HomeMy WebLinkAbout06-08-09BUREAU OF IN IVIDUAL TAXES
PO ~OX 28060
HgRRISBURG PA 17128-0601
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REV-1543 IX AFP (09aA
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PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND FILE N0. 21 l7q 053 i
~,~ -,,-;TA~CPAYER RESPONSE ACN 09126866
- DATE 04-27-2009
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~~0~ `~~~ _s r ~ 3: 06SSN. OF SARA160F016G6271
~~flK~~ DATE OF DEATH 04-15-2009
~~~,~ (~~~'{~A COUNTY CUMBERLAND
BETTY BARRICK {1L~~~~ ~"" PA REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
190 WEST MIDDLESEX DR CUMBERLAND CO COURT HOUSE
CARLISLE PA 17013 CARLISLE, PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
MEMBERS 1ST FCU 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, you were a joint 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 Comwonwealth of
Pennsylvania. Please call 1717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 43412-11 Date 08-14-1997 To ensure proper credit to the account, two
Established copies of this notice must accompany
payment to the Register of Wills. Make check
Account Balance 2, 138.10 payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 1,069.05 months of the decedent's date of death.
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax DUe $ 48.11 nine months after the date of death.
PART TAXPAYER RESPONSE
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 H E C K a discount or avoid interest, or check box "A" and return this notice to the Register of
C 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 ar will be reported and tax paid with the Pennsylvania Inheritance Tax return
0 N L Y to be filed by the estate representative.
C. ~ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART 3~ below.
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~AD
1
2 $ ~. 3 fl
3 X
4
5 ~I O .
6
7 X
8 +~ Q
P
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
-O o
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~ IUTAL ctnter on Line s or pax ~omputauon) s ~ ~ ~~_~ CJ
Under penalties of perjury, I declare that the facts I have reported a/b~ove are ^^t~~rue, correpct/^a~nd
complete the best o/~ kn6~ and belief. HOME C /~~) Q1~~ p V~g q
P!J`/~.~ WORK ( ) ~~r~ /
TAXPAYER SIGNATU TELEPHONE NUMBER DATE
1
GENERAL INFORMATION ,
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with apvlicable 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 taxable.
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 REY-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 "Taxpayer 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 (Porn 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: For a decedent who died after 12/12/82, accounts the decedent put in joint names within one year of death are
fully taxable. However, there is an exclusion not to exceed S3,D00 per transferee, regardless of the value of
the account or the number of accounts held.
If a double asterisk (*~) appears before your first name in the address portion of this notice, the S3,OD0 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 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 SURVIYINGBJOINT 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 for another individual(s) (trust beneficiaries):
1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT MULTIPLIED BY 100 = PERCENT TAXABLE
OWNERS OR TRUST BENEFICIARIES
Example: Joint account registered in the name of the decedent and two other persons and established within one near of death by
the decedent.
1 DIVIDED BY 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.
t
^The tax rate imposed on the net value of transfers from a deceased child 21 years of ag
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 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 then 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.
CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED
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 payment.
C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use 8 1/2" x 11" sheet of paper. Proof of
payment may be requested by the PA Department of Revenue.
A `~
IN ASSN TAG1' ~R ~`
~I~~ BUREAU Ofi iNTIIVItIUAt~ TAXES. AT
1vi~CE5 AY~RS 41 EC~AL H~ARINB ANDlC}R SpEA1CSN6 NEEDS
Date of Death Spouse Lineal Sibling Collateral
07/01/94 to 12/31/94 3 percent 6 percent 15 percent 15 percent
01/01/95 to 06/30/00 0 percent 6 percent 15 percent 15 percent
07/01/00 to present 0 percent 4.5 percent * 12 percent 15
e percent
or younger a
a~. R
TIME/DATE 07'41 04/14/2009
CORRECTED TO +60 degrees F
8.C. MANUALLY ENTERED 0.510
ACCUM.TOTAL BEFORE 00931613.E G
ACCUM.TOTAL AFTER 00931640.9 G
QUANTITY CORRECTED 00027.1 G
METER NUMBER
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ENFBARQ~
Pegs 1 of 8
Monthly Statement Account Number
April 13, 2009 717-249-3186-873
Payment Options & Contact Info Current Charges At-A-Glance
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CARLISLE
202 Westminster Drive in
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Pay Online
EMBARQ. comlmyaccount
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1-877-813-7604
Customer Ssrviee
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Repair Service
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EMBARQ Services Total
Local and Optional Services -Page 3 21.00
~y~ Entertainment -Page 3 41.98
taxes and Surcharges -Page 4 10.09
Total Current Charges
573.07
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Previous Balance Payments & Adjustments Balance Total Current Charges Total Amount Due
7z.ss 1 -7z.ss ~ .oo ~ 73-07 ~ ZT3.07
Current Charges Due gy: 05!06/09
g received after May 12: 573.98
^ ®Please Recycle
INSCRIPTION ORDER FORM
• • No. 12
in~rzc
MEMORIALS Since 1921
5243 Simpson Ferry Road, Mechanicsburg, PA 17050
(717) 766-5622 • Fax (717) 766-8007 • www.gingrichmemorials.com
CEMETERY
NAME OF DECEASED
LETTERING REQUIRED:
LOCATION
FAMILY NAME MEMORIAL IND. NAMES ON MEMORIAL
TYPE OF MONUMENT COLOR OF GRANITE ~~ °°
LOCATION: DRAW A PRECISE MAP OF LOCATION OF MEMORIAL ON CEMETERY (Use back of work order if necessary)
UPON EXAMINING THE ABOVE INSCRIPTIONS, I/WE THE UNDERSIGNED, FIND THE SPELLING AND DATES TO BE
CORRECT. THE WORK WILL BE COMPLETED AS IT IS ACCUMULATED. NO SPECIFIC COMPLETION DATE IS
GUARANTEED.
SIGNED SIGNED
PRICE $
DEPOSIT $
BALANCE DUE $
WHITE-Office YELLOW-Production PINK-Customer GOLDENROD-Branch
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~4L'<,4BERS 1ST FEDERAL CREDIT UNION . P.O. BOX 40 . h1GC1IANICSBIJRG, PGNNSYI_VANIA 17055
acct: XXXXXXX412 Teller: 0236 Date: 06/Ol/09Time: 10:50am
gee receipt for reference
No. 0000433572
:heck Number: 00 0000433572
purpose SHARE WITHDRAWAL
amount $838.65
>ay to MALPEZZI FUNERAL HOME
St
MEMBERS 1St
• FEDERAL CREDIT UNION
P.O. Box 40
Mechanicsburg, Pennsylvania 17055
No. 0000433572
•~:-. Issued By: Moneygram Payment Systems, Inc.
j~-G-~
>..~ .. P.O. Box 9476. Minneapolis MN 55480
„',1,Y~ Drawee: Boston Safe Deposi! 8 Trust Company
' ' ~" ' ' Boston, MA
5-709(110
DATE
06/01/09
*** EIGHT HUNDRED THIRTY-EIGHT DOLLARS AND 65 CENTS ***
$838.65
PAY EXACTLY~'8 38 ~o~~ars 6 ~j Cents
r, ,,.~, OFFICIAL CHECK
Drawer: MEMBERS 1ST FEDERAL CREDIT UNION
TO THE MALPEZZI FUNERAL HOME
ORDER OF
TWO SIGNATURES REQUIRED FOR CH~EC~K~OjV~ER~52~,500.00
CONTR E
11.00004 3 3 5 7 211' ~:0 ~ i00 709 2~:0 ~ 600 1 ~ 304 78 211'