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Home My WebLink About01-03-13 (2)COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TARES DEPT. 280601 HARRISBURG, PA 1 ] 128-0601 RECEIVED FROM: REV-1162 EX111-961 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 016994 DUPLICATE EVANS WILLIAM J 419 CARMELLA DRIVE MECHANICSBURG, PA 17050 ACN ASSESSMENT AMOUNT CONTROL NUMBER Iola ESTATE INFORMATION: ssN: iss-ia-3006 FILE NUMBER: 2112-1338 DECEDENT NAME: EVANS MARGARET W DATE OF PAYMENT: 01/03/2013 POSTMARK DATE: 12/14/2012 COUNTY: CUMBERLAND DATE OF DEATH: 10/02/201 2 REMARKS: SEAL CHECK# 4969 12165013 ~ 551.75 12165015 ~ 549.50 TOTAL AMOUNT PAID: INITIALS: HEA RECEIVED BY: 5101.25 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES PD BOX 280601 HARRISBURG PA 17128-0601 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response Pennsylvania DEPARTMENT OP REVENUE xEVaws ¢x oesxsc roena FILE NO. 2170 ACN 12165015 DATE 11-28-2012 WILLIAM J EVANS 419 CARMELLA DR MECHANICSBURG PA 17050-3718 Estate of MARGARET W EVANS SSN Date of Death 10-02-2012 County CUMBERLAND SOVEREIGN BANK provided the department with the information below above-named decedent you were a joint owner or beneficiary of the ac {'7 ~ o ~~ W ro m x n ~ y. r r ~ rn ~ ~ :za .,,_ x c.~ r,~ .) ~-: Type of Account Savings Checking Trust X Certificate -~; c~ ~ rn m ~ n ~ ~ -~ ~ ~ _..l c-+ I'~5 rrl w rp c~ _ rJ c7 R{ ".,T .3 1 ~ r, ~ at the c~eafN'of the ic.a rr,c7 RemN Payment and Forms to: Account No. 1055539702 Date Established 07-13-2011 REGISTER OF WILLS Account Balance $ 6,949.11 1 COURTHOUSE SQUARE Percent Taxable X 16.667 CARLISLE PA 17013 Amount Subject to Tax $1,156.21 Tax Rate X 0.045 Potential Tax Due $ 52 12 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. t 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 1 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. P eed to Step 2 on reverse. Do not check any other boxes. ~4c.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 81/2" 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 wrHten 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, pleas your relationship to the decedent: 1. Date Established 1 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 8. Tax Due 8 9. With 5% Discount (Tax x .95) 9 x $t@p 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. ~ , , ~n~~--, wore Taxpayer Telephone Number Date ~ 2 _ / 3 . ~ 2 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 BO% 280601 HARRISBURG PA 17128-0601 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response Pennsylvania ~.~1 DEPARTMENT OF REVENUE EY-E56i EX Oa[EXEC (OB-121 FILE NO. 2170 ACN 12165013 DATE 11-28-2012 WILLIAM J EVANS 419 CARMELLA DR MECHANICSBURG PA 17050-3718 Estate of MARGARET W EVANS SSN Date of Death 10-02-2012 County CUMBERLAND A C m r J:. ~. it e"1 Type of Account Savings Checking Trust Certificate c=~ ~L1 ~ rn rTj C7 ~- ~ O -_~ CR ~ n `- C, r' r'1 rXT :~ ~, , c n ~-} ...Y _ _. ~__..... '..~) •-7 F .v ' ~ 1Y1 F - ~~ O -U z z cn (-.1 ~.- ~1 -~ 1. ~ SOVEREIGN BANK provided the department with the information below indicatil~i'~ that at tl4e'death of the above-named decedent you were a joint owner or beneficiary of the account identified. Account No. 574175946 Date Established 07-13-2011 Account Balance Percent Taxable Amount Subject to Tax Tax Rate $ 7,263.06 X 16.667 $1,210.53 X 0.045 Potential Tax Due $ 54.47 With 5% Discount (Tax x 0.95) $ (see NOTE') Remit Payment and Fonns to: REGISTER OF WILLS 1 COURTHOUSE SOUARE 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 St@p 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.) 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). D ~ Changes or deductions listed. E ~ Asset will be reported on inheritance tax form REV-1500. The information above is incorrect and/or debts and deductions were paid. Complete PaR 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 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 81/2" x 11"sheets of paper.) Date Paid Payee Description Amount raid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If you are making a correction to the establishment date (Line 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% awned 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 [he 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. 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 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 [he best of my knowledge and belief. _ ~1 Work Home 'J t ~7 - ~Z t2-.3-~ ~ Taxpayer Sigr(ature 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 M+ p~+~ h~ ~} n ~~ 'F C _> '-" ,~ O 4a ~ Z7 r~~ m O ~ ~ a} /.c ~~rfff///~~~ r0 rJ ,IJIJJ 4.T ' ri J' ~ a n m ~ m ~- n v ~ G~ n 3~1 H N Q' LT ~ f G C QQ ~ ~. D 3 o ~' N N 0 w V I M r Q q r Q C_ (V e- f' ,C~ N O O 9 1 ~1 O LL a ~' O ~a~seH t- n+~`~~ *~i~~',r1',~• ,~,~ ,i r ~~: r,.~ ssv~a isei~ O b'T v ~n L`"~ t`'- I- _ („U i ~.,, U C` ,-~ -", ~. Lv~ ~!' J +~C ~ N U) ~... U n m 70 O ~ CS ~y c: ~ g O = L ~ m ~ W <'"; ~ ~ N T ~ ~ M (n N ~ 6p p N ~ ~~U o~ c -a ~ w-c~Q ~ ° ~ ~ ~ m~a~r~ ' ~ ti ~ ~ ~ c ~ ~ o = U ~ ~ ° N ~ C9~U.-U z ? 0 _' 0 ~ ~ 0 o0 '~ X F ~ ~ v U~cyi ¢o°NO~ m ~OcG m zoo ~~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT DF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA n128~0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT EVANS WILLIAM J 419 CARMELLA DRIVE MECHANICSBURG. PA 17050 mia ESTATE INFORMATION: ssN: tss-to-coos FILE NUMBER: 2112-1338 DECEDENT NAME: EVANS MARGARET W DATE OF PAYMENT: 01/03/2013 POSTMARK DATE: 12/14/2012 COUNTY: CUMBERLAND DATE OF DEATH: 10/02/2012 ACN ASSESSMENT CONTROL NUMBER REV~1162 EX111-961 N0. CD 016994 AMOUNT 12165013 ~ 5101.25 TOTAL AMOUNT PAID: REMARKS: CHECK# 4969 SEAL INITIALS: HEA RECEIVED BY 5101.25 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS