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PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AN D
PD BDx 2ao6Bl rF FILE NO. 21 U~'- U319<P
HARRISBURG PA 1nzB-B6B1 1`AX~%CYE1d RESPONSE
_ ACN 09110259
REV-1543 EX AFP (OB-OB) _ ~_~I '. DATE 02-24-2009
Z~c~9 ~~,~ ~ 8 ~~~ ~Z. TYPE OF ACCOUNT
~. OF JOHN L KING ^ SAVINGS
~.,` ,~, SSN 524-42-4870 ® CHECKING
,~ j`` ~ +';'` DATE OF DEATH 01-16-2009
~~t~l~i`~ ~ : f ~ ^ TRUST
CC,F ._ _., ~ .~(ff~;' COUNTY CUMBERLAND
CERTIF.
- ) ~~REMIT PAYMENT AND FORMS T0:
MICHELE K HASSINGER
30 COUGAR LN REGISTER OF WILLS
NEWVILLE PA 17241-8650 CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PNC BANK NA
provided the Department with the information below, which has been used in calculating the
potential tax due. Recorcls indicate that at the death of the above-named decedent,
you were a Soint owner/beneficiary of this account.
If you feel the information is incorrect, please obtain written correction from 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 Commonwealth of
P~nnsyl•rar,is. Please cal. C?1?1 :~:-827 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 000005140186575 Date
11 - O 1 - 1969 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 3, 862.13 payment to the Register of Wills. Make check
Percent Taxable X payable to "Register of Wills, Agent".
Amount Subject to Tax 16.667
$ 6 4 3. 7 0 N07E: If tax payments are made within three
Tax Rate X months of the decedent's date of death,
. 0 4 5 deduct a 5 percent discount on the tax due.
Potential Tax Due $ Any Inheritance Tax due will become delinquent
2 8. 9 7 nine months after the date of death.
P^T TAXPAYER RESPONSE
1
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT
A. The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
C C H E C K a discount or avoid interest, or check box "A" and return this notice to the Register of
0 N E ~ Wills and an official assessment will be issued by the PA Department of Revenue.
B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
0 N L Y to be filed by the estate representative.
PART If indicating :a different tax rate, please state
relationship to decedent:
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
i
z $
3 X
4
5 -
6
7 X
B S
OFFICIAL USE t7N~Y ~ AAF
PA DEPARTMENT OF REVENUE
PAD
1
2
3
4
5
6
7
8
nn:
0
DATE PAID PAYEE
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
S
~ Und penalties of perjury, I declare that the facts I have reported above are true, cor
--ea"plete to the st of my knowledge and belief.
c ~ ~# ;an d
HOME ( 71 - ~ 7 T ~ ' 7~~
-~-(J~-~.~ ~y_,~ , ~~
TAXPAYER SIGNATURE WORK ( ~ ~ ~~ ~ ~y _ ~ j S
TELEPHONE NUMBER ~ 3 _ /G ~J
DATE
C• ~^ The above informs ion is incorrect and/or debts and deductions were paid.
- Complete PART 2~ and/or PART 3^ below.
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 when the decedent's name was added as a matter of convenience.
4. Accounts (including those held between husband and wife) the decedent put in joint names within one year prior to
death are fully taxable.
5. Accounts established jointly between husband and wife more than one year prior to death are not taxab e.
6. Accounts held by a decedent "in trust for" another or others are fully taxable.
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 a 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 estate's representative, Place an "X" in Block B of Part 1 of the "T ax paver Response" section. Sign one
copy and return to the register of wills of the county indicated.
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 the date the account originally was established or titled in the manner existing at date of dea
NOTE: fully taxablet wHowever,athere Zis12an8 exclusiont n th to exceed S3 OOOn pert transferee thregardless of ftheavalueeof
the account or the number of accounts held.
wasadeductedafromlthe(accountebalanceoas reportedsby nthe financialdinstitutionn of this notice, the 53,000 exclusion
2. Enter the total balance of the account including interest accrued to the date of death.
3. The percentage of the account that is taxable to each survivor is determined as follows:
A. The percentage taxable of joint assets established more than one Year prior to the decedent's death:
1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY SURVIVINGBJOINT OWNERS MULTIPLIED BY 100 = PERCENT TAXABLE
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 = 16.7 percent (TAXABLE TO EACH SURVIVOR)
B. The Percentage taxable for assets created within one Year of the decedent's death or accounts owned by the decedent but held
in trust far another individual(s) (trust beneficiaries):
1 DIVIDED BY TOyOjNERSNORBTRUST BENEFICIARIESNT MULTIPLIED BY 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 BV 2 (SURVIVORS) _ .50 X 100 = 50 percent (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
7. Enter the appropriate tax rate (Line 7) as determined below.
Spouse Lir.ea'_ Sibling Collateral
Date of Death
6 percent 15 percent 15 percent
07/01/94 to 12/31/94 3 percent
01/01/95 to 06/30/00 0 percent 6 percent 15 percent 15 percent
15 percent
07/01/00 to present 0 percent 4.5 percent * 12 percent
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.
The lineal class of heirs includes grandparents, Parents, children and other lineal descendents. "Children" includes natural children
natural parentstand theirbdescendents,bwhethersoranotttheyhhaveebeendadoptedhbvdothersLladoptedsdescendentsnanddtheirldescendantsf the
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 beneficiaDE$TS AND DEDUCTIONS CLAIMED
CLAIMED DEDUCTIONS - PART 3 -
Allowable debts and deductions are determined as follows:
A. You are legally 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 the death of the decedent and can furnish proof of paymen .
C paymentemay bearequested by themPAeDepartment ofrRevenuef additional space is needed, use 8 1/2" x 11" sheet of paper. Proof of
TAXPAYER ASSISTANCE
IF YOU NEED FURTHER INFORMATIDN OR ASSISTANCE, CONTACT ANY REGISTER OF WILLS,
PA DEPARTMENT OF REVENUE DISTRICT OFFICE OR THE BUREAU DF INDIVIDUAL TAXES, AT
(717) 787-8327. SERVICES FDR TAXPAYERS WITH SPACIAL NEARING AND/OR SPEAKING NEEDS
ONLY: 1-80~-447-3020.
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
REV-1543 Ex ~y
PENNSYLVANIA INHERITANCE TAX
~ INFORMATION NOTICE
AND FILE
' '' - ~~ TAXPAYER RESPONSE ACN
_;t::.
8.~~_ ,.', I DATE
~~Qg ~R ~ 8 ~~~ I2~ 54 EST. OF JOHN L KING
SSN 524-42-4870
r! F~ ~"~'~' DATE OF DEATH o1-16-2009
.1 _, , ~
d~nHA~"~a"~' ;(~i ~~T COUNTY CUMBERLAND
CAROL ~~ ~~`, ~r_~., ~''1 REMIT PAYMENT AND FORMS T0:
KING REGISTER OF WILLS
30 COUGAR L.N
NEWVILLE PA 17241-8650 CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
N0. 21 ()~ Oz~~
09110258
02-24-2009
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
PNC BANK NA
provided the Department with the information below, which has been used in calculating the
potential tax due. Records indicate that at the death of the above-named decedent,
If you feel the information is incorrect, please obtain written correction from the financialainstitution, attach a copy to this form
and return it to the above address. This account is taxable in accordance with the Inheritance,7axtlawseofbthefCommonwealthlofaccount.
Pennsylvania. Please call C717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 000005140186575 Date
11-01-1969
Established To ensure proper credit to the account, two
Account Balance copies of this notice must accompany
$ 3, 862.13 Payment to the Register of Wills. Make check
Percent Taxable X payable to "Register of Wills, Agent".
Amount Subject to Tax 16.667
$ 6 4 3. 7 0 NOTE: If tax payments are made within three
Tax Rate X months of the decedent's date of death,
Potential Tax Due • 00 deduct a 5 percent discount on the tax due.
'~ . 0 0 Any Inheritance Tax due will become delinquent
PART nine months after the date of death.
10 TAXPAYER RESPONSE
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX A55ES5MENT
A• The above f
3n ormation and tax due is correct
CHECK .
Remit payment to the Register of Wills with two copies of
a di
th
scount or avoid interest, or check box "A" is notice to obtain
C
0 N E ~ and return
Wills and an official assessment will be i this notice to the Register of
B L 0 C K
B. [] The ssued by the PA
ab Department of Revenue.
0 N L Y to ove asset has been or will be reported and tax paid with
be filed b
t th
y
he estate representative. e Pennsylvania Inheritance Tax return
PART If indicating a different tax rate, please state
relationship to decedent: -
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
2 +~`
3 X
4
5 -
6 +~
7 X
8 $
0
OFFICIAL USL ONLY ~ AAF
PA DEPARTMENT OF RFYLNUE
PAD
I 1
2
3
4
5
6
7
8
DEBTS AND DEDUCTIONS CLAIMED
Under penaltie TOTAL CEnter on Line 5 of Tax Computation)
$
s of
perjury, I declare
complete to he best of my knowledge that the facts
and beli
f I have reported above are true, corre
t
" - -.iYt.r-^~f+ ~
.
e
.
~
HOME (~1~~ '7 %( c
a
-7~~~
PAYER SIGNATU WORK (~--
- _ TELEPHONE NUMBER --'~-=~=~~
DATE
C• ~~ The above informs ion is incorrect and/or debts and deductions were paid.
- Complete PART 2~ and/or PART 3^ below.
DATE PAID PAYEE
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 when the decedent's name was added as a matter of convenience.
4. Accounts (including those held between husband and wife) the decedent put in Joint names within one Year prior to
death are fully taxable.
5. Accounts established jointly between husband and wife more than one year prior to death are not taxab e.
6. Accounts held by a decedent "in trust for" another or others are fully taxable.
REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE
1• BnOBlock AloftPartnloofathen"TaxpayeruResponse" sectioniceSign tworcopiesdanddsubmitsthem withbalcheckafordthelamount of11
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. BLDCK 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 estate's representative, place an "X" in Block B of Part 1 of the "Taxpayer Response" section. Sign one
copy and return to the register of wills of the county indicated. check Block C and complete Parts 2 and 3
3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed,
accor11s9ofotheecountvuindicatedlowThe PAnDepartmentsofnRevenuetwillmissue anuofficialfassessmentu(Form REV-1548bEX)tuo nereceipter
of wi
of the return from the register of wills.
TAX RETURN - PART 2 - TAX COMPUTATION
LINE
1. Enter the date the account originally was established or titled in the manner existing at date of deat .
NOTE: fully taxablet wHowever,athere ~ s 2 n6 ex lusion n thto ex eed S3 DOOn per transfereethregardless offtheavalueeof
the account ar the number of accounts held.
If a double asterisk (~~) appears before your first name in the address portion of this notice, the 53,000 exclusion
was 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 Dercentage of the account that is taxable to each survivor is determined as follows:
A. The percentage taxable of joint assets established more than one Year prioMULTIPLIED BY 100,s aePERCENT TAXABLE
1 DIVIDED BY TJOINTNOWNERS F DIVIDED BY SURVIVINGBJOINT 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 = 16.7 percent (TAXABLE TO EACH SURVIVOR)
B. The percentage 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 gyNERSNORBTRUST BENEFICIARIESNT MULTIPLIED BY 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 BV 2 (SURVIVORS) _ .50 X 100 = 50 percent (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. Collateral
Spouse Lineal Sibling
Date of Death 15 percent
5 percent 15 percent
07/01/94 to 12/31/94 3 percent
6 percent 15 percent 15 percent
01/01/95 to 06/30/00 0 percent 15 percent
0 percent 4.5 percent ~ 12 percent
07/01/00 to present
^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.
The lineal class of heirs includes grandparents, parents, children and other lineal descendents. "Children" includes natural children
whether or not then have been adopted by others, adopted children and stev 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 beneficiaDE$TS AND DEDUCTIONS CLAIMED
CLAIMED DEDUCTIONS - PART 3 -
Allowable debts and deductions are determined as follows:
A. You are legally 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 the death of the decedent and can furnish proof of pavmen .
C. Davmentemay bearequested by themPAeDepartment ofrRevenuef additional space is needed, use B 1/2" x 11" sheet of paper. Proof of
P
TAXPAYER ASSISTANCE
IF YOPARTMDNTUOFHREVENUERDISTRICOROFFICETORCTHECBUREAU OFYINDIVIDUALDTAXESLSAT
PA D
1717) 787-8327. SERVICES FDR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEED
ONLY: 1-80~-447-302.
COMMONWEALTH OF PENNSYLVANIA
REV-1162 EX111-961
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
N0. CD 01 1012
HASSINGER MICHELE K
30 COUGAR LN
NEWVILLE, PA 17241-8650
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold
__________ ________
ESTATE INFORMATION: ssrv: 524-42-4s7o
FILE NUMBER: 2109-0266
DECEDENT NAME: KING JOHN L
DATE OF PAYMENT: 03/ 1 8/2009
POSTMARK DATE: 03/17/2009
COUNTY: CUMBERLAND
DATE OF DEATH: 01 / 1 6/2009
09110259 ~ $28.97
TOTAL AMOUNT PAID:
REMARKS:
528.97
CHECK# 124'1
INITIALS: JN
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS