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HomeMy WebLinkAbout12-03-12COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1~128~0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DAVIES BRIAN W 2495 COPE DRIVE SOUTH MECHANICSBURG, PA 17055 REV-1162 EX111-961 N0. CD 016867 ACN ASSESSMENT AMOUNT CONTROL NUMBER Iola ESTATE INFORMATION: FILE NUMBER: 2112-1252 DECEDENT NAME: DAVIES ROBERTA D DATE OF PAYMENT: 12/03/2012 POSTMARK DATE: 1 1 /30/201 2 COUNTY: CUMBERLAND DATE OF DEATH: 09/28/2012 12156187 ~ 531.85 12156190 ~ 54.30 12156193 ~ 5123.07 12156196 ~ 5856.05 TOTAL AMOUNT PAID: REMARKS: SEAL CHECK#168 INITIALS: HEA RECEIVED BY: $1,015.27 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OP INDIVIDUAL TAXES PO BOX 288601 HARRISBURG PA 17128-0681 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response ~ pennsylvania DEPARTMENT OF REVENUE xev-sae ex m~exec ~oean FILE NO. 2170 ACN 12156196 DATE 10-10-2012 RECQRDE;a GF~iG OF REGiSTcR Or L°;'s.,.LS Estate of ROBERTA D DAVIES fit S N 48-5650 Zl~i? CE~ 3 p+ I D to eath 09-28-2012 BRIAN W DAVIES County CUMBERLAND 2495 COPE DR CLERK Oi= MECHANICSBURG PA 17055-5355 ORPHANS COt1RT CUMBERLAND GG., PA Type of Account Savings Checking Trust X Certificate MEMBERS Isr Fcu provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Remit Payment and Forms to: Account NO. 272428 Date Established 03-25-2009 REGISTER OF WILLS Account Balance $ 120 143.60 1 COURTHOUSE SQUARE , CARLISLE PA 17013 Percent Taxable X 16.667 Amount Subject to Tax $ 20 024 37 . , Tax Rate X 0.045 NOTE': If tax payments are made within three months of the Potential Tax Due $ 901.10 ~~ decedent's date of death, deduct a 5 percent discount on the tax With 5% Discount (Tax x 0.95) $ (see NOTE')"` `a 5 (p,f/5 due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1: Please check the appropriate boxes below. 1 A ~ No tax is due. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. g ~ The information is correct. C ~ The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. E ~ Asset will be reported on inheritance tax form REV-1500. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15% All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete Part 2 and part 3 as appropriate on the back of this form. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART z Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach 8 1/2" x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total (Enter on Line 5 of Tax Calculation) $ PART Tax Calculation 3 If you are making a correction to the establishment date (Line 1) account balance (Line 2), or percent taxable (Line 3), please obtain a written correction from the financial institution and attach it to this form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "in trust for" another or others were 100% owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33%, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. It indicating a tlifferent tax rate, please state your relationship to the decedent: 1. Date Established 1 2. Account Balance 2 $ 3. Percent Taxable 3 X 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 7 X 8. Tax Due 8 9. With 5% Discount (Tax x .95) 9 X Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent" Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. ~.. Work r ~ ~ Home t..51-R311~ 1-lil\ /I - ~s-~- f~-- Taxpayer Signature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ON LY: 1-800-447-3020 BUREAU OF INDIVIDUAL TAXES PO BOX 288601 HARRISBURG PA 17128-0681 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response R;Yrd/ i~r l~ni Or ~ pennsylvania DEPARTMENT OF REVENUE REV-1543 E% YocE%E[ tRR~IZI FILE NO. 2170 ACN 12156193 DATE 1 U-10-2012 (~~,? DCL 3 PI'I 1 2~ Estate of ROBERTA D DAVIES CLERK Q" ssN z13-as-ssso Date of Death 09-28-2012 BRIAN W DAVIES t~ OR~HAflS' Cai~Ri'CountyCUMBERLAND MECHANOICSBURG PA 17055-53~~MBERLAi'JC mil'., ?f} Type of Account Savings Checking Trust Certificate MEMBERS Isr Fcu provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Account NO. 272426 Remit Payment and Forms to: Date Established 12-29-2005 REGISTER OF WILLS Account Balance $ 34,548.69 1 COURTHOUSE SQUARE Percent Taxable X 8.333 CARLISLE PA 17013 Amount Subject to Tax $ 2,878.94 Tax Rate X 0.045 NOTE': If tax payments are made within three months of the Potential Tax Due $129.55 decedent's date of death, deduct a 5 percent discount on the tax With 5% Discount (Tax x 0.95) $ (see NOTE') 12~i.~ due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1: Please check the appropriate boxes below. 1 A ~ No tax is due. g The information is correct. C ~ The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. E ~ Asset will be reported on inheritance tax form REV-1500. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15% All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete Part 2 and part 3 as appropriate on the back of this form. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART z Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach 8 1/2" x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total (Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If ou are makin a correction to the establishment date Line 1 account balance Line 2 , or Y 9 ( ) ( ) percent taxable (Line 3), please obtain a written correction from the financial institution and attach it to this form. 1 . Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "in trust for" another or others were 100% owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33%, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. your relationship to the deced 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 9. With 5% Discount (Tax x .95 cJtep 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent:' Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. ~ Work c ~\ ~' -n- mil-~/ 3((~ Taxpayer Signature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 1]328-0601 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response ~ Pennsylvania DEPARTMENT OF REVENUE xEV-,s~5 cx uo,cxEC cae-,z, FILE NO. 2170 ACN 12156190 DATE 10-10-2012 2112 D"t~ 3 FI~ i Estrate of ROBERTA D DAVIES _ SSN 213-48-5650 CLERK C Date of Death 09-28-2012 BRIAN W DAVIES ORPNANS~ C^,UF'CountyCUMBERLAND 2495 COPE DR MECHANICSBURG PA 171155-5~MBERLAND Cu., PA Type of Account Savings X Checking Trust Certificate MEMBERS Isr Fcu provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Account No. 272428 Date Established 10-03-2005 Account Balance Percent Taxable Amount Subject to Tax $ 1,208.64 X 8.333 $ 100.72 Remit Payment and Forms to: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 Tax Rate X 0.045 NOTE`: Ii tax payments are made within three months of the Potential Tax Due $ 4.53 decedent's date of death, deduct a 5 percent discount on the tax With 5% Discount (Tax x 0.95) $ (see NOTE`) D due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1: Please check the appropriate boxes below. 1 A ~ No tax is due. g ~ The information is correct. C ~ The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. E ~ Asset will be reported an inheritance tax form REV-1500. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Siep 2 on reverse. Do not check any other boxes. 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15% All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete Part 2 and part 3 as appropriate on the back of this form. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART z Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach 8 1 /2" x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total (Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If ou are makin a correction to the establishment date Line 1 account balance Line 2 or Y 9 ( ) ( ), percent taxable (Line 3), please obtain a written correction from the financial institution and attach it to this form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "intrust for" another or others were 100% owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33%, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. If indicating a different tax rate, please state your relationship to the decedent: 1. Date Established 1 2. Account Balance 3. Percent Taxable 4. Amqunt Subject [o Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due X X 9. With 5 / Discount (Tax x .95) 9 X Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent." Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. Work `- Home IZ-b~(I-~t`31(~ I (-3c3--(Z Taxpayer Signature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 BUREAU OF INDIVIDUAL TAXES PU BOX 280601 HARRISBURG PA 1]128-0601 ~ Pennsylvania DEPARTMENT OF REVENNE vev ssas Ex oo~Exee eae-~z, FILE NO.. 2170 ACN 12156187 DATE 10-10-2012 ..f;EGIST~R i3r"'~.'i:.'_S ~IJ12 ~~E~ 3 ~~ 1 Z~Estate of ROBERTA D DAVIES SSN 213-48-5650 C L E R~ G r Date of Death 09-28-2012 BRIAN W DAVIES County CUMBERLAND 2495 COPE DR ORPHANS CURT MECHANICSBURG PA 170555b5~ERLAND CD., PA Type of Account Savings Checking Trust Certificate MEMBERS Lsr Fcu provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Account No. 272428 Date Established 10-03-2005 Account Balance Percent Taxable Pennsylvania Inheritance Tax Information Notice And Taxpayer Response $ 8,940.83 X 8.333 Amount Subject to Tax $ 745.04 Tax Rate X 0.045 Potential Tax Due $ 33.53 With 5% Discount (Tax x 0.95) $ (see NOTE*) 3 ~ -~ ~ Remit Payment and Forms to: REGISTER OF WILLS 1000RTHOUSESOUARE CARLISLE PA 17013 NOTE*: If tax payments are made within three months of the decedent's date of death, deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1: Please check the appropriate boxes below. 1 A ~ No tax is due. g ~ The information is correct. C ~ The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. E ~ Asset will be reported on inheritance tax form REV-1500. I am the spouse of the deceased or I am the parent of a decedent who was 2f years old or younger at date of death. Proceed to Step 2 on reverse. Oo not check any other' boxes and disregard the amount shown above as Potential Tax Due. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15% All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete Part 2 and part 3 as appropriate on the back of this torm. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART 2 Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach 8 1/2" x 11"sheets of paper.) Date Paid Payee Work ~- Home '711- 6~j 1- 9'31 t~ Description PART Tax Calculation 3 If ou are makin a correction to the establishment date Line 1 account balance Line 2 , or Y 9 ( ) ( ) percent taxable (Line 3), please obtain a written correction from the financial institution and attach it to this form. 1 . Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "in trust for' another or others were 100% owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (Far example: 2owners = 50%, 3 owners = 33.33%, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. your relationship to the deced 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 6 ~ 7. Tax Rate 7 x 8. Tax Due 8 $ 9. With 5% Discount (Tax x .95) 9 x Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of W Ils, Agent " Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. Taxpayer Signature Amount Paid tt-3~-li Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT' 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 ~-+~~ CF RECORDED r,r„„~ RECts ~ ~i of ,;~,~_~s ~~i2 CEC 3 P(~t i 22 CLERK O' ORPHANS' CO~JRT CUMBERLAND CO•~ PA ~ ~~ w 'r, ~ u " ~• ~? ~, ~' ~~ ~,1 ~ h) _ ~ ~ ~„` • (CI ~' ~ 1 r,, e~ 1` ~~~, l/ ~~ ~•~o ~. y l7 :` i7'n T Ir .S ra '} ~s "~ a