HomeMy WebLinkAbout08-10-111505611180
REV-1500 EX (02-11)(FI)
OFFICIAL USE ONLY
PA De artment of Revenue Pennsylvania County Code Year File Number
p DEPARTMENT OF REVENUE
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601 ( / ,~ /, ~_)
Harrisburg PA 17128-0601 RESIDENT DECEDENT .-~ ~ l L +.1'
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
052-16-8866 02042011 08121919
Decedent's Last Name Suffix Decedent's First Name MI
WINCHESTER ANNA
(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 BOXES BELOW
0 1. Original Return 0 2. Supplemental Return 0 3. Remainder Return (Date of Death
Prior to 12-13-82)
4. Limited Estate Q 4a. Future Interest Compromise (date of 0 5. Federal Estate Tax Return Required
death after 12-12-82)
0 6. Decedent Died Testate Q 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
0 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (Date of Death 0 11. Election to Tax under Sec. 9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
CHRISTINE W. DELOACHE 7172498657
First Line of Address
737 OAK HILL DRIVE
Second Line of Address
City or Post Office State ZIP Code
BOILING SPRING PA 17007
Correspondent's a-mail address:
REGISTE _,f~fI~ILLS USE'ONLY
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DATE FILED -
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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 knowle+.~_
SI~ ~~ URE OFpEE~ N RIE~PU~NSI~E FOR~ILIN~N ~// ~ / ~..~
ADDRESS /''- /,l(~I~
737 OAK HILL DRIVE, BOILING SPRINGS, PA 17007
SIGNATUR ~~E2~_RER OTHE -~+EPRESENTATIVE DATE
ADDRESS
PADDEN GUERRINI & ASSOC._3425 SIMPSON FERRY RD_ CAMP HILL_ PA 17011
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505611180 1505611180 J
l",P~
Vil ;~
1505611280
REV-1500 EX (FI)
Decedent's Social Security Number
Decedent's Name: ANNA WINCHESTER 052-16-8866
RECAPITULATION
1. Real Estate (Schedule A) ......................................... 1. N 0 N E
2. Stocks and Bonds (Schedule B) .................................... 2. 16 9 9 . O O
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... 3. N 0 N E
4. Mortgages and Notes Receivable (Schedule D) ........................ 4. N 0 N E
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ... . 5. 4 2 9 9 . O O
6. Jointly Owned Property (Schedule F) OSeparate Billing Requested ..... .. 6. 9 4 9 2 8 . 0 O
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) OSeparate Billing Requested ..... .. 7. 6 516 6. O 0
8. Total Gross Assets (total Lines 1 through 7) ........................ .. 8. 16 6 0 9 2 . O 0
9. Funeral Expenses and Administrative Costs (Schedule H) ............... . 9. 18 9 3 . D O
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ........... . 10. 9 5 4 4 . D 0
11. Total Deductions (total Lines 9 and 10) ............................ . 11. 114 3 7 . O D
12. Net Value of Estate (Line 8 minus Line 11) .......................... . 12. 15 4 6 5 5 . 0 0
13. Charitable and Governmental BequestslSec 9113 Trusts for which
an election to tax has not been made (Schedule J) .................... .. 13. O • O O
14. Net Value Subject to Tax (Line 12 minus Line 13) .................... .. 14. 15 4 6 5 5 . 0 O
TAX CALCULATION -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 .0 O 1 5. O.O O
16. Amount of Line 14 taxable
at linealrateX.o 45 154655.00 18. 6959.48
17. Amount of Line 14
taxable at sibling rate X . 12 17. O . O O
18. Amount of Line 14 taxable
at collateral rate x . 15 18. 0 . 0 0
19. TAX DUE ...................................................... . 19. 6959.48
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~
Side 2
L 1505611280 1505611280
REV-1500 EX (FI) Page 3 File Number 052-16-8866
Decedent's Complete Address: 2011-00685
DECEDENT'S NAME
ANNA WINCHESTER
STREET ADDRESS
MESSIAH VILLAGE
100 MT ALLEN DRIVE
CITY STATE ZIP
MECHANICSBURG PA 17055
T ax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
(1) 6959.48
Total Credits (A + B) (2)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in box on Page 2, Line 20 to request a refund.
(3)
(4)
0.00
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 6959.48
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 .................................................................................................................. ...... ^ ^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 Jan. 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 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
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)]. 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-1737-3 EX + (6-08)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
NONRESIDENT DECEDENT
SCHEDULE B, Use Schedule B ONLY for
proportionate method of tax computation.
STOCKS & BONDS
ESTATE OF FILE NUMBER
ANNA WINCHESTER __ 2011-00685
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
39 SHARES OF METLIFE COMMON STOCK $43.56 PER SHARE
TOTAL (Also enter on Line 2, Recapitulation.
(If more space is needed, use additional sheets of paper of the same size)
DEATH
1,699
REV-1508 EX+(11-10) SCHEDULE E
Pennsylvania CASH, BANK DEPOSITS, & MISC.
NHERITANCEOAXR TURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
ANNA WINCHESTER 2011-00685
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
If more space is needed, use additional sheets of paper of the same size.
REV-1737-5 EX + (5-OS)
COMMONWEALTH OF PENNSYLVANIA SCHEDULE F, PART 1
INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY
NONRESIDENT DECEDENT
ESTATE OF FILE NUMBER
ANNA WINCHESTER 2011-00685
Part 1 must include jointly-owned real estate and tangible personal property located in Pennsylvania. Complete Part 2. on reverse side to
include all other jointly held property whenever located ONLY when the proportionate method of tax computation is elected.
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
A. CHRISTINE W. DELOACHE 737 OAK HILL DRIVE DAUGHTER
BOILING SPRINGS, PA 17007
B.
C.
LETTER DATE % OF DATE OF DEATH
ITEM FOR JOINT MADE DESCRIPTION OF PROPERTY DATE OF DEATH D ECD'S VALUE OF
NUMBER TENANT JOINT Attach deed fOf ~Ointl -held real estate. VALUE OF ASSET IN TEREST DECEDENT'S INTEREST
1. A. 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
PART 1 TOTAL
$ 0
PART 2 TOTAL
Pro ortionate Metho d Onl From rev erse side. $ 94,928
TOTAL (Also enter on Line 6, Recapitulation)I $ 94,928
(If more space is needed, use additional sheets of paper of the same size)
REV-1737-5 EX + (6-08)
REVERSE
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
SCHEDULE F, PART 2
JOINTLY-OWNED PROPERTY
Use Schedule F, Part 2, ONLY for
proportionate method of tax computation.
ESTATE OF FILE NUMBER
ANNA WINCHESTER 2011-00685
Part 2 must include jointly-owned real estate and intangible personal property wherever located.
ITEM
NUMBER LETTER
FOR JOINT
TENANT
DATE MADE
JOINT DESCRIPTION OF PROPERTY
Include name of financial institution and bank account number or
similar identi in number. Attach deed for'ointl -held real estate.
DATE OF DEATH
VALUE OF ASSET %a OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1. A. 11/1/2006 PNC BANK PREMIUM MONEY MARKET ACCOUNT 171,655 50% 85,828
NUMBER 5004883931 0
0
2 A 11/1/2006 PNC BANK INTEREST CHECKING ACCOUNT 18,200 50% 9,100
NUMBER 5004883309 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
PART 2 TOTAL
(Enter on Line 2, Part 1.) $ 94,928
(If more space is needed, use additional sheets of paper of the same size)
REV-1737-6 EX + (6-08)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
INHERITANCE TAX RETURN
NONRESIDENT DECEDENT
Use Schedule G, Part 2, ONLY for
proportionate method of tax computation.
ESTATE OF
FILE NUMBER
ANNA WINCHESTER 2011-00685
Part 1 must include all transfers of real estate and tangible personal property located in Pennsylvania.
Complete Part 2 ONLY when the proportionate method of tax computation is elected.
Include in the description of property the date the transfer was made and the name and relationship of the transferee. This schedule
must be completed and filed if the answer to questions 1 throu h 4 on the reverse si de of the R EV-1737 cover sheet is es.
DESCRIPTION OF PROPERTY
ITEM Include the name of the transferee, the relationship to Decedent and the DATE OF DEATH % OF DECD'S EXCLUSION
NUMBER date of transfer. Attach a copy of the deed for real estate. VALUE OF ASSET INTEREST (IF APPLICABLE) TAXABLE VALUE
1. 0
0
0
0
0
C
0
0
0
0
0
0
0
0
0
a
0
PART 1 TOTAL $ 0 0% $ 0 $ 0
•
DESCRIPTION OF PROPERTY
ITEM Include the name of the transferee, the relationship to Decedent and the DATE OF DEATH % OF DECD'S EXCLUSION
NUMBER date of transfer. Attach a copy of the deed for real estate. VALUE OF ASSET INTEREST (IF APPLICABLE) TAXABLE VALUE
1. PNC BANK ACCOUNT NUMBER 31800320260 65,166 100% 65,166
CERTIFICATE OF DEPOSIT, INTRUST FOR 0
CHRISTINE W. DELOACHE, DAUGHTER 0
ESTABLISHED 11-05-2007 0
0
0
0
0
0
0
U
0
0
0
0
0
0
PART 2 TOTAL $ 65,166 100% $ 0 $ 65,166
TOTAL (Also enter on Line 7, Recapitulation.)I $ 65,166
{If more space is needed, use additional sheets of paper of the same size)
REV-1737-6 EX + (6-08)
REVERSE
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
NONRESIDENT DECEDENT
Use Schedule H ONLY for proportionate
method of tax computation.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
ANNA WINCHESTER 2011-00685
Debts of decedent must be reported on Schedule I.
ITEM NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. MALPEZZI FUNERAL HOME- BALANCE DUE 123
2 LAST RITES - ST FRANCIS OF ASSI PARISH 200
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commission(s)
Name(s) of Personal Representative(s)
(Submit requested information for additional personal representative's on additional sheets)
Social Security Number(s) or EIN Number(s) of Personal Representative(s)
Street Address(es)
City(ies) State(s) ZIP(s)
Year(s) Commission Paid
2. Attorney Fees
3. Probate Fees
4. Accountant's Fees
5. Tax Return Preparer's Fees
6. Miscellaneous Expenses
REGISTER OF WILLS
REGISTER OF WILLS -SHORT CERTIFICATE
TOTAL (Also enter on Line 9, Recapitulation.) $
(If more space is needed, use additional sheets of paper of the same size)
1,200
362
8
1
REV-1737-7EX+(6-08) SCHEDULE
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS
NONRESIDENT DECEDENT
Use Schedule I, Part 2, ONLY for
proportionate method of tax computation.
ESTATE OF FILE NUMBER
ANNA WINCHESTER 2011-00685
Part 1 must include mortgage liabilities, liens and taxes against the Pennsylvania realty that were due and
owed as of the date of decedent's death.
Complete Part 2 ONLY when the proportionate method of tax computation is elected.
... ~~ ~ . .
ITEM
NUMBER DESCRIPTION AMOUNT
1.
TOTAL PART 1 $ 0
ITEM
NUMBER DESCRIPTION AMOUNT
1. MESSIAH VILLAGE -FINAL NURSING HOME BILLS 9,414
2 VAN CHARGE FOR TRANSPORTATION FROM HOSPITAL 48
3 VERIZON PHONE CHARGE 15
4 ALERT PHARMACY 67
TOTAL PART 2 $ 9,544
TOTAL Also enter on Line 10 Reca itulation . $ 9,544
(If more space is needed, use additional sheets of paper of the same size)
REV-1737-7 EX + (6-08)
REVERSE
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
NONRESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
ANNA WINCHESTER 2011-00685
When flat rate method is elected, list the beneficiaries of the Pennsylvania property.
When proportionate method is elected, list all beneficiaries.
RELATIONSHIP TO
ITEM DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSONS RECEIVING PROPERTY Do Not List Trustees OF ESTATE
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions and transfers under Sec. 2116 (a)(1.2)]
1. CHRISTINE W. DELOACHE DAUGHTER 154,655
737 OAK HILL DRIVE
BOILING SPRINGS, PA 17007
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON REV-1737 COVER SHEET OR THE PROPORTIONATE METHOD WORKSHEET
ON THE REVERSE SIDE OF REV-1737 COVER SHEET, AS APPROPRIATE.
Il. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II
Enter total non-taxable distributions on Line 13 of REV-1737 cover sheet. $ 0
(If more space is needed, use additional sheets of paper of the same size)
REGISTER OF WILLS
CUMBERLAND COUNTY
PENNSYLVANIA
CERTIFICATE OF
GRANT OF LETTERS
No . 2011- 00685 PA No . 2 9 - ~ ~ - 0685
Estate Of : ANNA W/NCHESTER
(First, Midd/e, Lastl
Late Of : UPPER ALLEN TOWNSHIP
CUMBERLAND COUNTY
Deceased
Soci a1 Security No : 052- ~ 6-8866
WHEREAS, on the I7th day of June 2011 an instrument dated
February 20th 1999 was admitted to probate as the last will. of
ANNA WINCHESTER
!First, Middle, Last1
Late of UPPER ALLEN TOWNSHIP, CUMBERLAND County,
who died on the 4th day of February 2011 and,
WHEREAS, a true copy of the wi11 as probated is annexed hereto.
THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, .hereby
certify that T .have this day granted Letters TESTAMENTARY to:
CHRIS T/NE W DEL OA CHE
who has duly qualified as EXECUTOR(R/X)
and has agreed to administer the estate according to law, all of which
fu11 y appears o:f record in my office a t CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and a.f.fixed the seal
of my office ~n the 17th day of June 201 ~.
* *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, .LAST)
~ro~~„ .... _..
~~st iCC ~tttb C`~e~ttt~ttertt
I, ANNA WINCHESTER, residing at 105 Grove Avenue, Albany, New York, being of
sound mind and memory, do make, publish and declare this to be my Last Will and Testament.
hereby revolting all wills and codicils heretofore made by me.
FIRST: I direct that all of my just debts and my funeral expenses by paid as soon as
practicable after my death.
SECOND: All the rest, residue and remainder of the property of whatsoever kind and
nature and wheresoever situate, I give devise and bequeath to my daughter, CHRISTINE
WINCHESTER DeLOACHE, absolutely and forever.
THIRD: In the event that my daughter, CHRISTINE WINCHESTER DeLOACHE
shall predecease me, then in that event, I give, devise and bequeath all the rest, residue and
remainder of my property, whether real, personal or mixed, of whatsoever kind and nature and
wheresoever situate, to my granddaughter, ALF,THEA WINCHESTER to be hers absolutely
and forever.
LASTLY, I hereby nominate, constitute and appoint my daughter, CHRISTINE
WINCHESTER DeLOACHE as .Executrix of this my Last Will and Testament hereby
revoking all former wills and codicils by me made, If my daughter is for any reason unable to
serve as Executrix, then and in that event, I nominate, constitute and appoint my granddaughter,
ALETHEA WINCHESTER as Substitute Executor and I direct that my Executrix and
Substitute Executrix shall not be required to file any bond for the faithful performance of their
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dlltleS. C~ ""'
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IN WITNESS WHEREOF, I hereby subscribe my name this ~ L day~~ary`~
~-~~~
Nineteen Hundred and Ninety-nine. no ?~~
N1~V A WINCHESTER ~'
~_
We, whose names are hereto subscribed, DO CERTIFY that on the~~ day of February,
1999, the Testatrix above named, subscribed her name to this instniment in our presence and in
the presence of each of us and at the same time, in our presence and hearing declared the same to
be her LAST WILL AND TESTAMENT, and requested us and each of us to sign our names
thereto as witnesses to the execution thereof, which we hereby do in the presence of the
Testatrix and of each other, on the day of the date of the said Will and write opposite our names
our respective places of residence.
/~ , ~ /~ I
(i '.~ ~~l :', C' _.V; ~ residing at ~')~ ~, f-f ri a4° > ' .~' ~ : ~r
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~J.1~tr;:.,.. t,X s__=~. "~.cz ;~_ residing at (c( del-L«?~:c;_~e p Lim i~i~t~.;rx~~
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STATE OF NEW YO12K:
~ : ss.:
I COUNTY OF ~1~~;~~
4
On this2-eJ day of February, 1999, personally appeared before me, a Notary Public in
and for the State of New York Gloria T1. Schultz and ?~rlli~ 11e.Loache who
being severally duly sworn on their respective oaths, depose and say that they witnessed the;
execution of the attached Last Will and Testament of ANNA WINCHESTER, the within named
-~ ~~
Testatrix, on they day of February, 1999; that said Testatrix, in their presence, subscribed
said Will at the end thereof and at the time of making such subscription declared the instniment
so subscribed by said Testatrix to be said Testatrix's Last Will and Testament; that they, at the;
request of said Testatrix and in the said Testatrix's sight and presence and in the sight and
presence of each other thereupon witnessed the execution of said Will by said Testatrix by
subscribing their names and witnesses thereto; that said Testatrix at the time of the execution of
said Will, appeared to them of full age and of sound mind and memory was in all respects
competent to make a Will and was not under any restraint; that they are malting this affidavit at
the request of said Testatrix.
// !!//c~_
~~ ~ ~~Llea~~ ,
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Sworn to before me this
.~~ day of February 1999. Notary Pub~cB. SCate oNNew York
~ ~ Qualified in Albany County
,~~~~,/~y ~ No 02CA5049496 c~c1
~~ Notary Public Commisscon Expires Sept. 18,19.
i
l'NETRO
BANK
Metro Bank
3801 Paxton Street
Harrisburg PA 17111-1418
1-888-937-0004
mymetrobank.com
>11251 6829443 001 (792140
ANNA WINCHESTER
CHRISTINE W DELOACHE REP PAYEE
737 OAKHILL DR
801LING SPRINGS PA 17007
We're here 7 days a week, 24 hours a day at 1-888-937-0004.
50 PLUS CHECKING 0833288103
Statbmetit'Salance as of Di126lit ; ~
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Check Transactions
Number _ Date Amount Number Date Amount Number DateAmount
~Q5 _ - 02122 1 $317_a~~~ , r ' 107* 02/22 $3,500.00 _' x'"'~ ~: ~ `; ~ u~. ;'
Items denoted with an "E" are electronic entries and will not have a check image. Items denoted with an ""' indicate processed checks out of sequence.
Interest Summary
Beginning Interest Rate a '
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Fees Summary
v ,., ~ ,
dotal C~ye~draft Fees this Stateme'~ :Pe d .~ ~ s ~`' -~ _ fi ;
a ~~
Total Overdraft Fees Year to Date 50.00
Total Retu~nedItem F~gs thls:Staterpe t "a ~Y, '--- - ,,-ys 1, r. ~ ~,,,:z4~ ,,: w~ 7 3 ,r. ~; ~ „ £= $0:00
Total Returned Item Fee ~ ~ ~ ~ ~ ~ r c ~ ~ -,w v ~~~
s Year to Date $0.00
For your convenience, a summary of overdraft and returned item fees appears on your monthly statement. Please note that the overdraft fee
summary includes non-sufficient funds fees, uncollected funds fees and unavailable funds fees. The summary does not reflect refunded or waived
items credited to your account.
2B Cycle Page 1 of 6 MErRo-ROLL
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AND F I L E
PD Box zeocol TAXPAYER RESPONSE ACN
HARRISBURG PA 17128-0601
DATE
REV-1543 EX AiP (06-OB)
N0. 21
11118120
03-18-2011
CHRISTINE W DELOACHE
737 OAK HILL DR
BOILING SPRINGS PA 17007-9624
EST. OF ANNA WINCHESTER
SSN 052-16-8866
DATE OF DEATH 02-04-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
~~ CHECKING
TRUST
CERTLF.
PNC BANK NA provided the Department with the information below, which has been used in calculatins the
potential tax due. Records indicate that at the death of the above named decedent, you were a 9oint 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
Pennsylvania. Please call C717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMEt~.7 INSTRUCTIONS
Account No. 5004883931 Date 11-01-2006
Established
Account Balance ,~ 171 , 654.63
Percent Taxable X 50.000
To ensure proper credit to the account, two
copies of this notice must accompany
payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
NOTE: If tax payments are made within three
Amount Subject to Tax $ 85,827.32 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 $ 3,862.23 nine months after the date of death.
PART TAXPAYER RESPONSE
FAitURE~..TO.-RESPOND-'WILCrRESULT>~`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 H E C K a discount or avoid interest, or 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.
ONE
B L 0 C K ~
O N L Y
B. ~ The above asset has been
to be filed by the estate
or will be reported and tax paid with the Pennsylvania Inheritance Tax return
representative.
C. ~ The above informs ion is
Complete PART ~2 and/or incorrect and/or debts and deductions were paid.
PART ~ below.
PART If indicating a different tax rate, please state ; -OFFICIAL" USE ONLY
~ AA F
relationship to decedent: ..
,
._>,
~
TA;;DEF.ARTME:NT
~ OF. REVENUE
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD' ' -
LINE
1.
Date Established
1 c=~ ~ .,
ll -
v
2. Account Balance 2 +fi l": r -
' -
2
3. Percent Taxable 3 X '3 ~' - > `"`''T
4. Amount Subject to Tax 4 +fi ~'4 "~"
5.
Debts and Deductions
5 ,~~
5 ';~~' - -
6. Amount Taxable 6 $ =,'6 ~7„3~`. ey;
7. Tax Rate 7 X °,7~ ^'i~,~c ~>?- t-~.,.-, Y~.~%,
,
8. Tax Due 8 ~` ..
r,
::;~8 ,'~.~a,a ~~,",~~ £~
PART DEBTS AND DEDUCTIONS CLAIMED
^S
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best cf my knowledge and belief. HOME C )
WORK C )
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
IUTAL tinter on Line 5 of Tax Computation) S
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU DF INDIYIDUAL TAXES AND FILE N0. 21
PD BOX 280601 TAXPAYER RESPONSE ACN 11118119
HARRISBURG PA 17128-0601
DATE 03-18-2011
REV-1543 EX AFP (DB -o 87
.~'
CHRISTINE W DELOACHE
737 OAK HILL DR
BOILING SPRINGS PA 17007-9624
EST. OF ANNA WINCHESTER
SSN 052-16-8866
DATE OF DEATH 02-04-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FDRMS TD:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
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, 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 Commonwealth of
Pennsylvania. Please call C717) 787-8327 with questions. _
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 5004883309 Date 11-01-2006 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance y` 18, 199.60 payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable )( 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax: $` 9, 099.80 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 $ 409.49 nine months after the date of death.
PART TAXPAYER RESPONSE
FAILURE TO RESPONI~3 ~~VILL!'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 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.
C. ~ 'f he above information is incorrect and/or debts and deductions were paid.
Complete PART ~ and/or PART ~ below.
PART If indicating a different tax rate, please state OFFICIAL llSE -0NLY ~ AAF
relationship to decedent: ~ rs -
PA;~,~DEP,ARTMENT"~OF REVENUE
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
LINE 1. Date Establishetl 1 j -
2. Account Balance 2 +S 2.
3. Percent Taxable 3 X ">3 ~ -
4. Amount Subject to Tax 4 $ 4
5. Debts and Deductions 5 - `..5 - '•f='cx"
6. Amount Taxable 6 $ `6 -
7. Tax Rate 7 X •;~'~ 4 ~"'~ `'~-'
8. Tax Due 8 $ ~ - ~ $ ( ~~?' ~ '"
PART DEBTS AND DEDUCTIONS CLAIMED
^3
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
IUTAL itncer on Line 5 of Tax Computation) S
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowledge and belief. HOME C ~
WORK C ~
TAXPAVFR STrNATI1RF TFI FPH(lNF NIIMBFR DATE
PENNSYLVANIA INHERITANCE T~
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES A N D
Po Box zao6ol TAXPAYER RESPONSE
HARRISBURG PA 17128-0601
REV-1543 EX AFP (OB-OB)
FILE N0. 21
ACN 11118118
DATE 03-18-2011
CHRISTINE W DELOACHE
737 OAK HILL DR
BOILING SPRINGS PA 17007-9624
EST. OF ANNA WINCHESTER
SSN 052-16-8866
DATE OF DEATH o2-04-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
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, you were a ioint 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
Pennsylvania. Please call (717') 767-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 31800320260
Account Balance
Percent Tazable
Date 11-05-2007
Established
$ 65,166.33
X 100.00
To ensure proper credit to the account, two
copies of this notice must accompany
payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Amount Subject to Tax $ 65, 166.33 NOTE: If tax payments are made within three
months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Potential Tax Due Any Inheritance Tax due will become delinquent
$ 2, 932.48 nine months after the date of death.
PART TAXPAYER RESPONSE
1^
FALtURE'T~D`RESPOND_WILLRESU~T INkAN'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 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.
C. ~ The above information is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART ~ below.
PART It indicating a different tax rate, please state
OFFICIAL USES DN
2 relationship to decedent: LY ~ AAF
.,PA`DEPARTMENT OF REVENUE
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD_
LINE 1. Date Established 1 1.'~. ~,
2. Account Balance 2 $ <2
3. Percent Taxable 3 X 3 .
4. Amount Subject to Tax 4 $ -'4 -
5. Debts and Deductions 5 - ~ '
6. Amount Taxable 5 $ 6
7. Tax Rate 7 X ~ '~-'- ~ °~t-
8. Tax Due g $ -: :8 , ir.
PART DEBTS AND DEDUCTIDNS CLAIMED
3^
DATE PAID PAYEE DESCRIPTION eMniiur DA7n
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowledge and belief. HOME C ~
WORK C ~
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
~~~.+~ ~~„~er vn amine ~ or iax Computation) S