HomeMy WebLinkAbout05-03-13 CQMMQNWEPATH Of RENNSY�VANIA REV-t 182 ER{11-Sfi}
�EPARTMENT OFRFVENUE
BUREAU OF INDIVIDUAL TAXES
DEPL 280601
NARfttSBUftG,PA 17128-960t
PENNSY�VANIA
RECEIVED FROM: INNERITANCE AND ESTATE 7AX
OFFICIAL RECEIPT
NQ. CD 017545
SHEIPE SCOTT
25 NAILOR LANE
fVEWVlLLE, PA 17241
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
---- — ,4�d
12159565 � 5901 .11
ESTATE INFORMATION: SSN: � 121 59557 � $$7.5$
FILE NUMBER: 2112-1185 12159558 � S90Q,82
o�cEDENT rvAnnE: SHEIPE LLOYD V 12159560 ( 51,351 .37
DATE OF PAYMENT: 05/(73/2013 �
POS7MARK DATE: 05/03/2013 I
COUNTY: CUMBERLAND �
DATE OF DEATH: 10/1 B/201 2 I
(
TOTA� AMC?UNT PAID: $3,220.88
REMARKS:
GHECK# 5354
INITIALS: HEA
sea� RECElVED BY: GLENCtA FARNER STRASBAl1GF1
REGISTER OF WILLS
REGISTER OF WILLS
� BURFAII oF INDIVIDUAL T�ES m�� pennsylvania
Po BOX 2806D1 Pennsylvania lnheritance Tax
HARRISeURG PA 1�128-o6u1 Information Notice DEPNRTMENTOFREVENUE
-� � � a[vas�s ex m�ersc <oeav
And Taxpayer Response FILE NQ.217$_ I � -11 ��
ACN 12159565
DATE 10-29-2012
Type of Account
Estate of LLOYD V SHEIPE Savings
Checking
Date of Death 10-16-2012 X Trust
SCOTT A SHEIPE CountyCUMBERLAND � �� Certificate
25 NAILOR LN `"
NEWVILLE PA 17241-8776 � � � � �
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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.
Accaunt No. 14353 Remit Payment and Forms to:
Date Established 04-19-2004 REGISTER OF WILLS
Account Balance $20,024.74 1 COURTHOUSE S�UARE
Percent Taxable X 100 CARLISLE PA 17013
Amount Subject to Tax $20,024.74
Tax Rate X 0.045
Potential Tax Due $901.11 NOTE*: If tax payments are made within three months of the
decedenYs 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. I am the spouse of the deceased or I am the parent of a decedent who was
21 years old or younger at date ot 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 The above information is correct, no deductions are being taken, and payment will be sent
correct. with my response.
Proceed to Step 2 on reverse. Do not check any other boxes.
� '� ne tax rate is incorrect. � � 4.5% I am a lineal beneficiary (parent, child,grandchild, etc.) of the deceased.
(Select correct tax rate at
right, and complete Part � �p�a I am a sibling of the deceased.
3 on reverse.)
� 15% All other relationships(including none).
p �Changes or deductions The information above is incorrect and/or debts and deductions were paid.
listed ---� ' _ Complete Part 2 and part 3 as appropriate on the back of this form.
E �Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax
inheritance tax form Return filed by the estate representative.
REV-1500. Proceed to Step 2 on reverse. Do not check any othe�boxes.
Please sign and date the back of the form when finished.
__
PART Debts and Deductions
2
Allowable debts and deductions must meet both of the following criteria:
A. The decedent was legally responsible for payment,and Ihe estate is insufficient to pay the deductible items.
B. You paid the debts after the death of the decedent and can furnish proof ot 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 g ( ) ( ), percent Wxable(Line 3),
please obWin a written correetion from the financial instftutlon 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%a 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:2 owners=50%,3 owners=33.33%, 4 owners
=25/a, etc.)
b. Next, divide the decedenYs 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:
t. Date Established 1 �/ r��/
2. Account Balance 2 =(�b� ��7 . / / _
3. Percent Taxable 3 X /QD
4. Amount Subject to Tax a $ ap�Qa y.��
5. Debts and Deductions 5 - Q _
6. Amount Taxable 6 $ ao,oa s��5� —
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 tor 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 �/J - 7 �Q -.S�(p�p
Home -
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
_ _ .
BURFAU OF INDIVIDUAL .aXES Pennsylvania lnheritance Tax � pennsylvania
' PD BoX 280601 DEPARTMENT OF REVENUE
HARRIS611RG PA 1]128-0601 Information Notice
aEV-�s�a E�uooeeee �oe-�z�
And Taxpayer Response FILE NO Yfi�--- 1 a -' I I �
ACN 12159557
DATE 10-29-2012
Type of Account
Estate of LLOYD V SHEIPE Savings
Checking
Date of Death 10-16-2012 X Trust
SCOT7 A SNEIPE CountyCUMBERLAND n - Certificate
25 NAILOR LN � p `" � �
NEWVILLE PA 17241-8776 � � � c�5 `y
m = � -c cn �
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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. 14353
Date Established 07-19-2010 REGISTER OF WILLS
Account Balance $1,501.31 1 COURTHOUSE SQUARE
CARLISLE PA 17013
Percent Taxable X 100
Amount Subject to Tau $ 1,501.31
Tax Rate X 0.045
Potential Tax Due $67.56 NOTE': If tax payments are made within three months of the
decedent's da[e 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 St@p 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 The above information is correct, no deductions are being taken,and payment will be sent
correct. with my response.
Proceed to Step 2 on reverse. Do not check any other boxes.
� �The tax rate is incorrect. � 4.5% I am a lineal beneficiary (parent,child, grandchild, etc.) of the deceased.
(Select correct tax rate at
right, and complete Part � 12% I am a sibling of the deceased.
3 on reverse.)
� 15% All other relationships (including none).
p �Changes or deductions The information above is incorrect and/or debts and deductions were paid.
listed. Complete Part 2 and part 3 as appropriate on the back ol this/orm.
E �Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax
inheritance tax form Return filed by the estate representative.
REV-1500. Proceed to Step 2 on reverse. Do not check any other bozes.
Please sign and date the back of the form when finished.
PART Debts and Deductions
2
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 hom the financial institutfon 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:2 owners=50%, 3 owners=33.33%,4 owners
=25%, etc.)
b. Next, divide the decedenYs 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 tauable is determined by subtracting the debts and deductions from the amount subject to tax.
7. Enter the appropriate tax rate from Step t based on your relationship to the decedent.
If indica[ing a different tax rate, please state
your relationship to the decedent:
1. Date Established 1
2. Account Balance 2 $ %,�Q�.��
��
3. PercentTaxable 3 X /OC�
4. Amount Subject to Tax 4 $ �. J���.��_
5. Debts and Deductions 5 -
6. Amount Taxable 6 $ � J�Q �
7. Tax Rate � X .�
8. Tau Due 8 $ FQ 7i Jr�
9. With 5% Discount(Tax x .95) 9 X
St@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 pery'ury, I declare that the facts I have reported above are true,correct and complete to the best of my knowledge and
belief.
wo�k 717-77� -5y(o,(
Home - 7 p�
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
. .
, w aoR�� oF INDIVIDUAL TAXES Pennsylvania lnheritance Tax � pennsylvania
Po BOX 280601 DEPARTMENT OF REVENUE
HAR2ISBURG PA 1]128-0601 Information Notice
vEV-�saa ee m�exEC <aeaz�
And Taxpayer Response FILLEN9-2798� ) � ' � ��
ACN 12159558
DATE 10-29-2012
Type of Account
Estate of LLOYD V SHEIPE �Savings
Checking
Date of Death 10-16-2012 X Trust
SCOTT A SHEIPE CountyCUMBERLAND Certificate
25 NAILOR LN n �;
NEWVILLE PA 17241-8776 �G � w rn �
W � = �? r3
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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:
AccountNo. 14353
Date Established 07-23-2009 REGISTER OF WILLS
Account Balance $20,018.33 1 COURTHOUSE SDUARE
CARLISLE PA 17013
Percent Taxable X 100
Amount Subject to Tax $20,018.33
Tax Rate X 0.045 NOTE": If tax payments are made within three months of the
Potential Tax Due $900.82 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. 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 notcheck any other boxes and disregard the amount
shown above as Potential Tax Due.
g �The information is The above information is correct, no deductions are being taken, and payment will be sent
correct. with my response.
Proceed to Step 2 on reverse. Do not check any other boxes.
� �The tax rate is incorrect. � 4.5% I am a lineal beneficiary (parent,child, grandchild,etc.) of the deceased.
(Select correct tax rate at
right,and complete Part � �p% I am a sibling of the deceased.
3 on reverse.)
� 15% All other relationships (including none).
p �Changes or deductions The information above is incorrect and/or debts and deductions were paid.
listed. Complete Part 2 and part 3 as appropriate on the back of this lorm.
E �Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax
inheritance tau form Return filed by the estate representative.
REV-1500. Proceed to Step 2 on reverse. Do not check any other bozes.
Please sign and date the back of the form when finished.
PART Debts and Deductions
2
Allowable debts and deductions must meat both of the following criferia:
A. The decedent was Iegaiiy responsible for payment,and the estate is insufficient to pay the deductibie items.
B. You paid the debts after the death of the decedent and can furnish proof of payment it requested by the department.
{if additionaf space is required,you may attach 8 t12"x 11"sheets of paper.)
Date Paid Payee description Amount Paid
Totai En#er on �ine 5 of Tax Galcuiation} $
PART Tax Calculation
� If you are making a carrection ta the estabiishment date{Line 1)accnunt balance{Line 2},or percent ta�cable{Line 3),
piease obtain a wdtten correction from the f+nanciai institutlon and attach it to this form.
1. Enter the dete the account was established or titled as it existed at the date af death.
2. Enter the total bala�ce of the account inciuding any interest accrued at the date ot death.
3. Enter the percentage of the account#hat is taxable fo ypu.
a. First,determine the percentage owned by the deoedent.
i. Accounts that are held"in trust foP'another or others were 100%owoed by the decedent.
ii. For joi�t accounts established mare tha�ane year prior to the dats of deaEh,the percentage taxable is 1 fl05b divided
by the tota(number of owners including the deceden[. (For example:2 ownets=509'0,3 owners=33.33%,4 owners
=25%,etc.)
b. Next,divide the decedent's percentage owned by the numbar of surviving owners or beneficiaries.
4. The amount subject to t�is determined by mul6plying the account balancs by the percent taxable.
5. Enter the iotai of any debts and deductions ciaimed fram Part 2.
6. The amount taxable is determined py subtracting the debts and deductions from the amount subject to tau.
7. Enter the appropriate tax rate from Step t based on your relationship ta the decedent.
If indicati�g a different tax rate,please state
your relationship to the decedsnt:
t. DateEstablished 1
2. Account Bata�ce 2 ��} alg, _3.3
3. Percent Taxable 3 X %O f?
4. Amount Subject to Taz 4 $ ,�[i G�t�. .3 �
5. I}ebts and Deducfions 5 - G}
6. AmountTaxable 6 $ i�G L?��. '�..�
7. T� Rate 7 x —.4��
S. Tax Due 8 $ �t"��i �a'
9. With 5% Discount(Tax x .95) 9 x
�Jt��} 2: Sign and date beiaw. Return TWO completed and s+gned capies to the Regisfer of Wilis Iisted on the front of this form,
along with a check fpr 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,carrect and compiete ta the best of my knowledge and
belief.
wo�k 7/7 -77�� -5�/�0.6
Fiame �l7' ' �c�
Taxpayer Signature Telephone Number Date
IF Y4U NEED FURTHER ASSISTANCE, G4NTACT GUMBERIANd GQUNTY RE{'.,ISTER t3F WI��S, PA
DEPARTMENT tJF REVENUE DISTRICT OFFICE, t7R THE INHERITANCE TAX DIVISi(JN AT
717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS
QNLY: 1-800-44?-3020
� BIIREAU OF INUIV3AUIIL TA%ES s � pennsylvania
PO BOX 280601 Pennsyivania inheritance Tax
HARRJSBURG PA 17128-0601 Information Notice DEPARTMENTOFREVENLIE
And Taxpayer Response "� ""`.�„"" <"", ���'.--
Fi�-mn— 10� --- 1
ACN 12159560
DATE 10-29-2012
Type of Account
Estate pf LLOYD V SHEIPE Savings
Ghecking
Date af Death 10-i 6-2012 � -- X Trust
SCOTT A SHEIPE CountyCUMBERLAND y � � �frtificate
25 NALLOR LN q� =� � n
NEWVZL�E PA 17241-8776 r+� �-� � � o
S, � r,�,,, "'� ct� �
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MEMSERS rsr Fcu provided the dapartment with the information below indicating that at the death af the
abave-named decedent you were a 'oint owner or beneficia of the account identified.
Remit Payment and Forms to:
AccquM No.14353
Date Established Ot-24-2009 REGISTER OF WILLS
Account ealance $3Q030.45 y COUR7HOUSE SQUARE
PercentTaxal�ie Xjpp CARL{SLE PA 17Q73
Amount Subject to Tax $30,030.45
Tax Rate X 0.045
Pote�tial Taac Oue $ 7,351.37 NOTE': If tax payments are made within three months of the
decedent's date ot death,deduct a 5 percent discount on the tax
With 5°lo Disoount{Tax x 0.35) $tsee NOTE'} �}U�. Any inheritance tax due wiI{become delinquent nine months
after the date of death.
�A� St�p 1 : Ptease check the appropri�te baxes below.
t
A �No tax is due. i am the spouse af the deceased or i am the parent of a decedent who was
21 years oId or yaunger at date of death.
Prpceed to Step 2 on reverse. Do not check any other boxes and disregard the amount
shown above as Potential Tar Due.
g �The information is The a6ave infarmation is correct,no deductlons are being taken,and payment wiN be sent
correct. with my response.
Praoeed to Step 2 on reverse. Da not check any other boxes.
� ❑The tax rate is inoorrect. � 4.59fl 1 am a lineal beneficiary{parent,child,grandchitd,etc.}of the deceased.
(Select correct tax rate at
right, and complete Part � 12% I am a sibling of the deceased.
3 on reverse.)
� 15°l AII other relatior�ships(including none}.
a ❑Changes or deductions The information above is incprrect and/pr debts and deductions were paid.
Gsted. Camplete Part 2 and part 3 as appropriate on the back of this form.
E �Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax
inheritance tax form Retum tiled by the esiate rspresentative.
REV-i 500. Prviceed to Step 2 on reverse. Da not check any other t�zes.
Piease sign and date tha back af the form when finished.
PART Debts and Deductions
2
Allowsbie debts and deductians must meet both of the(ollawing criteria:
A. The decedent was Iegaliy responsibie for payment, and the esiate is insufficient to pay[he deductibie items.
B. You paid the debts aker the desth of the deoedent and can furnish proof of payment if requested by the department.
{if additiona!space is required,you may attach 8 V2"x 11"sheets of papec)
Date Paid Payee Description Amount Paid
Totai Enter on Line 5 of Tax Galculation $
PART Tax Calculation
3 if au are makin a correction fo the establishment date Line 7}accoum 6aiance tine 2 ar
y g { { ), pert:ent texable{Line 3},
pteese abtsin a written correction from the flnanciai institutian 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 fnterest accrued at the date of death.
3. Enter the percentage of the account that is t�able 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. Far joint accounts estabiished mare#han one year prior to the date pf death,the percentage taxabie is 1 QO°l4 divided
by[he total number of owners including the decedent. (For exampie:2 owners=SDqo,3 owners=33.33°!0,4 owners
=25%,e[c.)
b. Next,divide the decedenYs percentage owned by the number of surviving owners or beneficiaries.
A. The amount subject ta taz is determined by mu�tiplying the accounf balance by the percent taxable.
5. Enter the totai of any debts and deductions ciaimed frpm Part 2.
6. The amount taxable is determined by subtraoting Ihe debts and deductions from the amount subject to tax.
7. Enter the appropriate Tt'u�rate from Step 1 based on yQUr reiationship to the decedent.
If indicating e different tax rate,piease state
your relatianship to the decedent:
l. Date Established 1 �-^
2. Accaunt Balance 2 $ L)� {h._�fJ.�1
3. Percent Taxable 3 X �/a('7 ,�-^
4. Amount Subject to Tax 4 $ '��T_C1, �tl
6. Debts and Deduations 5 - �
6. AmpuntTaxable 6 $ �CS.�.�Q. S�'ri
7. TaY Rate 7 X .0��
8. Ta�c Due 8 $ �1t ,3 Z
9. With 5°/4 Discount(Tax x .95) 9 x
.�t�$(} 2: Sign and date beiow. Ftetum TW4 completed and signed capies ta the Regis#er af WiIIs Iisted on the front of this�arm,
a(ong with a check for any payment you are making. Checks must be made payable to"Register of Wills,Agent" Do not send
payment directty to the Department ot Revenue.
Under penalty of perjury, 1 declare that the facLs I have repoRed a6ove are true,carreet and comptete to the best af my knowledge and
belief. `
Work 7��" 7� ";J7-�p�
t�ome 7 - 77 -� I �
Taxpayer Signature Telephane Number Date
IF YOIJ NEED FURTHER ASSISTANGE, GONTAGT GUMBERLANd COIJNTY REGISTER C}F WIC�S, 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-$00-447-3020