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"TI ~ :i! -< z 0 Ii) . c . z ~ ;llIi '< -< i1: 0 m z C -t ,......... ... -II -11-11 ~~ ~ ~ r.~l~1 15; ~ ~.... ~ '" ~~~ ~~ t - (\j r: Hj ""::.> (J) CD '''''I) ,~: G) ~.\~ L -' ~..o" f~> D :~ ..., ~ .~ ~ t; a:: - U-- ~ o ('J;) o i 00 N .,.- t--- ..- (G E p":' .':~:{~ t: O~i..i" 1D(t\ o () C;,} C1 J: w ~ :::J o ~ ~~ ~ ..:10 0 ~..:1uOC- H H ~,...; 330 W Uw ..:1.... 1Y)P'l: OQ:;:;o'/ u ;0 ;..ei::3~~ ;E-<a:a:1Y) ~w:::JH HeO..:1 ~ ~ u ~ ~~tJ.-lU ~ o ~... ~ ,'" ,.., ~ it] "" o 1" ... COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21-cl- 939 01145806 10-02-2001 REY-1545 EX AFP <09-00> EST. OF CHRISTINE M STADA S.S. NO. 209-58-7054 DATE OF DEATH 07-23-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT D SAVINGS [Xl CHECKING D TRUST D CERTIF. SUSAN STADA 900 CONLEY DR MECHANICSBURG PA 17055 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PENNSYLVANIA STATE BANK has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction froll the financial institution, attach a copy to this forM and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Comllonwealth of Pennsylvania. Questions May be answered by caJ.linf! (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 10401347 Date 08-26-1998 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 5,505.01 50.000 2,752.51 .045 123.86 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must accompany your paYMent to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax payments are made within three (3) months of the decedent.s date of death, you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Tax PART m The above information and tax due is correct. 1. You may choose to reMit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official asseSSMent will be issued by the PA Department of Revenue. [CHECK ] ONE BLOCK ONLY B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. C. [] The above information is incorrect and/or debts and deductions were paid by you. You IIUSt COMplete PART ~ and/or PART ~ below. PAR ~ DA- AND DEDUCTIONS CLAIMED PARl @] TA~ LINI ~-~~--~- - ~~~~----~ ~-- --~- -'ease state your (~ :5 ~D IT /TRUST ACCOUNTS DESCRIPTION AMOUNT PAID I $ TOTAL (Enter on Line 5 of Tax Computation) facts I have reported above are true, correct HOME (7/7) 7 If:> ~ - 7377 WORK (7f,) Z 5J' - .1z. c.j ~ TELEPHONE NUMBER and I r) - O'/-O( DATE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. 2. Inheritance tax becomes delinquent nine months after the decedent's date of death. 3. A joint account is taxable even though the decedent's name was added as a matter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of Wills. 2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one COpy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts 2 and 3 according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of Wills. TAX RETURN PART 2 TAX COMPUTATION LINE 1. Enter NOTE: the date the account originally was established or titled in the manner existing at date of death. For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (MM) appears before your first name in the address portion of this notice, the $3,000 exclusion already has been deducted from the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 16.77. (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) = .50 X 100 507. (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as determined below. MThe tax rate lmposed on the net value of transfers from a deceased Chlld twenty-one 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 07.. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in common with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3X 6X 15X 15X 01/01/95 to 06/30/00 OX 6X 15X 15X 07/01/00 to present OX 4.5XlE 12X 15X CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x 11". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ST ADA SUSAN 900 CONLLEY DR MECHANICSBURG, PA 17055 nu_n_ fold ESTATE INFORMATION: SSN: 209-58-7054 FILE NUMBER: 21-2001- 0939 DECEDENT NAME: STADA CHRISTINE M DATE OF PAYMENT: 10/11/2001 POSTMARK DATE: 10/04/2001 COUNTY: CUMBERLAND DATE OF DEATH: 07/23/2001 NO. CD 000371 ACN ASSESSM ENT CONTROL NUMBER AMOUNT 01145806 I $117.67 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: SUSAN ST ADA CHECK#1246 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS $117.67 MARY C. LEWIS REGISTER OF WILLS CITICORP CREDIT SERVICES, INC. ~VlA.J-,Q~ 8-\:-~Qo... (;) \ - Dl- ~ 34 ~ .:-- PROOF OF CLAIM (STATE OF MISSOURI ) (COUNTY OF PLATTE ) Shawn Harmer, duly sworn, deposes and says as follows: THA T she is an officer of Citicorp Credit Services, Inc., 7930 NW 110th Street, Kansas City, MO. 64153 THA T said Citicorp Credit Services, Inc. is the agent for Citibank (South Dakota) N.A., hereinafter referred to as "claimant" THA T the basis of this claim is the unpaid balance of charges incurred or authorized by CHRISTINE ST ADA, deceased, through use of a Citibank credit card, account number412803278118594. THAT the Estate of CHRISTINE ST ADA, deceased is indebted to claimant, Citibank (South Dakota) N.A., in the sum of$1185.43. THA T the said sum is now justly due this claimant. THA T no payment has been made thereon and that there are no offsets against same to the knowledge of this deponent; and the same is not secured by judgement or mortgage upon or expressly charged on the real estate of the deceased or any part thereof. Executed this 6 February, 2002 CITICORP CREDIT SERVIC S, INC. N ANNEr TE NEWBERR otalY PUDlic . Y State f - Notary Seal J 0 MISSouri acks ,.. My Appt Ex on o.,OUilty . Plies August 19 2 , 004 RI Sworn to before me, 06 day of February, 2002 SEAL KCOI50c/REV 4/87 09/03/01 !i!f:ijgM~@imi!ti $1201.49 $25.00 @!M~W.~WfJ ti@!i~ijtHMt!i SITE: KC CHRISTINE STADA 900 CONLEY DR MECHANICSBURG 17055-5160000 CITI CARDS P.O. BOX 8105 S HACKENSACK, NJ 07606-8105 PA Citi~ Card KCB1479 21:23:57: for Customer Service, call or write 1-800-950-5114 Account Number 4128 0032 7811 8594 Payment must be received by 1:00 pm local tIme on 09/03/2001 To report billing errors. write to this addreSIJ; calling will not preserve yow rights. BOX 6500 SIOUX FAllS, SO 57117 Statement/Closing Date 08/08/2001 Total Credit Line $4900 Available Credit Line $3698 Amount Over Credit Line $0.00 + Activity Since last Statement Cash Advance Limit $200 Avalleble Cash Limit $200 Purch/ Adv Minimum Due $25.00 = Past Due $0.00 + Sale Date Post Date Reference Number I 7/20 /44101170 I 8/08 PAYMENT THANK YOU 70 0000 0 0 PURCHASES*FINANCE CHARGE*PERIODIC RATE 84 0000 0 YOUR TOTAL CREDIT LINE HAS CHANGED! Please note your new total credit line. New Balance $1201.49 Minimum Amount Due $25.00 Amount -50.00 16.06 70000000000 1: } ;X () J . LI 9 I - J ~:_.~ 0 ~0i~~~ Account Summary PURCHASES ADVANCES TOTAL revlous Balance $1,235.43 $0.00 $1,235.43 (+) urc ases & Advances fO.oo 0.00 0.00 Rate Summary PURCHASES Standard Purch ADVANCES $1,209.92 $0.00 0.04425%(0) 0.05477%(0) 16.150% 19.990% PLEASE REfER TO THE REVERSE SIDE Of THE ORIGINAL STATEMENT fOR PAYMENT INFORMATION. Make check or money order payable in U.S. dollars on a U.S. bank to Citl Cards. Include account number on check or money order. No cash please. =) ew Balance $! , 201. 49 $0.00 $!, 201. 49 16.150% 19.990% /"/-/ g - 9 ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE *' NOTICE OF INHERITANCE TAX APPRAISEKENT~ ALLOWANCE OR DISALLONANCE OF DEDUCTION~. AND ASSESSKENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP (01-02) SUSAN STADA 900 CONLEY DR MECHANICSBURG PA 17,055 . \ DATE ESTATE OF DATE OF DEATH FILE NUMBER "~ COUNTY SSN/DC ACN 09-02-2002 STADE 07-23-2001 21 01-0939 CUMBERLAND 209-58-7054 01145806 CHRISTINE Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-y:is4-i-Ex--AFP--foi-:021------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 09-02-2002 ESTATE OF STADE CHRISTINE DATE OF DEATH 07-23-2001 COUNTY CUMBERLAND FILE NO. 21 01-0939 TAX RETURN WAS: S.S/D.C. NO. 209-58-7054 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION ACN 01145806 FINANCIAL INSTITUTION: PENNSYLVANIA STATE BANK ACCOUNT NO. 10401347 TYPE OF ACCOUNT: () SAVINGS ()() CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 08-26-1998 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due X 5.505.01 0.500 2.752.51 .00 2.752.51 .45 123.86 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT. SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS. AGENT." x TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 10-04-2001 CDOO0371 6.19 117.67 TOTAL TAX CREDIT 123.86 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 · IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. . ( IF TOTAL DUE IS LESS THAN $1. NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRJ. YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. J PURPOSE OF NOTICE: PAVMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTV: INTEREST: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). Detach the top portion reverse side. -- Make check or money of this Notice and submit with your payment to the Register of Wills printed on the order payable to: REGISTER OF WILLS, AGENT. A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance end Estete Tax" (REV-13l3). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-150l) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (570) discount of the tax paid is allowed. The 1570 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (670) percent per annum calculated at a dailY rate of .000164. All taxes which became delinquent on or after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2002 are: Year Interest Rate Daily Interest Factor Vear Interest Rate Daily Interest Factor 1982 2070 .000548 1992 970 .000247 1983 1670 .000438 1993-1994 n .000192 1984 1170 .000301 1995-1998 n .000247 1985 1370 .000356 1999 n .000192 1986 lOX .000274 2000 870 .000219 1987 970 .000247 2001 970 .000247 1988-1991 1170 .000301 2002 670 .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated.