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Home My WebLink About08-24-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 014885 MILLER DAWN L 24 PRESBYTERIAN DR MECHANICSBURG, PA 17050 fold ESTATE INFORMATION: ssrv: 207-34-6721 FILE NUMBER: 211 1-0274 DECEDENT NAME: SPOTTS KENNETH EDWIN DATE OF PAYMENT: 08/24/2011 POSTMARK DATE: 08/24/201 1 couNTY: CUMBERLAND DATE OF DEATH: 02/22/201 1 REMARKS: CHECK# 512 SEAL ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ S 1,626.86 REV-1162 EX111-96) TOTAL AMOUNT PAID: INITIALS: DB RECEIVED BY: S 1, 626.86 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS Aug 85 2811 14:15:58 Schmerge, Lauren -> Schmerge, Lauren Page 882 ~ REQUEST FOR WAIVER r, ~ - ~_ ', , - , '~: O Pennsylvania i oR ~E_ _ ': , ,~ QEPARTMENT of pEVENl1E NOTICE OF TRANSFER ~ ~~ ~ `~ BUREAU OF INDNIDUAL TAXES (FOR STOCKS, BONDS, SECURITIES OR PO BOX 28o6c1 HARRISBURG, PA iyuS-o6oi ~ SECURITY ACCOUNTS HELD IN BENEFICIARY FORM) ~, ~; ;_; ~ ~ Lr -' : ~ ~.~ L~ DECEDENT INFORMATION DECEDENT NAME; LAST C~~~`S~ FIRST ).(f'/~/)~/~) DECEDENT SOCIAL SECURITY NUMBER / 'DECEDENT DATE OF DECEDENT STREET ADDRESS ~~ CITY STATE ZIP CORPORATION, FINANCIAL INSTITUTION OR BROKER INFORMATION NAME OF CORPORATION, F]NANCIAL INSTITUTION, BROKER OR SIMILAR ENTITY /ZV t'.S'~1y7~~ 7 fJ FIRM STREET DDRE55 CITY _~ 2 Or VDi'15`)i r ~ Str~ f bias-~ ACCOUNT INFORMATION TYPE OF ACCOUNT vu.• -~, .} ~ MI CPS `','1"'' ~ :J'~~~ %~ ~~ ~ DYYYY~ ~,~~ d COUNTY "~ ~ '~r~~~~~r/Cti TELEPHONE NUMBER STATE ZIp n-I n CAPITAL STDCK REGISTERED BOND SECURITY A55ET SECURITY ACCOUNT OTHER ~ ~ ~ ~ ~ ACCOUNT BALANCE (Include atCrued Interest through date of death) IDE ~ FYING,NUMBER ~ ASS,ET _.,...,.,.,,..,., x`37, D,~?l1. ~~ ~~ ~-~~~ ACCOUNT TITLE [~ ACCOUNT WILL BE FILED ON REV-1500 ~ ~ ~ ^ BILL BENEFICIARIES SEPARATELY BENEFICIARY INFORMATION 1, NAME: LAST n FIRST ' ~~~ ~~ ~, l ~ II ~ y~ LC G(. J) MIL 1 ~ /DPERCENT TAXABLE STREET AD ESS I CI'fV ~ ',;.~ - ,.. RELATIONSHIP TO DECEDENT ~~ BENEFICIARY'S SOCIAL,SECURITY NUMBER ~~~ ;. BENEFICIARY INFORMATION :2,, NAME; LAST FIRST MI PERCENT TAXABLE STREET ADDRESS CITY STATE ZIP ~~~~~! >' i _ ~~ :... TA `~ ELATIONSHIP TD DECEDENT aFniocrrtenwc en~rA~ «,.,,~.~., .,~ ~....~ BENEFICIARY INFORMATION 3, NAME; LAST FIRST MI PERCENT TAXABLE ~ 'STREET ADDRESS ,CITY STATE ZIp - ,V~,~' '~~: ,:. RELATIONSHIP TO DECEDENT BIpENEFICIARY'S SOCIAL SECURITY NUMBER ~~•" ~ L.~~.. ~~ , ~,~,~~~~:~~~~~~~.~~u,~y..m~:„~~u,:ry,~l .: , Pleeae Ilat addltlonel t-eneilclerlea on another sheet of paper, provlding all required Informetlon. - ~ ~~ ~~ 7 580 - ~5zc~ SIGNATURE 0 PREPARER AYTIME TELEPHONE NUMBER Instructions for filing this notice ere on the reverse aide. Aug 85 2811 14:16:18 Schmerge, Lauren -> Schmerge, Lauren Page 883 INSTRUCTIONS FOR FILING THE REQUEST FOR WAIVER OR NOTICE OF TRANSFER PURPOSE OF INSTRUCTIONS Sactlon 6431 of the Probate, Estates and Fiduciaries Code (Title Z0, Chapter 64, Pennsylvania Consolidated Statutes) sets forth the requirement of reporting to the Department of Revenue the transfer of securities. This section states: (e) Payment of inheritance tax. - No corporation, financial institution, broker or similar entity shall transfer on its books or issue a new certlflcate for any share of its capital stock, Its registered bonds, a security pr a security account, belonging to or standing In the name of a resident decedent, belonging to or standing in the joint names of a resident decedent and one or more persons, held In trust by or For a resident decedent or In a beneflclary form Indl[ating that a resident decedent was the present owner or became the owner upon the death of another, unless the inheritance tax upon the transfer has actually been paid, or the written consent of the Secretary of Revenue, or Its designee, Is first secured, or there Is presented to It an affidavit of the personal representative or heir of the decedent, or his or their attorney, that the decedent was a nonresident at the time of his death, or that the person in whose name said security, security account, shares of registered bond stands jointly with the decedent by right of survivorship was the spouse of the decedent at the time of death and that the ownership in or designation of such spouse was not created within one year before the decedent's death, or written notification of the transfer is given to the Secretary of Revenue within ten days of the transfer as provided In subsection (d). WHO MUST FILE Corporations, flnandal Instltutlons, brokers, or similar entitles are required to report, The beneflclary, trustee or repreaentatlve of the estate may also request a waiver if all the necessary information is available to them. WHAT TO REPORT Capital Stock, registered bonds, a security or a security account which are held as follows: • Held as sole owner by the decedent with a sole beneflclary clause which controls distribution at the death of the decedent • Held as a sole owner by the decedent with a primary and secondary (contingent) beneficiaries clause which controls dis- trlbutlan at the death of the decedent, HDW TO REPORT Use a separate form for reporting each account submitted. If there is a main account with sub accounts creating that main account, please only report the main account number and total value. Each form must contain the following information to be processed: • tl~e appropriate decedent information • corporation, financial institution or registering entity inforrciation • account Information • beneficiary information • Multiple beneflclarles of the same asset should be reported an a single form, If there are mare than three beneflcla- ries please continue numbering on another sheet of paper of the same sine, indicating all of the required information. The actual security Information will be reviewed to determine taxability, Thls makes It extremely Important that the form be com- pleted accurately and completely. All assets must be reported at their value as of the decedent's date of death, including any accrued interest not yet credited or any dividend earned but not issued as of the date of death. Please also be sure to indicate under the Account Information if the account will be reported on the REV-150[7 ar if separate billings for each beneficiary listed should be prepared, Mail completed form to; PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION -WAIVER REQUEST PO BOX 28D6D1 HARRISBURG PA 17128-06D1