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HomeMy WebLinkAbout07-17-12~ PENNSYLVANIA INHERITANCE TAX BUREAU of INDIVIDUAL TAXES ~] C INFORMATION NOTICE FILE N0. 21 -- ~ ~ ~ Z~ HARRISBURG6PA 17126-0601 ren ` 1IF("~i.iL lit AND ACN 12137$$2 DE PARTM~OIFIREVP,NN~ :. _. Vt TAXPAYER RESPONSE REV-1543 @xt~i•i~'ta~.•ii~' ;i... '~~lc DATE 06-26-2012 TYPE OF ACCOUNT ~~~~ `~~~ f 7 PM 2~ 3~ EST. OF NORMA R FURLONG ^ savINGs SSN ® CHECKING _M ~;~ DATE OF DEATH 06 - 11 - 2012 ^ TRUST ~ ~~~,;~j~~j COUNTY CUMBERLAND ^ CERTIF. ~, pA REMIT PAYMENT AND FORMS TD: BRENDA L ZOCK mil'! REGISTER OF WILLS 1000 CHIPPENHAM RD 1 COURTHOUSE SQUARE MECHANICSBURG PA 17050-7687 CARLISLE PA 17013 1ST SUMMIT BANK provided the department with the information below, which was used in calculating the inheritance tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If yoU are the spOUSe Of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe 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. Please call 717-787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 2531753 Date 06-28-2010 7o ensure proper credit to the account, two Established copies of this notice must accompany Account Balance 3 ~ 196.80 payment to the Register of Wills. Make check V~ payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax ~` i , 598.40 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 ~` 71 .93 nine months after the date of death. PART TAXPAYER RESPONSE L TQ R D WILL- I N IL:I L X 5E 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 return this notice to the Register of Wills and 0 N E 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 filed by the estate representative. C. ^ The above inforna ion is incorrect and/or debts and deductions were paid. Complete PART ~2 and/or PART 3^ below. PART If indicating a relationship to different decedent: tax rate, please state ~~~~ TAX LINE RETURN - CALCULATION OF I . Date Established 1 Tl/~`X ON JOINT/TRUST ACCOUNTS NdV Z~ ~© SAD 2. Account Balance 2 p $ ~ ~ d 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due s X `~. 4 S . CIO s_ - Z 8' . 36 6 $ D 7 X 8 ~` ~ ~~~ PA DEPAiZfi~iENT OF REVENUE 1 2 ~ 3 4 5 6 7 Aar ..... ~. ~a ~. s PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID I D Pf{ H I C:Q coee..IC. ca i ~ r r ,3b _ un amine ~ yr ~ ax l,o mpUiailOn) S -~ ~ ~ /-1 ~~ Under penalties of perjury, I declare that the facts I reported above arffe true, correct and complete to the best ost oiL~owledge and belief. HOME CSI I~ } ~g©-~~Z (~.~~ O WORK C'I I ~ } ~ ~j (- Zio33 Q~SD-1'-~ ~~-I I. TAXPAYER SIGNATURE TELEPHONE NUMBER DAT GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information subeitted 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 calculation 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 IX) 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 two copies 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 IX) upon receipt of the return from the register of wills. TAX RETURN - PART 2 - TAX CALCULATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. 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 53,000 per transferee, regardless of the value of the account or the number of accounts held. If a double asterisk C~*> 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 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 near prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF MULTIPLIED BY 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 1D0 = 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 year 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. ^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 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. 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. c l PAYER ASSISTCE IF YDU NEED~\FURTHER INFORMATION OR ASSISTANCE, CONTACT AAI'~ REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE OR THE BUREAU OF INDIVIDUAL TAXES, AT (.717) 787-8327. SERVICES FOR,TAXPAYERS WITH SPECIAL HEARING AND10R SPEAKING NEEDS a ONLY: 1-800-447-3D2D. 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 percent ~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 21 `1Z -~-"~~~ BUREAU OF INDIVIDUAL TAXES ~ r •~~ , ,--, PO BOX 260601 ff HARRISBURG PA l~lza-0601 '.l - ~ AND ACN 12137$$2 ~~p~~~T~.~:RSa~~k TAXPAYER RESPONSE DATE 06-26-2012 REV-1543 EX RrP (05-11) CC~2.lUL I -~ P~ ~~ 3~ TYPE OF ACCOUNT d EST. OF NORMA R FURLONG ~ SAVINGS -,; SSN © CHECKING + +. n ''~``'~"` '' DATE OF DEATH o6-11-2012 ~ TRUST ~y~p~' ~~~~att "(~~,{~~~j COUNTY CUMBERLAND ~ CERTIF. ~IItJ'1lY~ """ ~ REMIT PAYMENT AND FORMS T0: BRENDA L ZOCK REGISTER OF WILLS 1000 CHIPPENHAM RD 1 COURTHOUSE SQUARE MECHANICSBURG PA 17050-7687 CARLISLE PA 17013 1ST SUMMIT BANK provided the department with the information below, which was used in calculating the inheritance tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you are the spouse Of the notifyethendepartmentnofoyour relationship tofthetdeceased by checkingnBox7CTin PARTllnbelowtandowritingy"spouse" intPART lust If you believe tthe information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. Please call 717-787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND-PAYMENT INSTRUCTIONS ~• L7J1 /5S Date 06-28-2010 To ensure proper credit to the account, two Established copies of this notice must accompany ACCOUnt Balance $ 3, 196 .80 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 50 .000 Amount Subject to Tax $` 1,598 .40 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 $ 71 .93 Any inheritance tax due will become delinquent nine months after the date of death. P RT TAXPAYER RESPO A NSE _ \ 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 return this notice to the Register of Wills and 0 N E an official assessment will be issued by the PA Department of Revenue. B L 0 C K ~ 0 N L Y g, ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return file d by the estate representative. C. ~ The above informs ton is incorrect and/or debts and deductions were paid Complete PART 2~ and/or PART ~ below. . PART ar lnalcaiing a tlifferent tax rate, please state relationship to decedent: TAX RETURN - CALCULATION 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 T X ON JOI 1 ~c~~ ~~ 2 $ s X 4 $ 6 $ b 7 X B_ $ AD PART BATE PAID PAYEE DEBTS AND DEDUCTIONS CLAIMED nFCrorarrnu ' ~ 1 1 L.~ r~,~vv~~~ 1 M1L ~ r Q -t- b i 2 3F, -- - -~ ~~ - iax ~ompuiail0n) $ Under penalties of perjury, I declare that the facts I reported above are true, correct and complete to the best of my knowledge and belief. HOME C~ I~ ~ 5~ ,,~j(pZ ~LQ ~ ~) TAXPAYER SIGNAT ~ ~~ WORK C~ ~~ ~ 1b l Z~33 ~x o-~~ Z TELEPHONE NUMBER D UST ACCOUNTS ~`OFf~1CP°AL~ USE DNI.Y ~ AMY PA DEf'ART#1ENT OF REVENUE 1 2 5 6 7 - 8 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 point 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 ioint 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 BLOCK A - If the information and calculation 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-1546 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 two copies 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 CALCULATION __ _ LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent who died after 12/12/82, accounts the decedent put in ioint names within one year of death are fully taxable. However, there is an exclusion not to exceed 53,OOD per transferee, regardless of the value of the account or the number of accounts held. If a double asterisk C^^) 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 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 TOTAL NUMBER OF MULTIPLIED BY 100 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A point 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 year 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 sub]ect to tax (Line 4). 7. Enter the appropriate tax rate (Line 7) as determined below. *The tax rate imposed an the net value of transfers from a deceased child 21 nears 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 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 Darent 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 B 1/2" x 11" sheet of paper. Proof of payment may be requested by the PA Department of Revenue. ,~ ~ TAXPAYER ASSISTANGE~ .gin ~~ IF YOU NEED FURTHER INFORMATION OR ASSISTANCE, CptACT ANA f~EGISTER DF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE DR TNf BUREAU OF INDIVIDUAL TAXES, AT 0717) 787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL NEARING AND/OR SPEAKING NEEDS ONLY : 1 - 8~=y4 4 0 '"°" ~~° 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 percent HARRISBURG PHARMACY 2250 MILLENNIUM WAY #300 ENOLA, PA 17025 (OFFICE) ~~ ~ ~ ~ a ** ACTIV_ TY FOR FII R IAN NORMA ~~~°°°°° --- _ - ~" Ob/04/12 645Q542 ~0 QII8'rIAPII~]E lOOMG Ol 10` 00 _ - 06/04/12 6450544 0 ~ FOLIC ACID 1MG TA 'O1' . 2 34 06/04/12 6450545 30 r CYMBALTA 60 MG CA O1 ' ~ I . 172.02 ~~~~~ ~~.v v`~ ~~ , ,~ 1b 717-732-2112 .00 1O.OOc .00 2.34 .00 172.02 4 I LEGEND • ' ' FOR MONTH • ~ • ~ .00 { 184.36 + .00 184.36 .00 184.36 Hospice of Central Pennsylvania 1320 Linglestown Road Harrisburg, PA 17110 Voice: 717_732-1000 FaX: 717-234-0384 Resident: Norma Furlong C/O Brenda Zock 1000 Chippenham Road Mechanicsburg, PA 17055 Resident ID: FurlongN Invoice Invoice Number: 4507 InVO1Ce Date: 6/30/12 Page: 1 j Payment Tem1s ( w Due Date Net 15 Days j 7/15/12 Description Amount esidential Care -May 26-June 11, 2012 ~ 2,300.00 , i 1 i ~.-~~~a r ~~~ ~z~.°~ Please note our new office address -- 1320 Linglestown Road, Harrisburg PA 17110 Total Invoice Amount Check/Credit Memo No: payment/Credit Applied TOTAL Thank you for choosing Hospice of Central Pennsylvania 2,300.00 2,300.00 w ~-., ry w n O ha ~ n ~ ~' N rJ Q ~. a ~ ~ ~ oc Y ~ x '-- a ~• 0 v. o {..r. ~i t,~ t :•r ;s ~~i i~~ G J O t ~. ~ <:~ ,-- C~ .~ .. O C a y m ~ < .-. n'