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Home My WebLink About11-18-13 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX�11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 1 7 1 28-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 018410 SULLIVAN CONNIE 523 SHED ROAD NEWVILLE, PA 17241 ACN ASSESSMENT AMOUNT CONTROL NUMBER °------ fold ---------- -------- 13149846 � $408.74 ESTATE INFORMATION: ssrv: 13149847 � $7.1 1 FILE NUMBER: 2113-0134 I DECEDENT NAME: KARNS JOHN E � DATE OF PAYMENT: 1 1/18/2013 � POSTMARK DATE: 1 1/18/2013 � COUNTY: CUMBERLAND � DATE OF DEATH: 12/20/2012 I � TOTAL AMOUNT PAID: $415.85 REMARKS: CHECK# 105 INITIALS: HMW SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGIST�R OF WILLS REGISTER OF WI�LS . Bu��►u oF �Nn�v�ow►� TAxES Pennsylvania lnheritance Tax � pennsylvan�a PO BOX 280601 DEPARTMENT OF REVENUE HARRISBI�G PA ��28-060� Information Notice REV-15i3 E%DoeEXEC l�l-12) And Taxpayer Response FILE NO.2113-0134 ACN 13149847 DATE 09-25-2013 TYPe of Account� . Estate of JOHN E KARNS , ��, Savings '�, ;Checking Date of Death 12-20-2012 � � �"''" Trust ' JAS�N L SULLIVAN County CUMBERLAND � �� ertificate 119 CONODOGUINET MOBILE NEWVILLE PA 17241-9488 �, � � -�� . � � � � � � � j, i _ � � � � � � 'C".. '� �D ,� "fi 'q'�,' �'i'» � � -��,". i�'3 C� U '.� '� C?;, 4 ""i'1 �,,.+. t-'" tri' ` � ;�, ;. � Y'.' '�'` �3 '* = ._ ,� � : _ _ _, . __ _ _ ._ — ___ _.. _. _ , __ � .._ •e. - _ _ _ '"�,1 . � � � - -�. _: : u ` -�._. � _. ___._._._._...r,�., ACNB BANK provided the department with the information below indicating that at.the death of the above-named decedent ou were a joint owner or beneficia ' of the account identified. Account No.137200 Remit Payment and Forms to: Date Established 05-23-2011 REGISTER OF WILLS Accownt Balance $947.53 1 COURTHOIlSE SQUARE Percent Taxable X 5p _ CARLISLE PA 17013 Amount Subject to Tax $473.77 - Tax Rate X 0.150 Potential Tax Due $71.07 NOTE*: If tax payments are made within three manths of the decedent's 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 �t�p 1: Plea�e 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�tep 2 on r+everse. Do not check any other boxes and disregard the amount shown abovre as Potenrial Tax Due. _._ _.__- -------- _ __---__� ----- ____ _______--- —-,- ---- ____._ _ _ ____ _ _ g �The,;information is The above information is correct, no deductions are being taken,and payment will be sent conect. 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 Tlie information above is incorrect and/or debts and deducti4n�were paid. listed. Complete Part 2 and part 3 as appropriate on the b�ck of this form. E �Asse�-w+l!be reported on The above-identified asset has been or wiH be reported and tax paid with the PA Inheritance Tax inheril�nce tax forrm Retum filed by the�state representative. ° . REY•1�5�0. Prc�ceed to Step 2 on reverse. De�ot check any other boxes. . � Please sign and date the back of the form when finished. PART Debt� 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 mak9ng a correct�on to the establishme�t date(Line 1)account balance(Line 2),or percent taxable(Line 3), please obtain a written correction from the fir�ancial instituti�n 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 statJe " , � , ��„��r�� ,��„��;,�� ' your relationship to the decedent:�' �° � �� ``'��`� `` '�+ �� ` �@`�#�`��\�``��```` � '� S .li�tj � ['� \� � � � � �� . ��\\\ ��\� � 'l_l . � ��.\� ��\\\��G��i��`��r:1i \\��\\\��\��\. C,i � - � \\�.� ��\�\�\\�\\\�>.:.�..\\\�\�\\\\\\\�\\�`.\��\\\\,-��\�\\�-.\�.\��\\�\��\\\\>�\�� 1. Date Established 1 7- �a3 �,:�.�i� �:: � � � � `� �� \��\ �� w �\ \\\��\��\��\��\��\\�\\��\\\�\\`��\\\\��\\��\\\��\\\�\\��\��\: n� T'`� \ ��\\\�\�:.�\\\� �\� �p� ;�\�\ �� \�� .\\\ �\\��\�\�� Q\� 2. Account Balance 2 W / ! �r�'a� �� \\\�\\\�\�� \\ \� ��\ \�\�\� \��\��\�� \��\�\ �� '4 \ \\ � \ \\ � ��\p��\��\\��\�\�\�� \�o�\��\�\�� \��\��\ ��' \ 3. Percent Taxable 3 X / � �' ��`� / \ � � \ �� -\��\�\�� \�� T � �� \ ��\��\\�� \ �\�\��\�� \ �� . � � ��\\ \\ \� \ \� ��\\\� \\\� ��\��\\\��\\\�\` 4. /�1f7�o�.lrlt Sub�ect to TaX 4 $ , , � � �� s�7, crs � �� `�`�� ` � �`� �� ` �� . � �� \\\� � \\ \\ \� �� \ \\ �� 5. Debts and Deductions 5 �� ' - �, � � � � �� A� ��A�p�� \p\� �\�� \\�� 6. Amount Taxable 6 � � `� � \ \ \ \ \ \ \ \ \ �� -� �:�✓ . � ��:� ��\��\��\�� \�Q \��\��\� \ �\� �� \� \�\ �\ �� \�: \�� `��\o�\�\�`�\�\\\��\��\� ��`��\\��\\\��\��\\� 7_ T�x RatP 7 X (:,;'. C�`<E:�S_' � � \ 2� �� \�� 8. Tax Due 8 $ �. l 1 � � �� ,� �; � � ,, ;� � �� ;, � � V �A��AV��V�V��\��\V��VVA��A\��A`�A��\��.��a � �� \��\��\��\��\�� \�\\��\��\\��\\`��. 9. With 5% Discount(Tax x .95) 9 X ��.��;�...,.��;��,��,.._.��.�...�� ... ;., ...�� ..V�..��..;..A..��..�_.��A�.�.��AAV\a\�� 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 l 7J7�� -��.�.�. `� . �� Home C�I 7 � ` � A � axpayer 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 r�' n � . . su��►u oF,INDIVIDWI TAXES Pennsylvania lnheritance Tax � pennsylvan�a PO dOX 2�50601 � HARRIS�INtG PA 17128-0601 - �nfOrl�atl�l� NOtICe DEPARTMENT OF REVENUE • REV-154i EX DoeEXEC(�!-l2) And Taxpayer Response FILE NO.2i�3-0134 � ACN 13149846 DATE 09-25-2013 Type of Accoun# t ,., .a�= {3 fsta#�of JOH�U,�;KAF�NS �, avings � hecking Date of Death 12-20-2012 � a rust- CaNNI E L `SUL L I VAN County CUMBERLAND � � � _ ertificate 119 CONOGUINET MUBILE E p� -�p � � NEWVILLE PA I7241- � � r � � � � � �v -C� "",� . � -� � e."� � ':.� '� C? � � G �, � Cn �. . G> . � � N -�; � - � � � �. u sw .. __. __,_ ;.�._ ._ �,_.__.�<,,. � _ -�-- .�n _ - .��.-�-�,.�.�- � 4 _,�_ �..�,.�..:,�� r..._ _.._ , _. ,_,�.��.�. _ . � _ .t u . . � _ ... ... , - __-___..�:. _..�..�.-:�.�..__.Y- . � _._�,__._�.�__.____ _ _ . __.w_ _�___ ._ -,_._ �_ �_ . ._..�._. __, ._._. � �.,._. _ . _ — __ _�_______ .._.. � _ . , . ... . ...,:�►`� w,�,�.>:� ACNB sAwK provided the department with the information below indica�ing that at the death of the above-named decedent ou were a joint owner or beneficia of the account identified. Remit Payment ar�d Forms to: Ac�coun#!�:9ID04�28735 Date Established 12-05-2011 REGISTER OF WILLS Account Balance $71,375.90 `1 GOURTHOUSE 3QUARE Percent Taxable X 5p CARLISLE PA 17013 Amount Subject to Tax $35,687.95 Tax Rate X 0.150 NOTE*: ff tax payments are made within three months of the Potential Tax Due $5,353.19 dec+edent's date of death,deduct a 5 percent discount on thetax Wi#h 5�o Di�count(Tax x 0:9�5) $(see N�TE*) due. Any inheritance tax due will b�come delinquent nine months after the date of death. PA� St�p �: Please check the appropriate bo��,below. t a Q Na'ta�c is due. l am the spcat�se of the dec:�ased or I arn the parent of a decedent who was 2t y�ars o�d or�a�unger at date vf death. � Proc�eed to Step�on rreverse. .Do naf cheek any other boxes and disriega�+al the amount : shown abQVe as Poiential Tax Due. __----.----=,____, - ��-,•.-.-_:�:a- ,�,, �_- 4�.. -:�,_..�.:..... �. �.-.: _ --- — --. _ ___ _..,_. _ -- --------- __ ____.___� , .,.:,:_.... _ .;:_.�s .__ .- . . g �The informafion is ^V 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�ate is incorrect. � 4.5% I am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased. �'(�elect correct tax rate at right,and complete Part � ��/o 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. Comp/ete Part 2 and part 3 as appropriate on the back of this form. �Asset will be reported on The ab�ove-identified,asset has been or will be reported and tax paid with the PA Inheritance Tax E inheritance#a�r form � Retum fited by the<estate representative. REV-1500. Proceed to S�sp 2 on r+everse. Do not check any other boxes. 'W P�ease sign and date the back of the form when fmtshed. . „ 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 - .y-��/� �_ ' , � �� • ��. -. - i.3- :.� -�o tc , '` C�C� �1 r" or�n e�- �� .'J�;�� '� 1 4l`�J V�I � �� J � �l.l� J^'.O I �O � ,� Q �.1�+F� ' � �'� �'/'ec.. �u-tii 4...^ I�L dV`S �a7�• �'�'�1 Total (Enter on Line 5 of Tax Calculation) $ /t'�y�, S�. �.�c°-��? PART Tax Calculation 3 If you are making a correction to th�establishment date(Line 1�accour�t balance(Line 2),or percent taxable(Line 3), � � please obtain a written correction from the iinanciai insiiiufic�n an�d aiia�h i�t��s f�r�. 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 indicatin a different tax rate le e state � � �� 9 , P � � � ��, �� your relationship to the decedent: : h��f��`��`,��,��,�\��,\,\� � ;\� �\\\\\\\\\ �� \\\� � �\� \�\\��\\\\ � � �`��\� � �\�� \\��\�� _ �� \��\��\�� 1. Date Established 1 �1-;�� (C ��:��,��:��\��;��`��\��`��`.,��°��`��\\��,, \\ `\\\�\\�\\\�\\�\\��\�\\�\\\\��\�\�\��\\�\\\\`\�\�..\ \ \\\�\\ 2. ACCOUIIt BSIaf1CG 'Z � �� .�. �f/� ��\ \ � ��\��\�� A\ V ��.�� \. '� 1 C1 �� :, � �\\�\\\�\��\\-�\�\\�\\�\\\\�\��\�\\��\��\\��\�\�\�\\\�� 3. Percent Taxable 3 X �(;, �,.� ��;�� , � � � ��,�� ,� � , �� ,�; �;�,��,�� i \ � �� \� � � \��\\\�\\ �� \�� \� �� \ \�� \�\\\��\\��\\\�\�� \�� \�� \�\\�� \� �� `A ��V��\V��V��\��\��\��\ 4. Amount Subject to Tax 4 � 1l,�'"��, � � �� , � , �,,,, � �� '� � \�� \\�\�� \ �� \�\��\ \: � ��\��\ ��.�\�. 5. Debts and Deductions 5 - � ��5 � . � � � �� \ �\ \\�� \�\\ \� \\ �\ � � � �\� � ��:\�\\��\��\\\� ��\��\��\��\� ..� ��0\\`\��_ \ 6. Amount Taxable 6 $ C:)�3.!/ �„ �� ,�, ;��,�;�� '� �� ,�� ,� �� .�� \��\��\��\�\��\\�\�\��\\��\��\�\� ��\\��\�\�\\��\\\\ T (� � G�4S `��,� �,� � �� 7. f aX i-'iQi�v 7 /� ► �� \ � �\ �\ \ �� \� �\�� \�\� � �\\\ � \ � � �� \\�\\\��\ �� \\ \�\�� \\\� ��\�� \\• 8. Tax Due 8 $ �� 7�F �� ,��,�� ,��,,; � �� ; , �� , �,� � ' ' �� `� ��\��\��\\�o\\\`��\��\\\�\��\��°��`��`\�� \�\�\��\��\��\\\��\�\��\��\\��\��\��..\\�\�:\�. 9. With 5% Discount(Tax x .95) 9 X � ..�� .....��`.:��.��.��\��\��\��\\��\�\\��\\�\��\��.��:a\\��.��\\��\�..\:�\.Q.:.:�\�\\�a��\��:�.�'� 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 : _�.r�.��:_�.�._.��.,�.,�—�.,�.. Home �?� �- 7� ;� 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 r. � . � ,, Pennsyivania DEPARTMENT OF REVENUE File No. 2113-0134 ACN 13149846 DATE 09-25 2013 Estate of JOHN E KARNS SSN 201-16-4889 Date of Death 12-20-2012 County CUMBERLAND Part 2 Continued _Da�e Pa�Ci � ,. ,v� Pa�ee - Desc�ip#ion - Amount Paid _ IRS Income Tax 1205.00 Reg. Of Wilis/Cornerstone 15.78 Total 2,815.25