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Home My WebLink About12-05-12COMMONW FAITH OF PENN SV LV ANIA REV 1162 EX(i 1-96) DEPARTMENT OF REVENUC BUREAU OF INDIVIDUAL ~AXEG DEPT. 280607 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 016878 CLAY BARRY A 225 FINEVIEW ROAD CAMP HILL, PA 17011 ACN ASSESSMENT AMOUNT CONTROL NUMBER fold ESTATE INFORMATION: ssrv: ass-24-4270 FILE NUMBER: 21 1 1 -1 140 DECEDENT NAME: SIMMONS CAROLINE R DATE OF PAYMENT: 12/05/2012 POSTMARK DATE: 12/03/2012 couNTY: CUMBERLAND DATE OF DEATH: 10/16/2011 REMARKS: BARRY A CLAY SEAL CHECK#5501 12004609 ~ $866.00 TOTAL AMOUNT PAID: $866.00 INITIALS: WZ RECEIVED BY: GLENDA EARNER STRASRAU~H REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES Penns Ivania Inheritance Tax PO BOX 280601 Y HARRISBURG PA 17126-06 01 Ipformation Notice _ ' ~At~Jrfaxpayer Response RECO~C` ~? Ji- ~~ REG1~~=R aF ''_~.S t`~12 OEC ~ Pennsylvania DEPARTMENT OF REVENUE REY-1543 EX pocEXEL (08-12) FILE NO. 2111-1140 ACN 12004609 DATE 11-26-2012 CLERK G" Type of Account pRpHAPIS' CGURT Estate of CAROLINE R SIMMONS Savings SSN 168-24-4270 X Checking BARRY CLAY CU'MgERLAND CU.. PA Date of Death 10-16-2011 Trust County CUMBERLAND Certificate 225 PINE VIEW RD CAMP HILL PA 17011 GRAYSTONE TOWER BANK provided the department with the information below indicating that at the death of the above-named decedent yourw~ere a joint owner or beneficiary of the account identified. Account No. 1710013127 -~p~ `~~' t Z 3 I Z. Date Established 04-08-2009j~ ~~~'~ [~~' Account Balance ~ ~~ 4 T` ~' 1 $ 19,026.11 Percent Taxable X 100 Remit Payment and Forms to: REGISTER OF WILLS 1 COURTHOUSE SOUARE CARLISLE PA 17013 Amount Subject to Tax $ 19,026.11 Tax Rate X 0.045 Potential Tax Due $ 856.17 -~ NOTE': If tax payments are made within three months of the decedent's date of death, deduct a 5 percent discount on the tax With 5% Discount (Tax x 0.95) $ (see NOTE') 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 isj y correcS. qs (Y~ t ~ t,tJ~' ~ h !~G u n i -i 112 t'f~.tv,,`t 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. V~~ PART Debts and Deductions z 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 (Lure t) 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. If indicating a different tax rate, please state ~ ~~ ~ ~ ~ ~~~'~ ~ ~` ~ ~ ~ a v.., wwy your relationship to the decedent: ~~~ a~ ~~~~~1~~'' v~tr~ ~ ; ~ 1. Date Established 1 ~~ ~~'~' ~`~`'~ 2. Account BalanceZ $ .q.i~ A~4y~,L \~!\i~Vw~~\le~~~,+ ,i ~. .,: A.e ~.. ...a~y~r^3F 3. Percent Taxable 3 ~ ~ ' ~~ x _._. Ryt ',t\\\~ vil\? ~i\~i~\~`~~\,~h~ly~~';i\\°\~. \;?~.. ...,i i~\a~~\'~~ 4. Amount Subject to Tax 4 $ _ tia~~ A ~~ ~ ~ `~ * \~~ ~~ ~ 5. Debts and Deductions 5 - ~:" '"' ~ ~ y 1 yy v~iyy ~`y= l~, ~' v ~y~y ~\ 6. AmOUnt Taxable ~J $ ~.'~ '~\\\,~`°~ i..Ai ~ t .. .gyi. ~~ \. t~33~~^,.. A'"~ \ t: 7. Tax Rate / x ~' ,\ 8. Tax Due 8 $ --- ``~`~ 9. With 5% Discount (Tax x .95) 9 X , ~ v~'yy ~.,. .:.:-.. y.,„~~y~.a u~ ~y,~,~,a ~.r a ~~w. sro , 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 f !i7) 6f~5'(/3y Y ~- Home 7l ~ S~ 5 -~l 30 `~ '~~! ~ ~ xpay gnature Telephone Number Date IF YOU NEED FURTHER A SISTANCE, 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 December 3, 2012 225 Fineview Road Camp Hill, PA 1 701 1-8449 Register of Wills 1 Courthouse Square Carlisle, PA 17013 Deaz Register of Wills: I have never received a penny of the $19,026.11 from the checking account identified in your document and never will. After my mother's death, my step-father took it all and has left me to pay the taxes. I have enclosed a copy of the check from the bank that shows he received the money. Having spoken with "Steve" in your office, I am aware that you do not caze about any of this. But I will say this: any law that forces me to pay inheritance tax on monies I never received is an unjust law, and one that needs to be changed. If this were done to you, you would agree. I pay this under protest. Respectfully Yours, C ~C~- ~/ ,1 Barry A. Clay (717) 605-6345 - W (717) 525-9630 - H I3arClavBiz~c~,comcast.net C o ^1~ ~, .'i7 ~ r^ m rn = ~ ~ ~ cn Z m ~ ~ ~ C7 ~'' es ,~ -s'y ~l "rT ~ ` .~ U^ C; ;.L7 --i f--+ rv - ~-~- t;7 r-. r y'r . _ y '~7 ~~~~~ GRAYSTONE BANK x GATE /b•2~ // ~ NAME LP.V'o N .J'71M N.L~OYIC ___ AMOUNT '~ .~~ Q7 Y+ SIGNATURE _ ~""'"^'~ - / T r o p/ 3 1 2 7 4 ~: 5 30 i~N i000~: nDA Debits - 10/2 Fi~~}3t3~9 DOA CLOSEOUT `/ ~}~trna [o ~ 06i s 7a g 4,Y9 Cara Hill SPl ! rah 13 10,~a~~11 ~ols:lE. Gtr P,eij(~lar 4dithdrawal NrrttF Y71~O13127 2`7af78?.4•? BOFD >031318907< 2011-10-25 886658829 is - 10/25/2011 ~ ^ ti w r W ru rv r r :. i 9 ~. ~P ~o~e F 55 a _id o+ 9 s c ~_ ~K O AA y A ~~OD T rsm< °o<D ru ~~ ~ - r ~ _ r ~ -S ru ~j -0 '', rv °r~ p~ ~ L1l LJf a N d ~.; 1 A y F 'vw' IT ~~~ /w LY N 0 ~~~ ~ ~ ~ ,:~ I -~ ~s. ': CLERK 0~ ~RAHANS'CpURT CUMBERLAND CO., pA 4s ~ ~ M i ^L rf ^, ~ 1 W •.,~.. f 4 /~ JV 1 ~rJ ('~ y Y ~ I'1 ~ ~ , -~ ~° R °~ ,~ ~ ~ iz: ~d ., ~~N ..~ 3 ~~. i i f ~ '~ , .. , ~ o-~ „' F ..: ~;::::~ Or" ~'lLLS .. C S ~'n 22 IO -.. :~ .^ .,.; ... .~ .~ .~ .~ ..1 ~ryit (jf eet r~ 5Y~ t.'t 'i'~ ~..( lam`.. ,...t