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Home My WebLink About07-23-13 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX�11-96) DEPARTMENT OF REVENUE BUFEAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBUFG,PA 1 7 1 2 8-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 017926 CALEY BEVERLEY L 645 SILVER SPRING ROAD MECHANICSBURG, PA 17050 ACN ASSESSMENT AMOUNT � CONTROL NUMBER ------- fold __"""" ""__" 13136011 � 5306.26 ESTATE INFORMATION: ssrv: �9�-56-6550 13136012 � 5565.90 FILE NUMBER: 211 3-001 6 13136013 � $227.70 DECE�EtvT ►vAtv�E: CALEY-SEIG SHERRIE � DATE OF PAYMENT: 07/23/2013 I POSTMARK DATE: 07/22/2013 I couNTY: CUMBERLAND � DATE OF DEATH: 1 1/1 1/201 2 � � TOTAL AMOUNT PAID: S 1 ,099.86 REMARKS: CHECK# 2979 INITIALS: CJ SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU oF INDIVIDUAL TAXES Pennsylvania lnheritance Tax � pennS�/LVdt11d PO BOX 280601 HARRISBURG PA 17128-0601 IC1fOfCTIatI011 NOtICe � DEPARTMENT OF REVENUE REV-1543 EX DocEXEC (OB-12) And Taxpayer Response FILE NO.2113-0016 ACN 13136011 r�r n r +�-�• . • .«t;- DATE 06-28-2013 r-- i�5_ _ . ,. � �..�.�,r Type of Account :'��i3 ��;_ `3 t';�l i �'� Lstate of SHERRIE CALEYSEIG Savings SSN 191-56-6550 X Checking Date of Death 11-11-2012 Trust BEVERLEY L CALEY �� CountyCUMBERLAND Certificate 645 SILVER SPRING RD ''•I � MECHANICSBURG PA 17050-g�3�`�;`i • SOVEREIGN 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. Remit Payment and Forms to: Account No.351060677 Date Established 11-30-1983 REGISTER OF WILLS Account Balance $13,611.68 1 COURTHOUSE SGIUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $6,805.84 Tax Rate X 0.150 Potential Tax Due $ 1,020.88 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 of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potentia/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 andlor 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 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 CaICUIatI0f1 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 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 �\�� V� � your relationship to the decedent: „(}"D_ Ct . �� \` � 1. Date Established 1 //-3a—Z33 \ 2. AccountBalance 2 $/� �//. (o� � � � 3. Percent Taxable 3 X .So �� 4. Amount Subject to Tax 4 $ �o�ds�'� r ��\y�� , �� , � \ �. 5. Debts and Deductions 5 - � � d'�3. � �� .. 6. Amount T�able 6 �v `� �� 7. Tax Rate 7 X �i�.S � 8. Tax Due 8 $ �b�.2� �� 9. With 5% Discount (Tax x .95) 9 X � � o '�\ s s � �� 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 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 Home - 7(�- %�/ �- Z Z - Taxpayer nature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA 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 Pennsylvania lnheritance Tax � pennsylvania PO BOX 260601 HARRISBURG PA 17128-0601 IllfOr171at1011 NOtIC@ � DEPARTMENT OF REVENUE REV-1543 EX OocE%EL f08-12) And Taxpayer Response FILE NO.2113-0016 ACN 13136012 „,_ - - DATE 06-28-2013 �._ , Type of Account ,i.... i� ;,�, � � � !'t.� ��ul. t_� • � � z • Estate of SHERRIE CALEYSEIG Savings SSN 191-56-6550 Checking Date of Death 11-11-2012 Trust BEVERLEY L CALEY � � County CUMBERLAND Certificate 645 SILVER SPRING RD ��„ ��;�;�. � � MECHANICSBURG PA 17050-�,$�� u SOVEREIGN 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. Remit Payment and Forms to: Account No.354002354 Date Established 01-01-1971 REGISTER OF WILLS Account Balance $25,151.39 1 COURTHOUSE S�UARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $12,575.70 Tax Rate X 0.150 Potential Tax Due $ 1,886.36 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 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. 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 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 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 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 stat �� ` �ti � � � .� your relationship to the decedent:�(�j�� " ` 1. Date Established 1 ,l��7/ ,� �� 2. Account Balance 2 $ �.S/.7�._'�� ' 3. Percent Taxable 3 X -� � � � � 4. Amount Subject to Tax 4 $/�,,�75. �4 �� ;� �� 5. Debts and Deductions 5 - � �� 6. Amount Taxable 6 � �� ,57.�`.%D � �� 7. Tax Rate 7 X ��S , 8. Tax Due 8 $ SGS,g6 \� .\ 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 pery'ury, I declare that the facts I have reported above are true,correct and complete to the best of my knowledge and belief. Work :� � Home �/ �7 -�/7/ —Z Z / Taxpayer Si ature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA 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 INDIYIDUAL TAXES p��Y�y��a ��ritance T�,x � pennsylvania P4 B4X 280601 HARRISBURG PA 17128-0601 IllfOrl1"IatIO11 NOtIGB DEPARTMENT OF REVENUE And Taxpayer Response REV-1543 EX OocEXEC <08-12) FI1�E NO.2113-0016 ACN 13136013 � - ' '`~ !"�"� DATE 06-28-2Q13 � �� _ � , ,,, . .:, t n TYPe of A�COUnt '`'"� ut��`" �� '��Estat��SHERRIECALEYSEIG Savings SSN 191-56-6550 Checking _ ._.,.. .. Date of Death 11-11-2Q12 Trust BEVERLEY L CALEY � Gpt��fy CUMBERLAND Certificate b45 SI�VER SPRIN6 RD �"" "'" `� � MECHANICSBURG PA 17050-2873 �;U '`��'� i�i�f::(�1., i .;" , `o� . SOVEREIGN BANK pravided the department with the information belaw indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Account No.5741p02077 Remit Payment and Forms to: Date Established 10-24-1983 REGISTER dF W[L�S Account Balance $10,12q.31 1 COURTHOUSE SGlUARE Percent Taxable X�p CARLIS�E PA 17413 Amount Subject to Tax $5,060.16 T�Ftate X Q.150 N(�TE": If tax payments are made within three manths of the Potential Tax Due $759.02 decedent's date af death,deduct a 5 percent discount on the tax With 5°to Discount{Tax x 0.95} $(see NQTE"`� due. Any inheritance tax due wi11 become delinquent nine monttts after the date of death. PART St�p 1 : Please check the appropriate boxes belaw. 1 a �No tax is due. I am #he spouse of the deceased or I am the parent of a decedent who was 21 years otd 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 informatian is correct, na deductions are being taken,and payment wil(be sent correct. with my response. Procesd fo Sfep 2 on reverse. Do naf check any ofher boxes. G �7he#ax rate is incorrect. � 4.5% I am a lineal beneficiary(parent,child,grandchild,etc.}of the deceased. {Select carrect tax rate at right,and complete Part � 12°/a I am a sibling of the deceased. 3 on reverse.) � 15°lo All other re(ationships(including none). � �Changes or deductians The informatian abave is incorrect andlor debts and deductians were paid. listed. Complete Part 2 and part 3 as appropriate on the back af this form. � �Asset will be reported on The abave-identified asset has been ar wiN be reparted and tax paid with the PA Inheritance 7ax 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 af 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 ��\�A ; ��,� "� . �� your relationship to the decedent: /'D-��3 �0 .�'�Pr � ,� �� 1. Date Established � �a a y a�� \ 2. Account Balance 2 $/�; �e�0,�/ � 3. Percent Taxable 3 X SO � 4. Amount Subject to Tax 4 $ ��60.�.S °°� �� 5. Debts and Deductions 5 - � 6. Amount Taxable 6 $ ��0 60, /.� , ' � � 7. Tax Rate 7 _X �.S � .� � .��.�..�,�� 8. Tax Due 8 $ �.�'7. 7� 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 Home /7- lo !o- /�� - � -/ Taxpayer Si ature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA 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 ; =ou �N b b. � G' � :j{ W �:. ;f W � �'" � � ' � �I � � y � a i > � x i O r r � �' �� .�� i � . ��: �� : � Fi Y� J'' `� �-�q +�' 7'"� _ w•« �L*: ..... �. } �k�. i 4 � � �� \) a \� � � �y, , � cfr � ��f + � � �� tYi a � ` .,.a �;"s � � ��° � � � �� , � ',.� �� .. �.�Y It7 �n'!'��n`� . � .. � � ��jJ it � . . ,�.�tl 1 ��,- �1 . .... . �.^ . �l' � \ q ' �j ; . ; �,�. —1 �Ii'� l�. �� . � y cy .�nj>� ` \ , :] \ l�� _ . �. . ��3� � � � � ��