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Home My WebLink About10-07-13 ,�-�BtlREAU OF INDIVIDUAL TAXES � enns Lvan�a Po gox Zao6o� Pennsylvania lnheritance Tax p y HARRISBUR6 PA 17126-0601 Information Notice , DEPARTMENT OF REVENUE � AtIC�TaXp1�/EI' RG$pOC1S@ eEV-isss�ex noeexec c�s-i:� FILE NO.21 �'�� ACN 13503294 DATE 08-23-2013 Type of A�cou,n# Estate of LE?#S:M HOLLER _ Security ;�.; S�C Acct Date of Death 07-10-20i3 �, ° S�ock Rt}XANNE C MORGAN County CWMBERLAND � $onds 203 E WALNUT ST � � � : SHIREMANSTOWN PA 17011-6768 m � � ----t � � �' � � �,,,,, C„�;1 �.`..r, , i"' � ►"� --J ;� �' �"' CJ� '� �, ;� .. . . .. .�efL.�.- � � l) � � . � � � � � � � � ....r. �f ; l--r �-.�..' �� ^'"' "'� � \ �� "�: : _ . � _ _. __._ . ._ __ _ -- - - --- - _ __ __ --- - _ :._� �='''. _.. . �".".� � . . . .. .�.3 AMER I PR I SE provided the department with the information below indicating that at the death of the above-named decedent ou were a joint owner or beneficiary of the account ident'�'ied. . : : ...: Remit Payment and Fa�nns to: �:co�r�rro.a�a��oo�ooz � Date Est�blished REGISTER OF WILLS Account Balance $7,702.61 1 Ct�tlRTH�USE SQllARE . ,. CARLIS�.E �A 17013 ; : � . :. Percent Taxable ' _ X 50 . . . Amount Subject to Tax $3,8b1.31 Tax Rate . � X 0.045 . , ,- - : � -.. ,;. . ; Potentia��Tax Due ' $173.31 NOTE*: I#tax payments are.made withir�three fihor�hs of the . decedent's date of death,deduct 8 5 percen�disc�tr�fi an,the tax With 5%Disccttmt,�'�c x�0.95) $�$ee NOTE'`) . due. Any inheritance tax due will bec�me delinquent�in�'months _ after the date of death. r.- �ART �.�:f please check the appropria#e boxes below. � . � . �.. A - Nt�ta�c i�due. 1 am�he.spouse af the deceased or I am the parent of a decedent who was � 21 years old o�'younger at d�te of death. �= Prooeeol to�ep 2 on reverse. Do not check any other boxes and disregard the arnount shown-s�bov�e�s Poten�ia/Tax Due. . . ,_ ,. . -_ _.�_.�_ �. _ . .. ,._ . , ..., w.;_ . _. _ g �The information is TMe above information is correct,no deductions are being taken,and payment will he sent correct. wi#h m�re�ponse. Proceed to Step 2 on reverse. Do not check any other boxes. C �The tax rate is incorrec�. � 4.5% t am a lineal beneficiary(parent,child,grandcF�ild,etc.)of the deceased. (�I�et co'�'eCt 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 Char�es or deductions The.infor ' is incorrect and/or deb#s and deductions were paid. ` listed. omptete Part 2 part 3 as approp�iate on fhe back oft�is:form. ��J Ass�rr�ll be repor#ed on The above-identified asset�has been or will be reported and tax paid with the PA Infieritanc�Tax . , . . �intiet�nEe��tax form Re�um filed by the e�tate represenia#ive. ; _ � ; RElt-15�. Proceed tc9�ep 2 on reverse. Dta not chedc any other boxes. r- Please sign and date the back of the form when finished. PART Debts and Deductions 2 Aliowable 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 � � ,�1+rlora � f'd7tZ� r n'1'�SSalrYlkN S '7i72r�L/ �'1��' /�� ' y /3 �- !" �"7�� e r� i j��.-, 6 r��G'n C�e r+�t�E'r- �f 7�'7�'° Total (Enter on Line 5 of Tax Calculation) $ /� S��• 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 ihe financiai institutio�and attaci�it ta this�orm. 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. Ths ar��u��t taxabie 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 te � � ` �;,' �� , ,��,\ �� , �' , � your relationship to the decedent: ��'� � �� ' � ��" � ` �� , o' �� ` ��?�'�t'�.�'��'�� 1. Date Established 1 '� �� \��,��\��y�\�� \�\�� '� � �� '�� ;�� 2. Account Balance 2 $ � ° � ,� �� \� �� \�� ` �\�� \� �\`\\ �\�\�\��\ �� X �� \ �� \� ��\ �� . 3. Percent Taxable 3 � ` �� \\\� �� \ �\ ��\ ��\�� \\ \\\ � \�\� �� .� \\�\\\�\� �\ \ \��\��\\�� `' 4. Amount Subject to Tax 4 $ °� � � � � . � � ��\ �\\� �� \\ �� .: �..,::� ...�� .�.., ;�� .\� �.��:��\�.\;��\ \� \�\,:� 5. Debts and Deductions 5 - �^ �� ' �` �-�\�\��\\ \\ \\�\\\ \� �\�:�\\\ � ..� : \�\�\ � ��\�� \��'. 6. Amount Taxable 6 � �� 7 T3?� �3t@ 7 �( � ` ` ��;� �� o � ��, ;�� \ ��,�� `� � � . . . � ` � �\ � �� \�\�\\\\\�\� \�. o ��. 8. Tax Due 8 $ �� , � �� \��\ \��\�� \�\ \�\\\�\ � �� \ � � . � X . \ � �� \. �� \ \�� \ 9. With 5% Discount(Tax x .95) 9 � ,........ ..�..,. . � �:�� ..._.�. �.....,�..,�...�: .�.....,.,.. .....�; � .._._....: ....�>�_�� ...�:� ., �� 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 �� q/- %S' �,s�' �.- Home 7 3 � - s �yc, � - 9 - r 3. Taxpayer Signature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE lNHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 ' /�,, �}- . .� `�'T �man :Fu��ral Home and Cremation Ser�ices , ��e 324 Hturtmei Av�w� . Lemo�ytte, PA 17a43 Tel:717-763-7444 Fax:717-730-9798 Brian C. Musselm�,Supervisor Ciif�ord D. Forester Sr.Fu►�Dir+ecbor �. Mr. G�rsid L.Holler _ . . - 18 Sc,�rsdek Drive C,arap H�ll,PA 17011 'Th�k you for��1 home ta prw�ick scervicas fioz ycxv fs�ni{3'du�.Yow time of ber+eaveana�t. I ht�e dmt you fawd au scrrices�>n�.�u be of xhe hi�est�thet w�a slwae�rs try�o sch�e. The following is a s�m�y of the�atiioe ct�s as p,�'�lY�a�d snd Pn�d�d h�v�e��onrt on t6e�ervioes foc: ,LOIS 1V1.HOLI_ER r��roxai,s�vjcEs s�n�aoa Other � ' of S Includod S incit�cied F P��eg $O�' S 3493.00 � Ta�al F�mar�al Servioe Selec�od '1�07'AL P1tOFffiSIOI�ilIL SERVICF•.S �5,�495.�98 Use of F�Ities 8t Stat€�or Vi�itation S It�dudod Ilee c�f�ad�Rt Staff�or C�ony�Fwraat Hane S Inciuded Use of��Ec�tpn�far Grav�de Servioe S Includod T�'of�Rat�to Fimeral Hane S Includod HeaEx/Funocal Coecti S Includcd Q1�A�'dLCHANiDI3E SELB;C't'ED � _ Ca� Co�m 51,400.00 Ou�erBtu�iai Cot� Sentmal in Silver 51,295.00 R�ar Boa�k�Rao�.s �� I��tamoci$1 Folders Ro9es S Inct�rd�d TOTAL OTHLR M�RCHANDISE SB�I.BCl�D �'E,�6lS.�A CASH ADVANCES Cartif�od C�o�es af l�sth Certific�e S Included Cie�y Ho�orac�um S l00.00 N�ws�_Ndioe �Ierrjsburg patriot I�kws S 170.00 � Fio�werx Pmk Roee Ca�ic�et Spray S 225.00 , _ _ y��F� _ S 3o,U0 C�SH ADVANCE T4TAL 5525.8� TOTAL OF SERVIC4S �S,71S.9A BALANCE DUE 58,715.9� If fihu+e are sny qc�s a'.c�t�t remain un�swe�ed,Please call me. S' lY, �