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Home My WebLink About05-07-13 COMMONWEA�TH OF PENNSYI_VA�I A REV-1162 EX�11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXE9 DEPT.280601 HARRISBURG,PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 017568 LOUGEE BARBARA J 206 W MAPLEWOOD AVENUE MECHANICSBURG, PA 17055-6426 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- faid 12159555 � 5450.41 ESTATE INFORMATION: ssN: I FILE NUMBER: 21 1 2- 1 1 85 I DECEDENT NAME: SHEIPE LLOYD V I DATE OF PAYMENT: 05/07/2013 I POSTMARK DATE: 05/04/201 3 I CoUrvrY: CUMBERLAND � DATE OF DEATH: 10/16/2012 I � TOTAL AMOUNT PAID: 5450.41 REMARKS: CHECK# 4276 INITIALS: CJ SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVAIVIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF WDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 17128-0601 PENNSYLVANIA REGEIVED FROM: INHERlTANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 017569 LOUGEE BARBARA J 206 W MAPLEWOOD AVENUE MECHANICSBURG, PA 17055-6426 ACN ASSESSMENT AMOUNT CONTROL NUMBER ------ roia --------- ------ 12159563 � 5450.23 ESTATE INFORMATION: sSN: I FILE NUMBER: 21 1 2-1 1 85 I DECEDENT NAME: SHEIPE LLOYD V � DATE OF PAYMENT: 05/07/201 3 I POSTMARK DATE: 05/04/201 3 I COUNTY: CUMBERLAND � DATE OF DEATH: 1 O/1 6/201 2 I � TOTAL AMOUNT PAID: 5450.23 REMARKS: CHECK# 4�75 INITfALS: CJ SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF W{LLS BoR�o oF INDIVIDUAL T,4XEs Penns Ivania lnheritance Tax �� e'nnS lvania PQ BOX 280601 � �`-� §� p � HARRISBURG PA 17128-0�501 IIlfOC111atI011 NOtICe DEPARTMENT OF REVENUE �-' �'�I REV-1543 E%DocE%FL (OB-12) And Taxpayer Response FILE NO:�21��—��t -12. -I Ig'� ACN 12159555 n r,� �,�. �,z:�- ,�C DATE 10-29-2012 1��.u'r� -T,�; l�1' l,`3�_�_$ Type of Account �'.'��3 �f�Y 7 E�I I 1 �*state of LLOYD V SHEIPE Savings SSN Checking ��' i� "� "'" Date of Death 10-16-2012 X Trust �✓�[..r;i, i;i` BARBARA J LoUGEE ,. County CUMBERLAND Certificate viz czHKCO cRV �;�t�'l��aNS' ��`v;t� MECHANICSBURG PA 17055-��;��L�:.�� f ,+., n,r� 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 05-06-2010 REGISTER OF WILLS Account Balance $ 10,009.16 1 COURTHOUSE SGIUARE Percent Taxable X 100 CARLISLE PA 17013 Amount Subject to Tax $ 10,009.16 Tax Rate X 0.045 Potential Tax Due $450.41 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. l 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. � �.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.) � �5% All other relationships (including none). p �Changes or deductions The information above is incorrect and/or debts and deductions were paid. listed. Comp/ete 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 other 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 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 if requested by the department. (If additionai 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 Caiculation 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 financiat institution and attach ii to this form. 1. Enter the date the account was estat�lished or titled as it existed at the date of death. 2. Enter the tota!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 10Q%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 muitipiying 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 � � �� ;�� 1��`� �� ;�� your relationship to the decedent: � �� `° �� `��`��` � �� o�� '� �A V�� V � Av-�� \V� A��V�'� � � A�� : 1. Date Established 1 „� � \ ;`�� \ �, �,��\ , , ��, �� L. ACCOUIIt BaI8f1C8 `Z � �� V`��A ��A�Y ��V �� \�\\��\��ti��\��\\ �� 3. Percent Taxable 3 X �� ;��` �� ,��, �� ;�� "`, " � ��; � � �.� � � 4. Amount Subject to Tax 4 $ ` � �\�� \\��;�\��ti��\\\ �\�� \\� \ �� 5. Debts and Deductions 5 - � �� Q��`�� A Y�� 6. Amount Taxable 6 $ �� ` ` �` � �AAA� � ��VA �A � �. � � � �� ' 7. 1� R$te 7 � �� .��V A � �� AA�\V� ��A� A�VA�.�� x� �;;� �v a��\� : � ��V � � � �� \ 8. Tax Due 8 $ `� �"` � °`�� ,�" ' � �� .��.� � �_....t..` �� *�C'�� ` �� , � . � � .:. ,. .. ., .0 , ..... °=��. 9. With 5% Discount(Tax x .95) 9 X � � �� ,. , � ., a. . . . , 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 7�� - b_,°1/- �S'�� ! l�� Home 7i7��'7-�22.0 Taxpayer Signature Telephone Numbe�� ao Dates�� 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 INDIYIDUAL TnxES Penns`'Ivania lnheritance Tax =; � vennSV lvania PO BOX 280601 1 � • J HARRISBURG PA 17128-OGO1 IC1fOCI71atIOf1 NOtICe DEPARTMENT�'JF REVENUE �-�---��-�� REV-I543 E%DucEXEC (08-12) And Taxpayer Response FILE NO.�°�1-}��'I�� ACN 12159563 DATE 10-29-2012 ��{�if�r`��.%i�it �.'." ' �i�. i;`i ,•. �'��lSs '�ii �i' ':.''�.'.-t> TypeofAccount :,!,�i� �I��( 7 FI� 1 l:2 SSNt164- SHEIPE Checgng Date of Death 10-16-2012 X Trust BARBARA J LOUGEE �� `�}� lf,,_ County CUMBERLAND Certificate 912 GINKGO GRV MECHANICSBURG PA 170��u' �.ij�;(�;� CU{�BERL,��;::. t�;'�., ;'�:1 MEMSERS 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. 14353 Remit Payment and Forms to: Date Established 05-17-2010 REGISTER OF WILLS Account Balance $ 10,005.10 CARLISLE PAS 1 0�13ARE Percent Taxable X 100 Amount Subject to Tax $10,005.10 Tax Rate X 0.045 Potential Tax Due $450.23 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. 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 othe�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. C �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 of thls 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�everse. Do not check any other 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 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:2 owners=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: �� , ; �� " � ' �� .��ti � �� ,�� . � 1. Date Established 1 �`°° �" �� ,y��,�� , �� c �� 2 � ��\� � ��:�ti � �� \ �A�ti�� A 2. Account Balance ,��\��\��?�\\�� "�� \y��\��`�� 3. Percent Taxable 3 X � `� �"� � � ��`�°�°� ;� � � , � �� . � ��. .o. �,. 4. Amount Subject to Tax 4 � �� "�� `�"� � � �� _A��V��yVV�� ``� � e � : rJ. �8bt$311C� �BC�UCtlOf1$ �J � ��\�A��;i�� ;� _°. 6_ Amount Taxable 6 $ �� ` �. �� ` �� ` � � � � � ` 7. Tax Rate 7 X �� ,�� ,� �. � �� A�AAVAp� p� ��_�� h � .� �. � � 8. Tax Due 8 � �� A�'�� A��A��V� : �� A ,.-.A�p�� s.. .Y'` �� - -�• � .A\...A b 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 Wilis, Agent." Do not send payment directiy 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 ^I!'7--1�9 !� �S"� Home �r� - 6 7-! a.� Taxpayer Signat e Telephone Number yi7„b9.�,,,�� Date��-,�3 IF YOU NEED FURTHER ASSISTANCE, COM1ITACT 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 � � � � � �ECt}f�� C��1C� 0� � � �tr��i�t�i:t� t�r `,'#I!._L� ,b �`` :''.'�:� (riRY ? �� 1 OZ � G � � CLEf;1� i!t� � � C�i,i�i�AN5' �Ull:�ti � �` CU�BERLAt�D C�?.. P�A ` C � � � ,,,� „\ � .� �V � � � � � :�� fi � ;�; � � � � ,,�. � � � �, •� �i � r�� t�} � ii� '�} v � ta[2 � ''� � � C' r (�3 � � , � � . g � � � � FOREyEp -� C n oa'xt o N c'i os2ss5as � p ` � � . � m � � . _ g o ' � � �_ ' F' � FpREYER � c a oa•x� o � c� os2�sas ;'-' �