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Home My WebLink About07-01-13 (2) COMMONWEALTH OF PENNSYLVANIA REV-1162 EX01-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 017817 BOYD LINDA A 604 MALLARD RD CAMP HILL, PA 17011 ACN ASSESSMENT AMOUNT CONTROL NUMBER ________ fold 13122891 $25.67 ESTATE INFORMATION: SSN: FILE NUMBER: 2113-0370 DECEDENT NAME: SCHARF JOHANNA A DATE OF PAYMENT: 07/01/2013 POSTMARK DATE: 06/27/2013 COUNTY: CUMBERLAND DATE OF DEATH: 02/17/2013 TOTAL AMOUNT PAID: $25.67 REMARKS: CHECK# 305 INITIALS: DMB SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ` BUR BOX OX 28 20601 INDIVIDUAL TAXES ..v Pennsylvania Inheritance Tax pennsylvania 8 �r HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE And Taxpayer Response ""C- ""°° " 1.1-11,FILE NO.2113-0370 ACN 13122891 DATE O1;-02-2013 RECORDED OFFICE OF Type of Account REGISTER OF ',:'iYs%te of JOHANNASCHARF Savings SSN Checking LINDA A BOYD X13 JUN 28 Pn Tal�@f Death 02-17-2013 Trust 604 MALLARD RD ountyCUMBERLAND Certificate CAMP HILL PA 17011-1219 CLERK OF ORPHANS' COURT CUMBERLAND CO., PA METRO BANK 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.833053648 Remit Payment and Forms to: Date Established 07.23-2009 REGISTER OF WILLS Account Balance $1,140.90 1 COURTHOUSE SQUARE Percent Taxable 750 CARLISLE PA 17013 Amount Subject to Tax $570.45 Tax Rate X 0.045 Potential Tax Due $25 4 NOTE': If tax payments are made within three months of the With tia Discount Tax x 0.95 decedent's date of death,deduct a 5 percent discount on the tax ( ) $(see NOTE') due. Any inheritance tax due will become delinquent nine months after the date of death. PART Ste 1 : Please check the a 1 P appropriate boxes below. An 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. B The information is y 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% 1 am a lineal beneficiary (parent,child,grandchild, etc.)of the deceased. (Select correct tax rate at right, and complete Part 12% 1 am a sibling of the deceased. 3 on reverse.) 15% All other relationships(including none). Di D¢S�Ir��itS�I� D Changes or deductions The information above is incorrect and/or debts and deductions were aid. _ 1 J listed. Complete Part 2 and part 3 as appropriate on the back of this orm. 1+ ��TaNti 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. / —I REV-1500. Proceed to Step 2 on reverse. Do not check any other boxes. )q Q � IR 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. j (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 y g ( ) ( ), 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: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 Official Use Only ❑AAF your relationship to the decedent: PA'Department of Revenue 1. Date Established 1 2. Account Balance 2 $ IPAD 1 Percent Taxable 3 X 2 4. Amount Subject to Tax 4 $ 3 5. Debts and Deductions 5 4 6. Amount Taxable 6 $ 5 7. Tax Rate 7 X 8 8. Tax Due 8 $ 7 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 f Home 7P-5z/D"-43 G3 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 I METRO 3801 Paxton Street BANK Harrisburg, PA 17111 m8ymetroba k.com May 16, 2013 Linda A Boyd 604 Mallard Rd Camp Hill PA 17011 To Whom It May Concern: Our above named customer is the owner of bank account 833053648. This account is solely funded by Ms. Boyd. She added her mother,Johanna Scharf, to the account so that she would have access to pay Ms. Boyd's expenses in the event that Ms. Boyd would be unable to. Johanna Scharf has never contributed to this account. If you have any questions, please do not hesitate to contact me at the store. You can reach me at 717-920-5740. Thank you so much for your help in this matter. Since�ly, n Ther sa C Palkovitz Customer Service Representative II Camp Hill Store—Metro Bank NMLS Registration: 913313 0 N. q � � V 1 vJ 3 E f Y O la n