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Home My WebLink About07-15-13 BUREIU OF INDIY[OUAL TA%ES � pennsylvania Pennsylvania lnheritance Tax Po eox zeaso� r��t xARRISBURG Pn 1712 8-06 01 Information Notice DEPANTMENTOFREVENIIE acw�s�e av o«cx¢c ueax� And Taxpayer Response �3'7S�v FILE NO. 21— _.....a,,,,,�. ACN 1313355 DATE 06-25-2013 � �t FICE OF' RE8ISTER OF t��li_LS 7ypeofAccount ?Oi3 JUL 15 [�a[e�of HARD GALLINA �Savings 5SN Checking Date of Death OS-28•2013 Trust AIICE GALLINA CLC'RK�PuntyCUMBERLAND X Certificate 430 SPRING HOUSE RD ORPHdNS' COURT CAMP HfLL PA 17011-1452 CUMBERLAND CO., PA >.:. 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. Account No.384898 Remit Payment and Forms to: Date Established 04-11-2012 REGISTER OF WILLS Account Balance $5,052.99 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $2,526.50 Tax Rate X 0.045 Potential Tax Due $113.69 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 St2p 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 disregaid 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 Ihe 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[ax 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 2 Debts and Deductions A�lowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible tor payment,and lhe eslate is insufticient 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 17"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 corcection to the establishment date Line 1 account balance Line 2 ,or ( ) ( ) percent taxable(Line 3), ,_., please obtain a writlen correction from the financial institution and attach it to this torm. 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. Enterthe percentage ofthe accountthatistaxab�eto 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. Forjoint 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°/a, 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 deduclions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to ta�c. 7. Enter the appropriate tax rate from Step t based on your relationship to the decedent. If indicating a different tax rate,please state Official US2 Only �AAF your relationship to the decedent: PA Department of Revenue 1. Date Established 1 2. Account Balance 2 S PAD 3. Percent Taxable 3 X 1 4. Amount Subject to Tax 4 $ 2 3 5. Debts and Deductions 5 - q 6. Amount Taxable 6 $ 5 7. Tax Rate 7 X 6 8. Tax Due g $ � 8 i 9. With 5%Discount(Tax x .95) 9 X d 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 payab�e to"Register of Wills,AgenL" 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 knowiedge and belief. Work �-3� �� .. . r , , � � Home �� • T xpayer ignature 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 a��,� oF �NO��ow� TAXES Penns Ivania lnheritance Tax �[� enns lvania PO BOX 280601 y � � HARRiSBURG PA 17128-0601 Information Notice �j�' DEPARTMENTOFREVENUE - tcv.�su cs m.E�a ��e-�r� And Taxpayer Response FILE NO.21-13"7S(� ACN 13133551 DATE 06-25-2013 � � � r EOF REGfSTER OF Y�I�LS Type of Account %Ui3 JUl_ 15 p� IS� 7pggDGALLINA Checking Date of Death OS-28-2013 �Trust ALICE GALLINA CLERK CF CountyCUMBERLAND Certiticate ' 430 SPRING HOUSE RD ORPHANS� COURT CAMP HILL PA 17011-1452 ' CUMBERLAND CO., PA . . .. _ . . � , _ NEMBERS 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.384898 Remit Payment and Forms to: Date Established OS-11-2010 REGISTER OF WILLS Account Balance $93,736.12 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $46,868.06 Tax Rate X 0.045 ' Potential Tax Due $2,109.06 NOTE': If tax payments are made within three months ot the decedent's date of death,deduct a 5 percent discount on the tax With 5%Discount(Tau x 0.95) $(see NOTE') due. Any inheritance lax due will become delinquent nine months after the date of death. PART $12 1 : Please check the a � p ppropriate boxes below. 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. P�oceed 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°/a I am a lineal beneficiary(parent,child,grandchild, etc.)of Ihe 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 appropnate on the back oJ 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 tiled 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 oi 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 It you are making a corcection 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 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 100%divided by the total number of owners including fhe 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 OffiCi81 Use Only �AAF �' your relationship to the decedent: PA DepBrtment Of RBVenue � 1. Date Established 1 2. Account Balance 2 $ PAD 3. Percent Taxable 3 X 1 4. Amount Subject to Tax 4 $ Z I 3 5. Debts and Deductions 5 - 4 � 6. Amount Taxable 6 $ 5 7. Tax Rate 7 X 6 4 8. Tax Due 8 $ � I 8 + 9. With 5%Discount (Tax x .95) 9 x tl St@p 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills lisled on the front oi this form, a�ong with a check for any payment you are making. Checks must be made payable to"Register of Wills, AgenL" 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 beliei. work �--,�. S's�b ( •� Home 3 Ta payer Signature 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 INOIVIOUAL ,�es Penns Ivania lnheritance Tax []�j enns lvania PO BO% 28U601 Y P Y HARRISBURG PA 17128-0601 Information Notice �� DEPAHTMENTOFREVENUE vcr.�su a oec[ecc ue-u� And Taxpayer Response FILE NO.21 -I3�7$(P ACN 13133550 DATE 06-25-2013 ur�' t,k h REGISTER OF WI�LS Type oi Account �'Ui3 JUI. 15 ��ta e obaICHARD GALLINA Savings Checking Date of Death OS-28-2013 Trust ALICE GALLINA CLERK �ountyCUMBERLAND Certificate 430 SPRING HOUSE RD ORPHANS� COURT CAMP HILL PA 17011-1452 CUMBERLAN� CO., pp _ : � 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. Account No.384898 Remit Payment and Forms to: Date Established OS-11-2070 REGISTER OF WILLS Account Balance $25,606.04 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $ 12,g03.02 Tax Rate X 0.045 Potential Tax Due $576.14 NOTE': If tax payments are made within three months of the decedent's dale oi 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 Ste 1 : Please check the a � p ppropriate boxes below. A �No tax is due. 1 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 fo 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 correcttax rate at right,and complete Part � �p=�, �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 appropnate on the back ol this/orm. E �ASSet will be reported on The above-identifed 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 tollowing criteria: A. The decedent was legally responsible for payment,and the estate is insuHicient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proot 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 Ta�c 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 trom 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 tauable 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 taxabie. 5. Enter the total of any debts and deductions claimed irom 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 diHerent tax rate, please state OffiCial Use Only Q AAF ' your reia��onsn�p co�ne decedent: PA Department of Revenue � 1. Date Established 1 2. Account Balance 2 $ PA� 3. PercentTaxable 3 x � 4. Amount Subject to Tax 4 $ 3 'i 5. Debts and Deductions 5 - 4 {I 6. Amount Taxable 6 $ 5 I, 7. Tax Rate 7 X 6 � 8. Tax Due 8 $ � —LL� 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 oi this torm, along with a check for any payment you are making. Checks must be made payable to"Register of Wills,AgenL" Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the tacts I have reported above are true, correct and complete to the best of my knowledge and • belieT. WOrk �-3 �- $�-�a� � , � a _��Nh O�T-P Home ��I 3 Taxpa .er Signa ure 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 BUREIIU OF INOIV1DWl TA%ES Penns Ivania lnheritance Tax ]�,� ] pennsylvania PO BOX 280601 Information Notice HARRISBURG PA 17128-0601 �' DEPAflTMENTOFREVENUE va.�sas a m�c�ec aoan And Taxpayer Response FIIE rvo.2i-�3-75� ACN 13133552 DATE 06-25-2013 t �" � RE6ISTER OF 4'J1LLS Type of Account 1013 JUl_ 15 �� 1 ��?[e of RICHARD GALLINA �Savings arv Checking Date of Death OS-28-2013 Trust ALICE GALLINA CLERK OF CountyCUMBERLAND Certificate 430 SPRING HOUSE RD CAMP HILL PA 1701 1-1452 ORPHANS� COURT CUMBERLAND CO., PA 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.384898 Date Established Ot-2&2011 REGIS7ER OF WILLS Account Balance $176,867.76 1 COURTHOUSE S�UARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $88,433.88 Tax Rate X 0.045 Potential Tax Due $3,g7g.5p NOTE': If tax payments are made within three months ot the decedenYs date of death,deduct a 5 ercent 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 conect, 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 beneticiary(parent,child,grandchild, etc.)of the deceased. (Select correct tax rate at right, and complete Part � �p% I am a sibling ot the deceased. 3 on reverse.) � 15% All other relationships (including none). p �Changes or deductions The inforrtiation above is incorrect and/or debts and deductions were paid. listed. Complete PaR 2 and part 3 as appropriate on the back ol 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 tax form Retum (iled by the estate representalive. REV-1500. Proceed fo 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 lhe 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 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 oi death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage o(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[he 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 tauable. 5. Enter the total oi 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 diflerent tax rate,please state Official Use Only ❑qqF � your reiac�onsn�p co cne decedent: PA Department of Revenue I 1. Date Established 1 • 2. Account Balance 2 $ PA� 1 3. Percent Ta�cable 3 x � d 4. Amount Subject to Tax 4 $ 3 J' i� 5. Debts and Deductions 5 - 4 � 6. Amount Taxable 6 $ 5 7. Tax Rate 7 X 6 � 8. Tax Due 8 $ � 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 iront 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 knowiedge and belief. Wortc �-3 � ��(O� Home � � � Taxpayer Signature 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