HomeMy WebLinkAbout11-13-13 BUREAU OF INDIVIDUAL TAXES Penns Ivania Inheritance Tax �` pennsylvania
BU BOX 280601 Y
HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE
REV-1543 E%OocE%EC (88-12)
And Taxpayer Response FILE NO.21 -13- lao b
ACN 13157068
DATE 10-25-2013
Type of Account
Estate of IRVING ROSEN Savings
SSN X Checking
Date of Death 08-09-2012 Trust
MYRNA C ROSENKRANTZ County CUMBERLAND Certificate
3824 MANOR DR
HARRISBURG PA 17110-3658
WELLS FARGO 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. 1010242810830 Remit Payment and Forms to:
Date Established 08-31-2009 REGISTER OF WILLS
Account Balance $7,022.39 1 COURTHOUSE SQUARE
Percent Taxable X 50 CARLISLE PA 17013
Amount Subject to Tax $3,511.20
Tax Rate X 0.150
Potential Tax Due $ 0.150 s i NOTE': If tax payments are made within three months of the
decedent's date of death,deduct a 5 percen�.discount on the tax
With 5%Discount(Tax x 0.95) $(see NOTE') due. Any inheritance tax due�become del�quen ntrae months
after the date of death. rn
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JAJNo Step 1 : Please check the appropriate boxes below. , )> M D M tax is due. I am the spouse of the deceased or I am the paro—qt Of4 dec v` o was
21 years old or younger at date of death.
Proceed to Step 2 on reverse. Do not check any other boxe�nd disregard t gibount
shown above as Potential Tax Due. = c5 r-
-0 r�7 CD
B 7-1 ne information is The above information is correct, no deductions are being takeand payme ill be dnt
correct. with my response.
Proceed to Step 2 on reverse. Do not check any other boxes.
C F—]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 F—] 12% 1 am a sibling of the deceased.
3 on reverse.)
15% All other relationships (including none).
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 F�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.
tDebts and Deductions
Allowable debts and deductions must meet bath 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 8112"x 11"sheets of paper.)
Date Paid Payee Description Amount Paid
t lb 5 PL- aG 'D AuS> (4F-0-c> tST"oNe..- (o03
E=1'j- tY sIPJC- tiF 'lam./Im %3 C;
F-J IF- .-A w1 a.9'l2 - Oa
VA- b... -TO t=a+w.... ¢u t'. a.,C'.r.
Total Enter on Line 5 of Tax Calculation $ -h'k f
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"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 0/., 3 owners=3133%,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.
S. 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 Officiaf Use Only ❑AAF
your relationship to the decedent: PA Department of Revenue
1. Date Established 1
2. Account Balance 2 $ PAD
3, Percent Taxable 3 X 1
4. Amount Subject to Tax 4 $ 3
5. Debts and Deductions 5 r g- 4
6. Amount Taxable 6 $ 5
7, Tax Rate 7 X 6
8. Tax Due 8 $ 78
9. With 50/6 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 /V//9
HomeN? �� 1?/��
Taxpa r Signature 0 Telephone Number/7—f Date !///S//3
[DISTRICT Y 6 NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE
OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR
XPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020
N — —
STAN OP DAVID MEMORIAL GARDENS AND FUNERAL�CHAPEL N! 807494'
Yfllt>adR!Y p0. NORTH CAiALE,R.ligK pit)
� - Con(ract
File Folder NameMumber
CEMETERY INTERMENT BIGHTS,NMCHANDM AND SERYICES MMICHAWSECMUTY ACMERWONT
I . 'THMS A.GREEMF.NT PR'OVEDES FOR CARE AND MAINTENANCE.
ardeaiBaal,ratans 4 d bmby rewr to pmbm an Iaaatmems Rish4,MwckmWM sad series da ft iesa,suk6 !to tad spprers of
tar.eeee�ei ur11eaaf. , •.i���
ratvi.41a:lna PMeec � � + l r t �i*.c ����i� (�.1 I (_
0m; �7—! Pala:
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C11,,11terdmer:Last Ntsm: I I l t l l l i l I I I I I I Fm: I I I I I 11 1 1 I I i I_1 iodic
Tdcolvau;(_.} s ssm Dtts: .,..1—. 1 Rmtm;
AM—, U I 1 1 1 � i l l l l l 1 1 I I I 1 1 1 1 I I ! I I Cty= I I I I I I I I I I I I 1 Serfs: LLj Ar
D MPOMM" I III 111F'b- 0 1 1 1 1 1
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tnsa CWfifiaw of l ft-at 160ts to: .
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1M'ERMENT MERMANDIM R BERViats
awisdes Lire am Wbiwan.ex s } r ^» suppr-
• ItdeaerrietadReeaasBtasFe41s 'lypelColot
• Outer BMW Cemftb • Demign/ ae /""~
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De 6talsias r..-.-- "TAM ALLOWANCES&TAM
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TERMS
Attememtt to Pq:Time Total Pumhsse Pricy is die aW payAb as of the bee of this Agreement.A dciiagadwy chaW of five pmem will be ssame4 morthiy on any
b11t410oe 1100 osid wit63s 70 days d the date of dtis Ayeeomeat if kus t!m fail psymaa u recsvrd.Salta ffia}i deduct do scarred 4dinQueacy c6aRe from the amouac
reaoived a,d cmdit dte ratwitider of the paya+ant to the Unprid 1111141000.
Titlm Sdiri(a ss amp�I will retain title to"batnelot Rim std Ma bsotliae rotil tbo 7boal Fumhale Mon.mrthar with a elf dalltwptm0y ehataea MOW wave bem
paid by Porehaserm Sdbc
Cen�tery Raier and R.pdmi amen Ptacbater shall tornply at all rim"with all Reba and Rsdulatiaas now existitp,at betaaita adopted by the Sally tad approved by the
Plarida Board d FmnL Ct wkxy,gad Comm,Se VWM IN the"M omtmL ma041sarcm 41nd laugectim ofp the�camolary std for all hmrpoem deamnd nacasary,by
Soller rue .adaeu.ds Resoa o a�peuian of6oa afScl> eta Gka1t ogtm wi;et the taaefmy was�such Rolm
The Pgrdlaaer dM bays thirty dw b m the date d eneutlog dthis AgreenmW to caned the Agreement and reechv a total Mood
of all monks pad lbr kems aims geed.
Any gaesdoas or aft 6nown*thin transaction map he diraded to the Fkeidlt Board of Funeral,Ceaeterp,and ConsuMW
Servitxs at(M)
NgfltCE:By siIIeiy f6is AyeemaM.Prrchaae is ug the try shim Ptrmbam may hue against theSeller stall be molted by stbitratim sad Pondma w is`ivinj up
his/her b r oorrt 11r trial a t o hlalhm of J
°&ignld this 1WA409, I _
An STAR OF DAVID MRMCMBAL*AM=01
of
tPusrtt Rtsta6otigbip: A—pad by., t,r.sa.tr,.p+ttrdr�.rruraw.,ry:adorrtne.us
PiOI lCE: &r A&Udoua Tams and Coasdith m wbleb are Part of This Agreement
f David ❑ Baffle;
*: Sta r o Bailey
„-5 Memorial Gardens and Funeral Home Memorial Gardens
7701 Bailey Road 7801 Bailey Road
North Lauderdale, FL 33068 North Lauderdale, FL 33068
Phone: 954-722-9000 Fax: 954 _''^"
Outside FL: (800) 456-5252 or
;6y4-7912
-7 -- Y k/ '
To: Phone:
Fro Fax: 17Z/ �
rte.-------------------7-------rw------------w -----r
authorize Star of David/Bailey Memorial to charge my
(name)
credit card for: I i amount of$
(descript n of co tract)
(credit card numb ) (expiration date)
311 S--
(dat ) n re)
i
Should you have any question, please feel free to call our office.
CONFIDENTIALITY NOTE:
The information which follows and is transmitted herewith is privileged,trade secret and/or confidential information intended
only for the viewing and use of the individual recipient named above. If the reader of this message is not the inteded recipient,
you are hereby notified that any review, use,communication,dissemination,distribution or copying of this communication is
strickly prohlblted: If you have received this communication in error,please immediately notify us by telephone.
I
- 1
allETRICK-BITNER ❑ RONALD C.L.SMITH ❑ JESSE H.GEIGLE
FUNERAL HOME,INC. FUNERAL HOME FUNERAL HOME,INC.
3125 Walnut St.Hbg.,PA 17109 A branch of Hetrick-Bitner Funeral Home,Inc. 2100 Linglestown Rd.,Hbg.,PA 17110
(717)545-3774 Fax(717)545-2325 325 North High St.,Duncannon,PA 17020 (717)652-7701
Nathan A.Bitner,Supervisor (717)834-4515 Vaughn Miller,Supervisor
Graham S.Hetrick,Funeral Director Timothy A.Hobbs,Supervisor
Ronald C.L.Smith,Funeral Director
Funeral Expense Agreement
This is an explanation of charges as well as a sales agreement presented in accordance with the regulations of the PA State Board of
Funeral Directors.
STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED
Charges are only for those items that you Selected or are required. If we are required by law or by a cemetery or crematory to use any items,we
will explain the reasons in writing below. If you selected a funeral which may require.embalming, such as a funeral with a viewing,you may
have to pay for embalming. You do not have to pay for embalming you did not approve, if you selected arrangements such as direct cremation
or immediate burial. If we charge for embalming we will explain why below.
Legal,cemetery,crematory or other requirements com pellin he purchase of any items listed below:
Reason for Embalming: nn ,gyp
Funeral Services for t��nl f��.S�n Date of Death t4�iGll� 1, )IU ,Date of Service
GOODS AND SERVICES SELECTE
TYPE OF SERVICE AUTHORIZED TO BE PROVIDED Register Book. . ....... .. .. ... ... .. . ..... .. $
L3 Traditional Full Service ❑Viewing day of Service Prayer Cards.... . . . .. ... . . ... . .. ..... . . .. . $
Crucifix . ... . .. . $
L)Graveside service only ❑No Viewing Temporary Gr ave Mar ker... ... ....... . .. ..
$
❑Cremation ❑Immediate Disposition Memorial Board Rental . .. ..... ..... . ..... . $
❑Public Viewing ❑Anatomical Gift Casket Rental..... . .. ......... .. . .. . ...... $
❑Private Family Viewing ❑Memorial Service Clothing. . .. . ..... ... ... ....... ..... .. .... $
❑Evening Viewing AIShipping Service Flag Case. .... .. .. ... .. . .. . ............. .. $
Other $
❑Receiving Service Total of Merchandise Selected(C).. .. . .. . .. . .. . $
A. Package Arrangement o D. Special Charges
Forwarding Remains to
$ $ d��
B. Charge for Services Selected: Receiving Remains from
1. PROFESSIONAL SERVICES $
Basic Services Fee .. ... . .. .. . .. ... .. . .. $ Immediate Burial.. .. .. ........ .. . .. ... . ... $
Embalming . . .... . .. . .. . .. . . .... .. .. . . $ Equipment Rental.. .... . .. .... .. . ... ...... $
Cremation. ... . .. ... ... ... .. ... . . .. .. . $ Direct Cremation.. ... .... .. ... .. . ... .... .. $
Other Preparation of Body Total of Special Charges(D) .. ... ......... . .... $
E.Cash Advances
$
Transfer of Remains to Funeral Home . . . $ Opening of Grave.. ..... .. ......... . .. .... $
Cemetery Equipment. .. .......... .. ... .... $
Sub-Total of Professional Services(Bl) . . . . . $ Clergy/Mass Offering .. . .. . .......... . . ... $
2. ADDITIONAL SERVICES AND FACILITIES Flowers .. ...... .... ... . ... .. ...... .. .... . $
Visitation.. . .. . .. ... .. ...... .. .... ... . $ Hairdresser....... ..... ... ....... ...... ... $
Funeral Service. .. . . . .. . ... .. .. . .. ... . . $ Certified Copies of Death Certificate ..Id... $ _77Z
Memorial Service. .. .. ....... .. . .. . .. . . $ Newspaper Notice .. ..... ..... . .. ........ . $
Graveside Service ....... . .. . .. . ... .. . . $ Cemetery Lot and Deed........... .. . .. .... $
Sub-Total of Additional Pallbearers..... ... .. .... ... ....... ........ $
Services and Facilities(132). .. . .. . . . . .. . .. . . $ Airfare .. ... ....... .... .. ................. $
3. AUTOMOTIVE EQUIPMENT Vault Service Charge.... ..... ..... ..... .... $
Honor Guard . ............................ $
Funeral Coach . .. .. . . . . .. .. ... . . . . ... . $
Organist.... . ... .. .... .. ............. . .... $
Lead/Clergy Car... .. . ..... . .... ...... $ Other $
Flower Car.... . .... ... . ... ... . ... .... . $
For your convenience,we will advance the cost of the foregoing items;however,any
Family Car. ... .. . ... . . . . . . .. . . .. . . . . .. $ �_ error made by any supplier of services shall be the sole responsibility of that supplier
Other than local 20 mile Transportation. . $;T MO and our funeral home is relieved of liability therefore by acting as your agent.Hetrick-
Bitner Funeral Home, Inc., Ronald C.L. Smith Funeral Home and Jesse H. Geigle
Sub-Total of Automotive Equipment(B3)... $ Funeral Home, Inc. are entitled to take and retain any discounts offered on the
purchase of a cash advance item.
Total of Professional Services,Additional Services �and Facilities,and Automotive Equipment(B) .. $ Total of Cash Advances(E) . .... ... .. . .. . ... .. . $
C.CHARGE FOR MERCHANDISE SELECTED A. PACKAGE ARRANGEMENTS. ... .. ... . ... $
Casket B. ADDITIONAL SERVICES / FACILITIES.. . . . $32-S-(,
Description $ C. MERCHANDISE.. ...... ... . .. .. . ..... . . . . $ _
Other Receptacle $ D. SPECIAL CHARGES ... ... ....... . ... . ... .
Description -'
Outer Burial Container Total of Funeral Home Charges............ $
Description $ E. CASH ADVANCES.. ..... ... ... ..... .. . ... $
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Flight, Hotels, Car: Fort Lauderdale Sun, Aug 12, 2012
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Flight+ Hotel Package Billing information
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