B. CHARITABLE AND GOVERNMENTAI DISTRTBUTIONS:
1.
TOTAL Of PART II- ENTER TOTAL NON-TAXABIE DISTRIBUTIONS ON l[NE 13 OF REV•1500 COVER SNEET, $
If more space is needed,use additional sheets of paper of the same size.