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Home My WebLink About07-23-14 , pennsylvania BUREAU OF INDIVIDUAL 7AXES P@IlP1SyIVaf111 IIIII@CItaC1C@ TaX : DEPARTMENT OF REVENUE PO BOX 280601 , -.. �,��ation Notice HARRISBURG PA 17128-0601 �� ;,;;1 � : REV-1543B ex nooExee <os-iz� C � � � t � �° � -' p�d".�` payer Response _��,�� FILE NO.21 —I� � r ��..�'� '� ' �- '```'� ACN 14503899 DATE 06-17-2014 �., `�t? ..,;. Type of Account ;' r;;;. :..:� Security �1��'H/'•jV`� vU�f}� SSNt193 24 3530 LUCK X SEC Acct CUMBERIA�D C�3., �A Date 2014 Stock JAMES A LUCK County CUMBERLAND Bonds 310 EVERGREEN ST . NEW CUMBERLAND PA 17070-1324 MERRILL LYNCH 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. Remit Payment and Forms to: Account No.872 Date Established REGISTER OF WILLS 1 COURTHOUSE SGIUARE Account Balance $89,561.67 CARLISLE PA 17013 Percent Taxable X 33.333 Amount Subject to Tax $29,853.59 Tax Rate X 0.045 NOTE*: If tax payments are made within three months of the Potential Tax Due $1,343.41 decedenYs date of death,deduct a 5 percent discount on the tax With 5%Discount(Tax x 0.95) $(see NOTE*) after the dateeof death ax due will become delinquent nine months 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 a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. g �The information is 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. 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 The inf�Q�p�ete Part 2 and part 3 a sapproprate o athe back of th s forl m. listed. 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�oceed to Step 2 onpeverseat�Do not check any other boxes. REV-1500. Please sign and date the back qf the form when finished. PART 2 Debts and Deductions 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 3 Tax Calculation if you are making a correction to the estabiishment 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 decedenYs 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 �� ;, ,� �� , .... . your relationship to the decedent: � � � \� \, � �� 1. Date Established � �� 2. Account Balance 2 $ � �, 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 $ �� : � .. � � \ . , \ '�� ; � � ,,: : �, 5. Debts and Deductions 5 - � � \� �. � , � . . � .� ;� � �. � 6. Amount Taxable g $ , ` � � �: � . �.. , � �.�� .� �� .� �� 7. Tax Rate 7 X , � � � _ � i \� � � � � 8. Tax Due $ $ �:��\� �� ` o. �� \\\��"��e s" � � � \ . � \�� 9. With 5% Discount(Tax x .95) 9 X �� , �� .,�� ;A� V . � . \�� ' � 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 Z�Z��a �� Home f �—��( lC l 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-g327, SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 „ �`&�''�t"�i�v��i��ril(�ritanceTax � pennsylvania BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE PO BOX 280601 ""�� j�n#�o�m��Q�c Notice . � ��;,, D � REV-1543B EX DocEXEL (OB-12> HARRISBURG PA 17128-0601 � And�Taxpaye"r Response FILE NO.21 —1�”�l��i ACN 14503900 �'"'4 f � �t)�. ��..J �!i ��= 3�3 DATE 06-17-2014 ,� � �� r Type of Account D�i��h:ti � v�U�'�� (�,�f ji��1[� Cl�„ �tate of TREVA R LUCK Security SSN 193-24-3530 X SEC Acct Date 2014 Stock County CUMBERLAND Bonds DAVID P LUCK 271 WINDSOR DR EPHRATA PA 17522-2650 MERRILL LYNCH 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. Remit Payment and Forms to: Account No.872 REGISTER OF WILLS Date Established 1 COURTHOUSE SGIUARE Account Balance $89,561.67 CARLISLE PA 17013 Percent Taxable X 33.333 Amount Subject to Tax $29,853.59 Tax Rate X 0.045 NOTE": If tax payments are made within three months of the Potential Tax Due $1,343.41 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 �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 Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. g �The information is 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. 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 The infoComplete Part 2 and part 3 as appropr ate o nthe back of th s for�m. listed. E �sset 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 ReturnProceed to Step 2 onpeverseatiDo not check any other boxes. REV-1500. Please sign and date the back of the form when finished. PART 2 Debts and Deductions 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 3 Tax Calculation If you are making a correction to the establishment date(Line 1)account balance(Line 2),or percent taxable(Line 3), please obtain a wrritten 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 taxabie 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 �, �� , � your relationship to the decedent: A � � �' �\'� 1. Date Established 1 2. Account Balance 2 $ � � 3. Percent Taxable g X 4. Amount Subject to Tax 4 $ �� 5. Debts and Deductions 5 - �� \. \`� 6. Amount Taxable g $ ;� � �`�� 7. Tax Rate � X � � � � �� ,�..v 8. Tax Due g $ - ` � �� .� � .,� ; ��,.. � � � � � ,�� .�� .��;�y� �.. 9. With 5% Discount(Tax x .95) 9 X �� \�u \o..\ , , \ � ,...�:\\`�� 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 Wilis,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. ,n�� , Work �'1i7,1 ZZ4--G��/ �� Home Taxpayer Signature 7 �l � 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 y�. Inheritance Tax � pennSy�Vanld BUREAU OF INDIVIDUAL TAXES �r�F'��„ ��'F� DEPARTMENT OF REVENUE � , r ,�,,y } n + p PQ $�X 28�6�1 y � i i.,: ' '�1�� `IOI I NOIICG � � � .� REV-15438 E%UocEXEG (�e-12) HARRISBUR6 PA 17128-0601 ,., ' {�:, , �,}-,_,,..;,�. �And��payer Response FILE NO.21-1�{'(;�G�fQ ACN 14503901 4.,,• „ p�, �. �s._, DATE 06-17-2014 � .� F;�`1 �� ..t�. Type of Account ,. , . G+'��''i� � "�L�T Estate of TREVA R LUCK Security (��C�� C�•• PA SSN gonds MARGARET E STOUFFER County CUMBERLAND 501 S WASHIN6TON ST GREENCASTLE PA 17225-1339 MERRILL LYNCH provided the department with thepenefc aiono the alcc�ount de t fied the death of the above-named decedent you were a�oint owner or Y Remit Payment and Forms to: Account No.872 REGISTER OF WILLS Date Established 1 COURTHOUSE SGIUARE Account Balance $89,561.67 CARLISLE PA 17013 Percent Taxable X 33.333 Amount Subject to Tax $29,853.59 Tax Rate X 0.045 NOTE': If tax payments are made within three months of the Potential Tax Due $1,343.41 decedenYs 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 �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 Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. g �The information is 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. 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.) � �5% All other relationships (including none). p �Changes or deductions The inf Complete Part 2 and part 3 as appropr ate o n the back of th's porl m. listed. E �sset 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�oceed to Step 2 onpeverseatiDo not check any other boxes. REV-1500. Please sign and date the back of the form when finished. PART 2 Debts and Deductions 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 3 TaX �!a�CU�c1tIOC1 If you are making a correction to the establishment date(Line 1)account balance(Line 2),or percent taxable(Line 3), pl�ase obtain a virritten eorr��tios�from tlhe financial institut9a��nd attach it t�#his 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 decedenYs 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 �,�„ � your relationship to the decedent: �"`� � �� ` " � �� 1 ��\�\\ \ 1. Date Established � 0��,; , 2. Account Balance 2 $ \ 3. Percent Taxable 3 X � �, � �� , 4. Amount Subject to Tax 4 $ �.� � .. , , _�, � .� �� ; \� `�� ,� �� c�.� 5. Debts and Deductions 5 - � 6. AmountTaxable g $ ` �,`�V A,�`� ,', � ` � �' ` a \ � � �� .� � �� 7. Tax Rate � X ; � � �� \ \ � \ � � � � �`V� ��\ $. T8X �U@ $ � � � � '� `��_.�� .��`�.�� a:��n`��°�� :� � .. �. � � C��.��ti 9. With 5% Discount(Tax x .95) 9 X �� , �' � � �� i�v. � �� ' \�\ ��\� \��.�� .. �.� �\ - .� \� Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed along with a check for any payment you are making. Checks must be made payable to"Register of Wills,Agent e Donnotfse dform, 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 Home /-7'J y 8le0-� _! Taxpay Signature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-g327, SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 Pennsylvania lnheritance Tax � pennSy�Vanla BUREAU OF INDIVIDUAL 7AXES DEPARTMENT OFREVENUE Po eox zaocoi � �;"' �it'�f�I7lation Notice ' HARRISBURG PA L712a-�6�1 r'� j�'»+�;Y# 1 � j� '-' '� REV-15438 E%OocE%EL (08-12) ��' , -An�;T�xpayer Response n •-r :,( , � FILE NO.21-��'G��b • _: .;,�..,., 1�=�- '','.-''� ` `` ACN 14503902 DATE 06-17-2014 . ,� s.. _ Type of Account �`'��,�� r�`�'� �t,T Estate of TREVA R LUCK Security �r�'L`�' �'`��Jt ' SSN 193-24-3530 X SEC AcCt (;U�Q�R�� 'Q" �A Date S toc k JAMES A LUCK County CUMBERLAND Bonds 310 EVERGREEN ST NEW CUMBERLAND PA 17070-1324 MERRILL LYNCH 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. Remit Payment and Forms to: Account No.872 Date Established REGISTER OF WILLS 1 COURTHOUSE SGIUARE Account Balance $6,636.47 CARLISLE PA 17013 Percent Taxable X 33.333 Amount Subject to Tax $2,212•13 Tax Rate X 0.045 NOTE`: If tax payments are made within three months of the Potential Tax Due $99.55 decedent's date of death,deduct a 5 percent discount on the tax With 5%Discount(Tax x 0.95) $(see NOTE�) after the dateeof death ax due will become delinquent nine months PART Step 1 : Please check the appropriat� 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 Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential T�Due. g �The information is 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. 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 The inf Complete Part 2 and part 3 as approprate o athe back of th s forl m. listed. 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 ReturnProceed t Step 2 onpeverseatiDo not check any other boxes. � REV-1500. Please sign and date the back of the form when finished. � PART 2 Debts and Deductions 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 3 Tax Calculation 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 iitled 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 decedenYs 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 �� ti�� . �.., , your relationship to the decedent: � � 1. Date Established 1 2. Account Balance 2 $ \ � 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 $ ,\ � , �� , � 5. Debts and Deductions 5 - \\\\� � \ , , � 6. Amount Taxable g $ �,: ,�� ,� � \ 7. T� Rate 7 X � " �� @ �` � \ 8. T3X �U8 ;� �� :�A��:.�, �., �� . A � � : � � �r� 8 W \�� \ \"�*� o�\\:.`��.\��.\\\� c\' q�,�� 9. With 5% Discount(Tax x .95) 9 X .,�� ' � ; . ��\� A ��.�� \��:_ Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this for along with a check for any payment you are making. Checks must be made payable to"Register of Wills,Agent." Do not send m� 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. ,�—_ �7�� Work 7l 7 L Z– ��Sb O"`"'� Home l `z�{—(Q�(o�' l C l 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 p � pennsylvania BUREAU OF INDIVIDUAL TAXES {-,��Kl vania lnheritance Tax DEPARTMENT OF REVENUE �- r,�, ,� .��, PO BOX 280601 �'{��; � !i . � �\�� ormation Notice � REV-15438 EX DocEXEC (0842> HARRISBURG PA 17128-0601 .� � .. �.�y � ; ��Taxpayer Response FILE NO.21�-l`��C�$ ACN 14503903 � ,,, i� DATE 06-17-2014 � o Type of Account Q}��'�;�'�� 'v'�!Jf'7 Estate of TREVA R LUCK Security � GUMBE�j..ANp CQ.. PA SSN 193-24-3530 X SEC Acct Date of Death 05-23-2014 Stock County CUMBERLAND Bonds DAVID P LUCK 271 WINDSOR DR EPHRATA PA 17522-2650 MERRILL LYNCH 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. Remit Payment and Forms to: Account No.872 REGISTER OF WILLS Date Established 1 COURTHOUSE SGIUARE Account Balance $6,636.47 CARLISLE PA 17013 Percent Taxable X 33.333 Amount Subject to Tax $2,2�2•�3 Tax Rate X 0.045 NOTE*: If tax payments are made within three months of the Potential Tax Due $99.55 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 �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 Step 2 on reverse. Do not check any oiher boxes and disregard the amount shown above as Potential Tax Due. g �The information is 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. 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 The infoComplete Part 2 and part 3 as appropr ate o n the back of th s Porl m. listed. E dAsset 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�roceed t Step 2 onpeverseatiDo not check any other boxes. REV-1500. � Please sign and date the back of the form when finished. PART 2 Debts and Deductions 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 s Tax Calculation 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 correctio�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 decedenYs 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 your relationship to the decedent: � 1. Date Established � 2. Account Balance 2 $ 3. Percent Taxable 3 X ' � 4. Amount Subject to Tax 4 $ 5. Debts and Deductions 5 - � � 6. Amount Taxable g $ 7. Tax Rate '� \ 7 X �\ 8. Tax Due g � ` `��:� �� . ��. 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, I declare that the facts I have reported above are true,correct and complete to the best of my knowledge and belief. Work C`7/� ZZ4�--G6 3� °�'"• 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-g327, SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 � pennsylvania BUREAU OF INDIVIDUAL TAXES Pe11r1S1�/IV^ar111a IlllleCltallCe TaX . DEPARTMENT OF REVENUE PO $QX 2$�6�1 �){�� J�?� �-j^�.`I��lJ�,11�1IO,1 NOIICG � REV-1543B EX DocE%EL <OB-12) HARRISBURG PA 17128-0601 �'s�� _ t. v� A�d T�xpayer Response F�LE NO.21�\a�C�� . .i �`� .�,_.s_�� "-`-"'=`'` ` �`" ACN 14503904 DATE 06-17-2014 Type of Account � . Estate of TREVA R LUCK Security u��`��." �'��r SSN 193-24-3530 X SEC Acct C�� " pA Date Stock MARGARET E STOUFFER County CUMBERLAND Bonds 501 S WASHINGTON ST GREENCASTLE PA 17225-1339 MERRILL LYNCH provided the depart nt ownertoebenefic alry ofthe alcc�ount identified the death of the above-named decedent you were a�o Remit Payment and Forms to: Account No.872 REGISTER OF WILLS Date Established 1 COURTHOUSE St�UARE Account Balance $6,636.47 CARLISLE PA 17013 Percent Taxable X 33.333 Amount Subject to Tax $2,212•13 Tax Rate X 0.045 NOTE": If tax payments are made within three months of the Potential Tax Due $99.55 decedenYs 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 �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 Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. g �The information is 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. 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 The information above is incorrect and/or deo�ate on�the back of th's Por�m. listed. Complete Part 2 and part 3 as app p 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 ReturnProceed to Step 2 onpeverseatiDo not check any other boxes. REV-1500. Please sign and date the back of the form when finished. PART 2 Debts and Deductions 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 s Tax Calculation If you are making a correction to the establishment date(Line 1)account balance Line 2 or please obtain a written correction from the financial institution and attach it to this form.�� rcent taxable(Line 3), 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 your relationship to the decedent: � ` � 1. Date Established y 2. Account Balance 2 $ � 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 $ �, 5. Debts and Deductions 5 - ;�, , � � � �. �� 6. Amount Taxable g $ � � ` � 7. Tax Rate � X 8. Tax Due �� 8 $ . � . � �i:\.�O ,.c��'� '�� c:'�\�o � ��,°. , \_ � � �� \\_� 9. VVith 5% Discount(Tax x .95) 9 X � �' � �� ,� Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills li along with a check for any payment you are making. Checks must be made payable to"Register of WiIlseAge the Do notfsendform, 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 Home /— / — � � — �� Taxpaye Signature `� —/ Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-7g7_g327, SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 STONE LAFAVEI3 & SHEKLETSKI ATTORNEYS AT LAW 414 BRIDGE STREET OF COUNSEL DAVID H.STONE POST OFFICE BOX E CHARLES H.STONE GERALD J.SHEKLETSKI NEW CUMBEBLAND,PA 17070 �ON F.LwFAVER wwwstonelaw.net TELEPHONE(717)774-7435 FACSIMILE (717)774-3869 July 22, 2014 Cumberland County Register of Wills 1 Courthouse Square r�.� c� -�. Room 102 �� Carlisle, PA 17013 �� -- �'� ��'� � _, �f. x'► r" �`.. --�, RE: Estate of Treva R. Luck ��, :� � r 1 + �'} Estate No. 21-14-0668 r`>� <��--,. c�c�:: x�, ::: __- O� � y � Greetings: n �' � �� ' cn �'�� cx� `r' We represent the Estate of Treva R. Luck. Please find attached three (3) origACN N s��14503899,�14503903aand 14503904,Notice an d T a x p a y e r R e s p o n s e f ar t h e f o ll o w i n g Please time-stamp one of each of the originals and return them to us in the enclosed self- addressed, stamped envelope we have provided for your convenience. Thank you for your attention in this matter. Please do not hesitate to contact us should you have any questions regarding this matter. Very truly yours, STONE LaFAVER & SHEKLETSKI � � / D vid H. S e squire DHS/jam Enclosures cc: James A. Luck, Executor k[�:�=:� . . .. ,n �E�� - 1��,�r' z o Rtl�= �._ � c� c o A r J '�1 .��1.. �� . 3 y j'' �7 �, .� � ys ma � � � � � Tc°� x ° ,"� T � , O m y � m ,�P{''1i'`� �✓: �{n ("�� ,'V�� V�! lr l' � _I y y _. v �'� ��- .tND CO., r� � {��lV'•F` ' D x m � � � m � y� o �� o H � � t� i'� �-' C'� O � `= O � � � � (D �a n tV � ,..� G G � H '� �' m � U= o � � � � � � � 'c � ro 0'Q �. � fG O ^-n � cn j -k .�T�'^' � � f.�'. ,r �'.' . 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