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Home My WebLink About07-03-14 BUREAU OF INDIVIDUAL TAXES PerICIS �vania �nheritance Tax � � � Per1t'1S�/LVa111a PO BOX 280601 y HARRISBURG PA 17128-0601 ��}i. �` '', i DEPARTMENT OF REVENUE � � , ; -( "� �mation Notice REV-1543 EX OocE%EC (08-12) J�,� ; Ar� + �xpayer Response r.`_�:-!��. � . "_.i.�� FILE NO.21 ��-C�� ACN 14126911 DATE 05-19-2014 .._ s Type of Account �iI.L . Q��j'j �;�j;I;�j Estate of HELEN OLSHEFSKI Savings CIJMBERl.A3JJ C�, PA Checking Date of Death 05-07-2014 Trust JAMES R OLSHEFSKI CountyCUMBERLAND X Certificate 605 CENTRAL ST MECHANICSBURG PA 17055-4111 MEMBERS isr 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. Remit Payment and Forms to: Account No.247199 Date Established 04-16-2013 REGISTER OF WILLS Account Balance $4,293.32 '1 COURTHOUSE Sf�UARE Percent Taxable X 8.333 CARLISLE PA 17013 Amount Subject to Tax $357.76 Tax Rate X 0.045 Potential Tax Due $ 16.10 NOTE*: If tax payments are made within three months of the 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 informaiicn is �he ab�ve intormation 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 � �2qo 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. 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 Total (Enter on Line 5 of Tax Calculation $ PART Tax Calculation 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 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: 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 6 $ 7. Tax Rate 7 X o - ,�� ..� , 8. Tax Due 8 � ' 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 pen of perjury, I declar that the facts I have reported above are true,correct and complete to the best of my knowledge and belief. Work C�'I�-)(�I 0—��bS HomeC�- —[ � �'�-8� a-o1� T xp yer 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 INDIVIDUAL TAXES Penns Ivania lnheritance Tax � pennS�/LVd111a PO BOX 280601 � HARRISBURG PA 17128-0601 � o ation Notice ' DEPARTMENT OF REVENUE ��;�r��l � �� ' REV-1543 E%OocE%EC (OB-12) �' Aii,e�� payer Response �F.?I_,;� �, ,,. ,�;i'I � FILE NO.21-1`�'�fi�'(D� ' ''--�-'� ACN 14126914 DATE 05-19-2014 t �• �� Type of Account Q��H��;- , Estate of HELEN OLSHEFSKI Savings " '�v`�}�T SSN 178-22-6524 Checking CUMBERLAN� C(�., PA Date of Death 05-07-2014 Trust JAMES R OLSHEFSKI County CUMBERLAND X Certificate 605 CENTRAL ST MECHANICSBURG PA 17055-4111 MEMBERS isr 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. Remit Payment and Forms to: Account No.247199 Date Established 09-07-2012 REGISTER OF WILLS Account Balance $48,060.00 1 COURTHOUSE SGIUARE Percent Taxable X 8.333 CARLISLE PA 17013 Amount Subject to Tax $4,004.84 Tax Rate X 0.045 Potential Tax Due $ 1 gp.22 NOTE*: If tax payments are made within three months of the decedenYs date of death,deduct a 5 percent discount on the tax With 5°/a 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 inforr;ation is- The ab�ve information is correct, no deductions are being taken,and payment wili 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 debts and deductions were paid. listed. Complefe 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 Total Enter on Line 5 of Tax Calculation) $ PART Tax Calculation 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 multipiying 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 ,:�`�p � � � 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 6 � 7. Tax Rate 7 X y. �a . � �� .. . _ ,. _� ...�. 8. Tax Due 8 $ �'� ' 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 decl that the facts I have reported above are true,correct and complete to the best of my knowledge and belief. Work C.`�'I��p 10—`� a-(pS Home (�1� � —Iq �"oZ� �0 ayer 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 INDIVIDUAL TAXES y � � � pennsylvania PO BOX 280601 r Penns Ivania lnheritance Tax HARRISBURG PA 17128-0601 ��'I��w "�° u'..• r �;�1 mation Notice DEPARTMENT OF REVENUE rj��'3f ` '� ��xpayer Response REV-1543 Ex DocEXEC (OB-12) � ' '`-�-'� FILE NO.21..��.,(��`� ACN 14126917 nn � � DATE 05-19-2014 `•„ ,. Type of Account �rH''�y� �v:Jrt t Estate of HELEN OLSHEFSKI CUMBFf�(.qN�} C�., PA SSN 178-22-6524 Savings 2014 Checking JAMES R OLSHEFSKI CountyCUMBERLAND Trust 605 CENTRAL ST X Certificate MECHANICSBURG PA 17055-4111 MEMBERS isr 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.247199 Remit Payment and Forms to: Date Established 11-10-2011 REGISTER OF WILLS Account Balance $ 19,451.34 1 COURTHOUSE SGIUARE Percent Taxable X 8.333 CARLISLE PA 17013 Amount Subject to Tax $1,620.88 Tax Rate X 0.045 Potential Tax Due �72.94 NOTE�: If tax payments are made within three months of the With 5%Discount(Tax x 0.95) $(see NOTE') decedenYs date of death,deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1 : Please check the a ro riate boxes below. i pP p � A �No tax is due. I am the spouse of the deceased or 1 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. B �The irformation �s fhe above information is correct, no deduciions are being taken,and payment will be sent correct. with my response. P�oceed 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 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.) Pa ee Description Amount Paid Date Paid y Total (Enter on Line 5 of Tax Calculation) $ PART Tax Calculation � If ou are making a correction to the establishment date(Line 1)account balance(Line 2),or percent taxable(Line 3)� Y please obtain a written correction from the f�nancial institution and attach it to this orm. 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 alCnumber of olwners ncl d ng the decedent r(Forhexamplef 2 o ne se P50%n3 ownersbl 33.33�0/4 o w ers by the tot =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, piease 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 6 � 7. Tax Rate � X 8. Tax Due 8 $ � ,':�� .e� � , g. With 5%Discount(Tax x .95) 9 X Step.?' chleck for antepaymentyotu areTmaOk ng Che ks musgbe made payable oegReg ste ofIWillseAge the Do not se dorm, along wit a Y payment directly to the Department of Revenue. Under pe y of perj I cl hat the facts I have reported above are true,correct and complete to the best of my knowledge and belief. Work �t��Olc�^��S - - '' Home (�(�-��R(o— l �' �SC I`� T x ayer 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 INDIVIDUAL TAXES Pennsyivania lnheritance Tax � � pennsylvania PO BOX 280601 DEPARTMENT OFREVENUE HARRISBURG PA 17128-0601 ��'}�� '��'��I rmation Notice ' ° r ; q � xpayer Response REV-1543 E%OocE%EC (OB-12) {��.?,W!._.. . �" �`..1�3 FILENO.21 �I�r�ID� ACN 14126920 DATE 05-19-2014 �'� � ; Type of Account ```� ; r�-� ;�r Estate of HELEN OLSHEFSKI Savings D�it'h�,�i�� vUv ' Checking C UM�sERLANp C�.� �A Date of Death 05-07-2014 Trust JAMES R OLSHEFSKI County CUMBERLAND X Certificate 605 CENTRAL ST MECHANICSBURG PA 17055-4111 MEMBERS isr 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. Remit Payment and Forms to: Account No.247199 Date Established 01-04-2013 REGISTER OF WILLS Account Balance $5,235.08 1 COURTHOUSE SGIUARE Percent Taxable X 8.333 CARLISLE PA 17013 Amount Subject to Tax $436.24 Tax Rate X 0.045 Potential Tax Due $19.63 NOTE': If tax payments are made within three months 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 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 nof 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 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 tau 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 Total (Enter on Line 5 of Tax Calculation $ PART Tax Calculation 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 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 1 � 2. Account Balance 2 $ �, � � 3. Percent Taxable 3 X � 4. Amount Subject to Tax 4 $ �` 5. Debts and Deductions 5 - '' ��' 6. Amount Taxable 6 $ ,� � 7. Tax Rate 7 X `:�� \ � 8. Tax Due 8 $ � 9. With 5% Discount(Tax x .95) 9 X �\,v,�, � \\ \ � Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wilis 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 directty to the Department of Revenue. Under pen y of per'ury declare that the facts I h eported above are true,correct and complete to the best of my knowledge and belief. Work��l��( a—��PS Home (�- �-a —( �o2b� o2-c�) 7- Taxp y r 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. 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