Loading...
HomeMy WebLinkAbout03-24-05 "-- . '..~~ ')'; ',-v ,; - c ..... ....1 -, '.. ..... (..1 ..... ,'It l:~' u, I.':' - - - == r~ , f\ ~~~ ~ ~~ ~ t~. ~f - - == - - - - :.. ~ :::;:;;;: g.~i' .~. 2'2 ~ g.~t"1 " ~..... ~~ f ~ i. ~ ~ :;; .. , i'ii.. -.r ~ '.~.'c :~ :0 " .'b -~ "1 } ,.. . ~~ ~'Itf, COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z8D6Dl HARRISBURG~ PA 171Z8-D6Dl *' 1~'.!", i ' REY-m~:. .~~ 'JFP_.t.~EDDl INFORMATION NOTICE AND ~t~AYER RESPONSE "'''' FILE NO. ACN DATE 21 as ~lt4 05106582 03-01-2005 ;)1" r.. ,)~ST. OF MARIE A THIEME ~s.S. NO. 180-01-4596 DATE OF DEATH 11-10-2004 COUNTY CUMBERLAND TYPE OF ACCOUNT IX] SAVINGS D CHECKING D TRUST D CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 HERBERT C THIEME JR 15 MANOR DR MECHANICSBURG PA 17055 PSECU has provided the Departllent with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent~ you were a joint owner/beneficiary of this account. If you feel this information is incorrect~ please obtain written correction froll the financial in$titution~ attach a COpy to this for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (717) 787-83Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0180014596-51 Data 12-09-2000 Established 41,102.69 16.667 6,850.59 .045 308.28 PART TAXPAYER RESPONSE [!]I!l!~l~~~~.i!ii~iiiig~~_:iii~~~~i!iii.~~i!i!i~~!i!l~!i!i.~~i~.!!!i!~~i!!!"'l!l!.iiii.!!ii~~~!i!i.I~~~~!1 rr.Tr.T...............................,.-...........,...,.,...T.................................................................~...........................................................'...'.....' .....'.'...'.'...'.....'.....'.'................................................................T...-.....-....li~...-...,.,...,.,...,...,..,..................................,........,.............. ... Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due To insure proper credit to your account~ two (Z) copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax payments are .ade within three (3) lIonths of the decedent's date of death~ you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent nine (9) 1I0nths after the date of death. Tax x [CHECK ] ONE BLOCK ONLY A. ~ The above inforllation and tax due is correct. .1. You lIay choose to rellit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest~ or you may check box nAn and return this notice to the Register of Wills and an official assessllent will be issued by the PA Depart.ent of Revenue. B. 0 The above asset has been or will be reported and tax pillid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. c. 0 The above inforllation is incorrect and/or debts and deductions were paid by you. You must complete PART 0 and/or PART @] below. rtRI J!~~o~~~~}F~~wa differ!nt tax rate} please state your 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions S 6. Aaount Taxabl. 6 7. Tax Rate 7 x 8. Tax Due 8 PART @] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I $ I TOTAL (Enter on Line 5 of Tax Computation) Under penalties of perjury} I declare that the cO..~t~nd belief. TAXPA G ATURE facts I have reported above are true} ~ect and HOME (71/7) C.91-tt'llJ ~ ) WORK () 73 ~ Z<J ()S TELEPHONE NUMBER ATE \?' GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT with spplicablB interest based on infor.atien submitted by the financial institution. Z. Inheritance tax beCOMes delinquent nina months after the decedent"s date of death. 3. A joint account is taxable Bvsn though the decedent's naes was added as a Batter of convsnlence. 4. Accounts (Including those held between husband and wife) which the decedent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts establishsd jointly betwBBn husband and wife .ore than one year prior to death are not taxable. 6. ACCDunts held by a decedent nln trust forR another Dr others are taxable fully. REPORTING INSTRUCTIONS - PART 1 TAXPAYER RESPONSE 1. BLOCK A - If the infor.ation and cOllputation in the notice are correct and deductions are not being clailled~ place an "X" In black "A" of Part 1 of the "Taxpayer Response" secUon. SIgn two copies and sub.it thell with your check for the allount of tsx to the Register of Wills of the county indicated. The PA Departllent of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return fro. the Register of Wills. 2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representl!ltive~ place an "X" in black "BOO of Part 1 of the "Taxpayer Response" section. Sign one COPy and return to the PA Departmant of Revenue~ Bureau of Individual Taxes~ Dept 280601~ Harrisburg~ PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice infor.aUon is incorrect and/or deductions are being clai.ed~ check block "C" and cOlllPlete Parts 2 and 3 according to the instructions below. Sign two copies and sub. it thell with your check far the a.ount of tax payable to the Register of wills of the county indicated. The PA Depart.ent of Revenue will issue an official assessllent (Farm RfV-lS48 EX) upon receipt of the return from the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter NOTE: the date the account originally was established or titled in the lIanner existing at date of death. For a decadent dying after 12/12/82: Accounts which the decedent put in joint nSlles within one (I) year of death are taxable fully as transfers. However~ there is an exclusIon not to exceed $3~ODO per transferee regardless of the value of the account or the nu.ber of accounts held. If a double asterisk (MM) appears before your first nalle in the address portion of this notice~ the $3~000 exclusion already has been deducted frail the eccount balance as reported by the finencial institution. 2. Enter the totsl balance of the account including interest accrued to the date of death. 3. The psrcBnt of the account that Is taxable for each survivor is detBrminBd 8S follows: A. The percent taxabls for joint assBts BstablishBd more than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF JOINT OWNERS Exa.ple: A joint esset registered DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE SURVIVING JOINT OWNERS in the na.e of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED DY t (SURVIVORS) ~ .167 X lDD 16.7~ (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created wi~hin one year of ~he d8C8den~'s death or accounts owned by the decedent but held in trust far another individual(s) (trust beneficiaries): 1 DIVIDED BY TDTAL NUMBER DF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Example: Joint account registered the decedent. 1 DIVIDED BY 2 (SURVIVORS) ~ .50 in the name of the decedent and two other persons and established within one year of death by X 100 50~ (TAXABLE FOR EACH SURVIVDR) 4. The amount subject to tax (line 4) is determined by .ultiplying thB account balance (line 2) by the percent taxable (line 3). 5. Enter the total of the debts and deductions liStBd in Part 3. 6. The a.ount taxable (line 6) is deterllined by SUbtracting the debts and deductions nine 5) fro. the amount subject to tax (line 4). T. Entar the appropdate tax rate (line 7) as deter.ined below. I ~;~~~~;: ~: :;~:::.I :;. I 4 ..~~. I ~;;. I ~;~ I _The tax rate lllposed on the net value of transfers froll a deceased child twenty-one years of ege or younger at dBath to or for the use of a natural parent~ an adoptive parent, or a stepparent of the child is O~. The lineal class of heirs includes grandparents~ parents~ chIldren~ and lineal descendents. .Children" includes natural children whether or not they have been adopted by others~ adopted children and step children. "Lineal descendentsR includes all children of the natural parents and their dascendents~ whether or not they have been adopted by others~ adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least ona parent in co..on with the decedent~ whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiarIes. CLAIMED DEDUCTIONS PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are deter.ined as follows: A. You legally are responsible for paYllent~ or the estate subject to administration by a personal representative is insufficient to pay the deductible ite.s. B. You actually paid the debts after death of the decedent and can furnish proof of pay.ent. C. Debts being clailled lIust be itBllized fully in Part 3. If additional space is needed~ use plein paper 8 1/2" x II". Proof of pay..nt .ay be requested by the PA Departllent of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX( 11-96) RECEIVED FROM; PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT THEIME HERBERT C JR 15 MANOR DR MECHANICSBURG, PA 17055 __nnn fold EST A TE INFORMATION; SSN: 180-01-4596 FILE NUMBER; 2105-0264 DECEDENT NAME; THIEME MARIE A DATE OF PAYMENT; 03/24/2005 POSTMARK DATE; 03/23/2005 COUNTY; CUMBERLAND DATE OF DEATH; 11/10/2004 NO. CD005116 ACN ASSESSMENT CONTROL NUMBER AMOUNT 05106582 I $308.28 I I I I I I I I TOTAL AMOUNT PAID: $308.28 REMARKS: CHECK# 5300 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WillS GLENDA FARNER STRASBAUGH REGISTER OF WillS ~;:,~ ?.....~ ~%"~ , -~:l. Ii (';:..n ."~f...h~ .'~ a '...J"" ,0; 1T~\.'., ~ ) !, ,.;; ,-."., ......... .... .,\ () .... ,,,\ + (, ~\ C) N \t, '- ~ ~t~ - '" 2- ~\~ - - l f ~. ..., , 'v :'~.., ,~ CO ...') \ :/ . " Ii:} ~I~""I(':'''J '. j'1 ,. , , , , , , COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG~ PA 17128-0601 * INFORMATION NOTICE AND !~j(PAYIl~C:~!f~:ONSE FILE NO. ACN DATE 21 05-~~lf 05106586 03-01-2005 REV-15~3 EX AFP 109-DDl ~s~. Dr !~A~i A THIEME S.S. NO. 180-01-4596 DATE OF DEATH 11-10-2004 COUNTY CUMBERLAND TYPE OF ACCOUNT D SAVINGS D CHECKING D TRUST IX] CERTIF. HERBERT C THIEME JR 15 MANOR DR MECHANICS BURG PA 17055 REHIT PAYHENT AND FDRHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PSECU has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent~ YOU were a joint owner/beneficiary of this account. If you feel this infor_ation is incorrect~ please obtain written correction from the financial institution~ attach a COpy to this for_ and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co_monwealth of Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0180014596-551 Date 12-09-2000 Established Account Balance Pe...cent T.xable Amount Subject to Tax Rate Potential Tax Due x 101,943.16 16.667 16,990.87 .045 764.59 To insure proper credit to your acco~t~ two [2] copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Wills~ Agent". x NOTE: If tax payments are made within three (3) months of the decedent's date of death~ yoU may deduct a 5X discount of the tax due. Any inheritance tax due will become delinquent nine (9] _onths after the date of death. Tax PART TAXPAYER RESPONSE [!]1!i!ill~.~.IIIII.1111._II!I~I~~~!I!I!"~!III!~llillll111E~I~gll~f~II!I!.IIII~I!iiM.!ili~II!I!g~~111!.~elilliI [CHECK ] ONE BLOCK ONLY A. D The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest~ or you may check box "A" and return this notice to the Register of Wills and an official assess_ent will be issued by the PA Department of Revenue. B. D The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent.s representative. c. ~ The above information is incorrect and/or debts and deductions were paid by you. You lIust complete PART 0 and/or PART ~ below. PART ~ TAX RETURN - COMPUTATION OF TAX ON LINE 1. Date Established 1 2. Account Balanc. 2 3. Percent Taxable 3 X 4. Amount Subj.ct to Tax 4 S. Debts and Deductions S 6. Amount Taxabl. 6 7. Tax Rate 7 X 8. Tax Due 8 JOINT/TRUST ACCOUNTS If you indicate a diffe....nt t.x ....te~ please state you... ...elationship to decedent: PART ~ DATE J~ 990, ~7 ID t'J7t./.OI " 9 1/... lU: ,OYS 311.. (. DEBTS AND DEDUCTIONS CLAIMED PAID PAYEE DESCRIPTION AMOUNT PAID f_ A , , \ / ,let"'. I-tTJ \ "- TOTAL (Ent.r on Line S of T.x Computation) $ IOO7~.O' Und.... penalties of pe...ju...y~ I decl.re that the co~lete to the best of my knowledge and beli.f, ~<-~ TAXPAYER SIGNATURE facts I have ....po...t.d .bove a...e t...ue~ correct HOME (7/7) (97-0117..r WORK ( ) TELEPHONE NUMBER and ~~ ~ol as DA E GENERAL INFORMATION "' 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information sub.itted by the financial institution. 2. Inheritance tax becolles delinquent nine months after tha decedent.s date of death. 3. A joint account is taxable Bven though the decadent's nadS was added as a datter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointlY bstwBBn husband and wife 1I0re than one year prior to death are not taxable. 6. Accounts held by a decedent ftln trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice ara correct and deductions are not being clai..d~ place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of Wills. Z. BLOCK B _ If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent"s representative~ place an "X" in block "B" of Part I of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue~ Bureau of Individual Taxes~ Dept Z80601~ Harrisburg~ PA 171Z8-0601 in the envelope provided. 3. BLOCK C _ If the notice infortllation is incorrect andlor tJeductions are heing clal.ed~ cheCk block "C" and complete Parts Z and 3 according to the instructions below. Sign two copies and submit them with your check for the a~ount of tax payable to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of Wills. TAX RETURN PART 2 - TAX COMPUTATION LINE 1. Enter NOTE: the ~ate the account originally was established or titled in the manner existing et date of death. For a decedent dying after 12/12/82: Accounts which the decedent put in joint na.es within one (1) year of death are taxable fully as transfers. However~ there is an exclusion not to exceed $3~OOO per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (MM) appears before your first name in the address portion of this notice~ the $3~OOO exclusion already has been deducted from the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is deterMined as follows: A. The percent taxable for joint assets established more than one year prior to the decedent"s death: 1 DIVIDED BY TOTAL NUMBER OF JOINT OWNERS Example: A joint asset registered DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE SURVIVING JOINT OWNERS in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) ; .167 X 100 16.7~ (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent"s death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiarIes): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES )( 100 PERCENT TAXABLE Example: Joint account registered the decedent. 1 DIVIDED BY Z (SURVIVORS) - .50 in the na.e of the decedent and two other persons and established within one year of death by X 100 50~ (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is determined by mUltiplying the account balance (line 2) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The a.ount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4), 7. Enter the approprIate tax rate (line 7) as determined below. _The tax rate lmposed on the net value of transfers from a deceased Chlld twenty-one years of age or younger at death to or for the use of a natural parent~ an adoptive parent~ or a stepparent of the child is O~. The linesl class of heirs includes grandparents~ parents~ children~ and lineal descendents. "Children" includes natural children whether or not they have been adopted by others~ adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents~ whether or not they have been adopted by others~ adopted descendBnts and their descendants and step-descendants. "Siblings" al"'e defined as individuals who have at least one parent in COllmon with the decedent~ whether by blood or adoption. The "Collateral'" class of heirs includes all other beneficiaries. Date of Death Spouse Lineal Sibling Collateral 07101/94 to 12131/94 3% 67. 157. 157. 01/01195 to 06130/00 07. 67. 157. 157. 07101100 to present 07. 4.5%- 127. 157. CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determinBd as follows: A. You legally are responsible for paYllent~ or the estate SUbject to adllinistration by a personal representative is insufficient to pay the deductible itBms. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts bBing clailled must be itemized fully in Part 3. If additional space is needed~ use plain paper 8 l/Z" x n". Proof of paYllent .ay be requested by the PA Department of Revenue. FINAL EXPENSES Attachment to File 21ACN 05106586 MARIE A THIEME Part 3 Debts and Deductions Claimed 1111212004 Giant Markets- food items for after service 1111512004 Giant Markets- food items for after service 1111512004 BJs Warehouse- food items, paper goods - napkins etc 11/1612004 Royers Florist - flower arrangements for 11/16104 service 11/1612004 Rt 15 Storage - storage unit for Marie Thieme possessions 11/1612004 Messiah Village - skilled nursing care for month of October 04 11/1912004 Pastor Ebersole- Participant in memorial service 1112212004 Pastor Burgard- Officiating at 11/16/04 memorial service 1113012004 Woodlawn Cemetery-Interrment fee 12/1012004 Alert Pharmacy Services- Marie Thieme medications 12/1312004 Rt 15 Storage - storage unit for Marie Thieme possessions 12/1512004 Express Scripts- Marie Thieme medications 12/2012004 Messiah Village - skilled nursing care for 10 days in Nov 04 111212005 Messiah Village Chapel- payment chapel use 11116/04 service 21112005 Rt 15 storage - storage unit for Marie Thieme possessions 212312005 Rt 15 storage - storage unit for Marie Thieme possessions $29.64 $12.61 $83.91 $93.20 $95.40 $6,448.84 $100.00 $100.00 $600.00 $193.45 $95.40 $20.00 $1,875.78 $100.00 $130.38 $95.40 $10,074.01 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT 2B0601 HARRISBURG, PA 17128-0601 REV-1162 EX( 11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT THIEME HERBERT C JR 15 MANOR DR MECHANICSBURG, PA 17055 ------- fold ESTATE INFORMATION: SSN: 180~01A596 FILE NUMBER: 2105-0264 DECEDENT NAME: THIEME MARIE A DATE OF PAYMENT: 03/24/2005 POSTMARK DATE: 03/23/2005 COUNTY: CUMBERLAND DATE OF DEATH: 11/10/2004 NO. CD 005117 ACN ASSESSMENT CONTROL NUMBER AMOUNT 05106586 I $311.26 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 5299 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $311.26 GLENDA FARNER STRASBAUGH REGISTER OF WillS