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HomeMy WebLinkAbout06-23-14 BUREAU OF INDIVIDUAL TAXES /4'9�' 6j'ety.-� Pennsylvania Inheritance Tax pennsylvania PO BOX 280601 �.. ' DEPARTMENT OF REVENUE HARRISBURG PA 17128-0601 Information Notice aEV- s 1....exec 11.-Ul And Taxpayer Response FILE NO.-: 1 C)GC49 J l(0_J ACN 14110739 DATE 03-03-2014 Type of Account Estate of VIRGINIA L FREELAND Savings SSN Checking Date of Death 02-19-2014 Trust LARRY C FREELAND County CUMBERLAND Certificate 2416 RYE CIR - MECHANICSBURG PA 17055-5760 V MEMBERS 1sT FCU 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.70402 Remit Payment and Forms to: Date Established 06-08-1973 REGISTER OF WILLS Account Balance $38,491.34 - #.T44&T" 1 COURTHOUSE SQUARE Percent Taxable X 16.667 i CARLISLE PA 17013 Amount Subject to Tax $6,415.35 Tax Rate X 0.045 Potential Tax Due $288.69 NOTE If tax payments are made within three months 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 Step 1 : Please check the appropriate boxes below. 1 A 7 No taxis due. I am the spouse of the deceased or I am the parent of a decedeqwho was 21 years old or younger at date of death. n Proceed to Step 2 on reverse. Do not check any other boxes aA(&egard fly amognq shown above as Potential Tax Due. a o - r� � g The information is The above information is correct, no deductions are being taken,and'pay"meni_will be sent.41 c, correct. with my response. = 3> i� ro ¢''� r'I Proceed to Step 2 on reverse. Do not check any other boxes. > o C The tax rate is incorrect. ❑ 4.5% 1 am a Hneal beneficiary (parent, child,grandchild, etc.)p�the de Wised. n �n (Select correct tax rate at F = C right, and complete Part F—] 12% 1 am a sibling of the deceased. `I--• rr— m 3 on reverse.) ❑ 15% All other relationships (including none). co D ®Changes 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 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. 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 ;t' AMC of �O.ao Z9 6-fl RN !l3 o�u CAN g44e - f �ZI MIfffM Cy/ RSSrSfEO HIP 01 7 CR i 2 Total Hier on Line 5 of ax Calculation $ 7L/ r7 PART Tax Calculation S 519•g7 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"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 state Official Use Only ❑AAF your relationship to the decedent: I PA Department of Revenue 1. Date Established 1 2. Account Balance 2 $ PAD 3. Percent Taxable 3 X 1 2 4. Amount Subject to Tax 4 $ 3 5. Debts and Deductions 5 5 3S 4 y 6. Amount Taxable 6 $ 55 7. Tax Rate 7 X C) 7 8. Tax Due 8 $ (� $ 9. With 5% Discount (Tax x .95) 9 X I( ' 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 7/ 7 - 9a(f - l Sao Home 7/ 7 -Li S'- 0/S3 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 BUREAU OF INOIVIOUAL TAXES ATIN 0+v0. Pennsylvania Inheritance Tax , pennsylvania PO BOX 280601 T DEPARTMENT OF REVENUE UARRISBURG PA 17128-0601 Information Notice ev-sa5 E ueeec roe-.x And Taxpayer Response FILE NO.21 ACN 14110743 DATE 03-03-2014 Type of Account Estate of VIRGINIA L FREELAND Savings SSN Checking Date of Death 02-19-2014 Trust LARRY C FREELAND County CUMBERLAND X Certificate 2416 RYE CIR ' MECHANICSBURG PA 17055-5760 MEMBERS 1ST FCU 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.70402 Remit Payment and Forms to: Date Established 06-02-2004 REGISTER OF WILLS Account Balance $2,753.68 1 COURTHOUSE SQUARE Percent Taxable X50 CARLISLE PA 17013 Amount Subject to Tax $1,376.84 Tax Rate X 0.045 Potential Tax Due $61.96 NOTE If tax payments are made within three months the decedent's date of death,deduct a 5 percent discount on the tax With 5% Discount(Tax x 0.95) $(see NOTE-) `S$.Bb due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1 : Please check the appropriate boxes below. 1 A ❑No tax is due. I am the spouse of the deceased or I am the parent of �decedenilkho was 21 years old or younger at date of death. c o s m Proceed to Step 2 on reverse. Do not check any other boxes and-disregard tFlb-Dmount shown above as Potential Tax Due. 110 v z z B [4The information is The above information is correct, no deductions are being taken,and payment will b6)§bnt rrn rn correct. with my response. N ,- Proceed to Step 2 on reverse. Do not check any other boxes. >< c> o u n o =D I -n C F-]The tax rate is incorrect. F-1 4.5% 1 am a lineal beneficiary (parent,child,grandchild, et(Ro@he beceasecl. ` c> (Select correct tax rate at ;;o r= rn right, and complete Part F-] 12% 1 am a sibling of the deceased. o s r- o 3 on reverse.) > 7 -n co ❑ 15% All other relationships (including none). D 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 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. 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 cut G ` 1 Goc� s. A'feSsrAG l.rSa yS IfSSoSril true •.03 p .21 ntri !w g'2 Total Enter on Line 5 of Tax Calculation $ / PART Tax Calculation q�,�519.�9 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 "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 state Official 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 $ 2 3 5. Debts and Deductions 5 ($7 4 6. Amount Taxable 6 $ O 5 , 7. Tax Rate 7 x U 6 8. Tax Due 8 $ 7 — —' 8 9. With 5% Discount (Tax x .95) 9 x IL 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 penally of perjury,J declare that the facts I have reported above are true,correct and complete to the best of my knowledge and belief. J4--� wor k 71-7- ?Home / 7 - Z/ —(// S/ _ cL Taxpayer Signatur Telephone Number Date 7 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 /'P1167(A3 BUREAU OF INDIVIDUAL TAXES Pennsylvania Inheritance PO BOX 280601 itance Tax HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE And Taxpayer Response REV-.ws ex ucccxcc<aa.�z,j FILE NO.21 ( ACN 1411074 DATE 03.03-2014 Type of Account Estate of VIRGINIA L FREELAND Savings SSN X Checking Date of Death 02-19-2014 Trust LARRY C FREELAND County CUMBERLAND Certificate 2416 RYE CIR . MECHANICSBURG PA 17055-5760 ry rn Co G 0 Z 4� yDR CJ r-JO MEMBERS 1sT FCU provided the department with the information below indicating that at NtJeath of the c> above-named decedent you were a joint owner or be ficiary of the account identified." c3 co "' -n Remit Payment and Forms to: Account No.70402 W CD Date Established 10-16-1991 REGISTER OF WILLS Co Account Balance $1,485.29 1 COURTHOUSE SQUARE Co Percent Taxable X1fi.fi67 CARLISLE PA .17013 Amount Subject to Tax $247.55 Tax Rate X 0.045 i r Potential Tax Due $11.14 NOTE*: if tax payments are made within three months of the decedent's date of death,deduct a 5 Dercent 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 Step 1: Please check the.appropriate boxes below. a A F�No tax is due. I am the spouse of the deceased or I am the parent 0IJ dkedet`afrwhi!w'ais 21 yedrs ofd'or younger at date of deafh. Proceed to Step 2 on,reverse. Do not check any other boxes a;fl diyq rd f,!�amdonf� shown above as Potential Tax Due. B The information is The above information is correct'no deductions,are being taken,and payment-will tl ent`'T correct. with my response. c� o ProSed to Step 2 on reverse. 'Do not check any other boxes. 9 e 1-1 rn r— O F�The tax rate is incorrect. F-1 4.5°1d' t am a lineal beneficiary(parent,child,grandchild,etj�of the debZ#ed.f ' o (Selegt correct tax rate at Fight, and complete Park I am a sibling of the deceased. 3 on reverse.) FJ 15/6 - All other relationships.(including none). D 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. Y E 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.}�� 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 i wq d CIV -tt !4 eft .tiv cRLL CRk'rZe Guth Fiaa '1 3.sr *$44PRA t r q1e, a3 r I his o. Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 51 9.8fi 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%,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 state Official Use Only ❑AAF your relationship to the decedent: PA Department of Revenue 1. Date Established 1 2, Account Balance 2 PAD 1 Percent Taxable 3 x 1 4. Amount Subject to Tax 4 $02 _ 2 3 5. Debts and Deductions 5 - Z 4 6. Amount Taxable 6 $ © 5 7. Tax Rate 7 x fl s 6 8. Tax Due 8 $ n $ '--- 9. With 5%,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, 1 declare that the facts I have reported above are true,correct and complete to the best of my knowledge and belief. � Work ! 9� oo Home 717 -2!$— !S,3 Taxpayer ignature Telephone Number Date E NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE T OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR ERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 Ll ItvWd Z)at MESSIAH VILLAGE 100 MT.ALLEN DR.,MECHANICSBURG,PA 17055 ..RESIDENT# I UNIT I STMT. DATE 61001 346 02/28/2014 RESIDENT(S) LARRY FREELAND Miss VIRGINIA FREELAND 2416 RYE CIRCLE MECHANICSBURG,PA 17055 TOTAL AMOUNT DUE- $4,543.63 DATE DUE 03/31/2014 ..- - .. ... PATE DESCRIPTION RATE .Days/Units -CHARGES CREDITS '- BALANCE_-' Balance Forward 5,615.00 02/28/2014 PAYMENT RECEIVED -THANK YOU!!! 5,615.00 0.00 02/25/2014 MEAL GATHERING VLG CTR 1,172.63 1.00 1,172.63 +t?2-e FUNERAL LUNCH Iq 1.03 *** Enhanced Living *** 02/18/2014 ELPS - OHIO SINGLE 02/01-02/18 180.00 18.00 3,240.00 4,412.63 02/19/2014 ELPS - OHIO SINGLE 02/19-02/19 143.00 1.00 143.00 4,555.63 02/19/2014 MEAL CREDIT -12.00 1.00 12.00 4,543.63 ` RD3usrEb Per scu,SStotJ w,-M fl2 f}NvIlty Oil 1e r / 31,111116- QC _�d Effective April 1, 2014, the new Business Office hours will be 9am-2pm Monday through Friday or by appointment. RESIDENT 11 CURRENT OVER 30 - OVER 60 OVER 90 OVER 120 TOTAI--A-MOUNT DUE 61001 4,543.63 0.00 0.00 0.00 0.00 $4,543.63 RESIDENT NAME Miss VIRGINIA FREELAND wn Pa-0' Please make check payable to Messiah Lifeways at Messiah Village. A 1% finance charge may be assessed on accounts for which payment has not been received by the due date. Than you: If you have any questions or concerns about your bill,please address them directly to Fiscal Se ices at 790-822 hank � C � �79 �: � 5f MESSAGES EXPLAINED BELOW ! . Service D- ' • -- Balance Due. This Is After Your Insurance Processed. Please Pay. ^^^ ~ Thank,You y -•••• Please Pay upon Receipt. If there are billing questions, please call ** 877-856-2279, %2517, Monday-Friday between 7:30 a.m. and 4:00 p.m. *** -WW A Thank you. 01/15/14 1 2 L OFFICE VISIT EST LEVEL 4 99214 188.0 130.78 87.25 03/ 10/14 Highmark Fre Payment -26.75 03/ 10/14 Accept Assign Adj . -1.78 15.00* 03/ 10114 Accept Assign Adj . 02/11/14 1 2 L OFFICE VISIT EST LEVEL 2 99212 188.9 52.77 26.27 03/ 10/14 Highmark Fre Payment 10.97 03/10/14 Accept Assign Adj . --0.53 15.00* 03/10/14 Accept Assign Add . L-The 'PLEASE PAY' includes unpaid co-pay or co-ins. Please make payment. SATE LAST PAID AMOUNT - e • - .� • - •� • - o - _-- 00/00/00 r 0,007 30.00 0.00 0.00 0.00 0.00 0.00 0.00 30.00 :AK E CAPITAL AREA HEALTH ASSOCIATES 0 K 100 MOUNT ALLEN DRIVE SL ro: - MECHANICSBURG, PA 17055-6100 Payment Due Upon Receipt 7Ph (877 30.00*`85.6 279 Acct#: 1408 Cocklin Funeral Home, Inc. Acct: Contract # 300 MEMORANDUM OF SERVICE SERVICES OF: Virginia L. Freeland DATE: 2/25/2014 (A) Services: Traditional Service Package $4,500.00 Total (A) $4,500.00 (B) Cash Advance Items: Certified Copies $48.00 Newspaper Notice-Harrisburg $363.08 Flowers $368.88 Total (B) $779.96 Total Amount $5,279.96