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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. Z8D60l
HARRISBURG, PA 171Z8-0601
*'
INFORMATION NOTICE
AND
,r~TAXPAYER RESPONSE
!\-- ~- '
ACN
DATE
FILE NO. 21 05 C2~
05109797
03-10-2005
REV-lSOEXAfP tOg-OO}
<"',"I"
r I; ie'
EST. OF FRANCES J AMI CUCCI
5.5. NO. 169-26-6793
DATE OF DEATH 11-17-2004
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
IX] CHECKING
o TRUST
o CERTIF.
,
"\'
~~ DEBORAH R STEPHENS
1205 CROSS CREEK DR
MECHANICSBURG PA 17055
REHIT PAYHENT AND FDRHS TO,
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MEMBERS 1ST FCU has provided the Daparbant with the information listed below which has been usad in
calculating the potential tax due. Their records indicata that at the daath of the above decadent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect. plaase obtain written correction from tha financial institution, attach a COpy
to this forM and return it to the above address. This account is taxabla in accordance with the Inheritance Tax Laws of the Commonwaalth
of Pennsylvania. Questions .ay ba answered, by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 30740-11 Date 08-14-2004
Established
Account Balance 665 . 33
Percent Taxable X 100 . 00
Allount Subject to Tax 665 . 33
Tax Rate X .045
Potential Tax Due 29.94
PART TAXPAYER RESPONSE
[!Jliijiji~g~l!li!i!~I!!!!~~!jijl~~~;i;![~gg~i!i!iil!iii.ijij.~~~~~~!!i!i~lI!i!i!..~.I!l]!ijU.il!j~II!I!~I~li!!'jjj~~Iji!l~
A. '~The above infor.ation and tax dua Is correct.
~ I. You .ay choose to remit payment to the Reglstar of Wills with two copies of this notice to obtain
a discount or avoid intarest. or you may check box "A" and return this notice to the Register of
Wills and an official assess_ent will ba issued by the PA Department of Revenue.
To insura proper credit to your account, two
(Z) copies of this notice must acco.pany your
paymant to the Register of Wills. Make check
payable to: "Ragister of Wills, Agent".
NOTE: If tax payments are mada within three
(3) months of the decedent"s date of death,
you may deduct a 57. discount of the tax due.
Any inheritanca tax due will become delinquent
nine (9) months after the date of death.
[CHECK ]
ONE
BLOCK
ONLY
B. D The above asset has been or will ba reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by tha decadent's representative.
C. 0 The above information is incorrect and/or debts and deductions wera paid by you.
You llIust complete PART 0 and/or PART @] below.
X
If you indicate a different tax rate, please state your
relationship to decedent:
PART
@J
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
S. Debts and Deductions
6. Amount Taxable
7. Tax Rate
B. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3
4
5
6
7
8
X
PART
[!J
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line S of Tax Computation)
penalties of perjury, I declare th.t the facts I
the best of my knowledge and belief.
I
$
have reported above are true, correct and
HOME (717) 7'- 1- 777'-
WORK (7, 7) 'J 7 7 -; YU
TELEPHONE NUMBER
7 it r jr, )---
DATE
()
AXPAYER SIG ATURE
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on infar.ation
submitted by the financial institution.
Z. Inheritance tax bBco.es dslinquent nine .onths after the decedent's data of death.
3. A joint accQunt is taxable even though the decedent's name was added as a matter of convenience.
4. Accounts (including those held between husband and wife) which the daCBdent put in joint names within one year prior to
death are fully taxable as transfers.
5. Accounts established jointly betwBsn husband and wife more than one year prior to death are not taxable.
6. Accounts held by a decedent "in trust for" another or others arB taxable fully.
REPORTING INSTRUCTIONS - PART
1
- TAXPAYER RESPONSE
1. BLOCK A - If the information and co.putation in the notice are correct and deductions are not being clai.ed~ place an "X"
in block "A" of Part I of the "Taxpayer Rliilsponse" section. Sign two copies and submit the. with your check for the amount of
tax to the Register of Wills of the county indicated. The PA Depart.ent of Rliilvenue will issue an official assliilssment
(For. REV-1548 EX) upon receipt of the return from the Register of Wills.
Z. BLOCK B - If the esset 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 1 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 information is incorrect and/or deductions are being claimed~ check block "c" and complete Parts 2 and 3
according to the instructions below. Sign two copies and SUbMit the. with your check for the amount of tax payable to the Register
of Wills of the county indicated. The PA Department of Revenue will issue an official assess.ent (For. REV-1548 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 .anner existing at date of death.
For a decedent dying after lZ/12/8Z: 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 $3~000 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 $3~000 exclusion
already has been deducted from the account balance as reported by the financial institution.
Z. 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 .ore than one year prior to the decedent's death:
1 DIVIDED BY TOTAL HUMBER OF
JOINT OWNERS
Example: A joint asset 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 BY Z (SURVIVORS) = .167 X 100
16.7% (TAXABLE FOR EACH SURVIVOR)
B. The percent taxable for assets created within one yeer of the decedent's death or accounts owned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
I DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
X taO
PERCENT TAXABLE
Example: Joint account registered
the decedent.
I DIVIDED BY 2 (SURVIVORS) = .50
in the na.e of the decedent and two other persons and established within one year of death by
X 100
sox (TAXABLE FOR EACH SURVIVOR)
4. The amount subject to tax (line 4) is determined by mUltiplying the account balance (line Z) by the percent taxable (line 3).
S. Enter the total of the debts and deductions listed in Part 3.
6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line S) fro. the amount subject to tax (line 4).
7. Enter the appropriate tax rate (line 7) as determined below.
death to or for the use of a natural parent~ an adoptive parent~ or a stepparent of the child is OX.
The lineal class of heirs includes grandparents~ parents~ children~ and lineal descendliilnts. "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 descendents and their descendants
and step-descendants. "Siblings" are defined es individuals who have at least DOS parent in co~eon with the decedent~ whether by blood
or adoption. The "Collateral" class of heirs includes all other beneficiariss.
Date of Death Spouse Lineal Sibling Collateral
07101/94 to 12/31/94 3X 6X 15X 15X
01/01/95 to 06/30/00 OX 6X 15X 15X
07101100 to present OX 4.5%. 12X 15X
MThe tax rate Imposed on the net value of transfers froe a deceased chIld twenty-one years of age or y
ounger at
CLAIMED DEDUCTIONS
PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are detereined as follows:
A. You legally are responsible for payment~ or the estate subject to adeinistration by a personal representative is insufficient
to pay the deductible items.
B. You actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being claimed .ust be ite.ized fully in Part 3. If additional space is neBded~ use plain paper 8 112" x 11". Proof of
payment may be requested by the PA Depart.ant of RevenuB.
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
STEPHENS DEBORAH R
1205 CROSS CREEK RD
MECHANICSBURG, PA 17055
_____u_ fold
ESTATE INFORMATION: SSN: 169-26-6793
FILE NUMBER: 2105-0280
DECEDENT NAME: AMICUCCI FRANCES J
DATE OF PAYMENT: 03/28/2005
POSTMARK DATE: 03/24/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 11/17/2004
NO. CD 005123
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
05109797 I $29.94
I
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I
I
I
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TOTAL AMOUNT PAID:
$29.94
REMARKS:
CHECK#1365
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS