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HomeMy WebLinkAbout10-24-14 BUREAU OF INDIVIDUAL TAXES Pennsylvania Inheritance Tax pennsytvania PO BOX 280601 DEPARTMENT OF REVENUE HARRISBURG PA 17128-0601 Information Notice REV-1543 EX D..EXEC (08-12) And Taxpayer Response FILE No.21 -14-IM ACN 14156507 1 DATE 10-14-2014 Type of Account Estate ofSARA LHAYS Savings SSN17S- Checking Date ofDeath O8-24-2O14 Trust KENNETH C HAYS County CUMBERLAND | \Certificate 6 GLEwDALE DR nECHANICSauRG PA 17055'6137 [� o :::0�� rn c� rn FARMERS & MERCHANTS TRUST CO provided the department with the informationt:155 w incliMcingbat the death of the above-named decedent you were a joint owner or beneficiary of uqiderffi ied. Remit Payment and Forms to.-- Account No.3015696 C> C) Date Established 05-02-2008 REGISTER OF WILLS -7q Account Balance $3,539.02 1 COURTHOUSE SQUARE 7) — <7> CARLISLE PA 17013 7", F M Percent Taxable x 50 r- Amount Subject to Tax $1,769.51 Tax Rate X 0.120 NOTE*:� |fbmpa'm-n tsaremadewithinthreomon1hooftho Potential Tax Due docoden�adate ofdeath,deduct a5percent discount onthe tax With 5%Discount(Tax xO.95) duo. Any inheritance tax due will become delinquent nine months after the date nfdeath. PARTI Step I : Please check the appropriate boxes below. A | |�W� tax is due. Uammthe spouse of the deceased orUaNmthe parent of a decedent vmh��wnas �_� 21 years old or younger at date of death' Proceed ArStep 2onneverse` Donot bheokany other boxes and disregard the amount shown above uuPotential Tax Due. } Theinformation is The above information iacorrect, nodeductions are being taken,and payment will besent TI- uonoct. with my response. Proceed to Step 2nnreverse. Donot check any other boxes. C F-��Thetaxm0eieinnornact' F-] 4�4.5% }ama8nma|bon*#ioi�y(pan*ni.child,grandchild,�o.)uf the deceased. - -1� (Select correct tax rate ok right, and complete Part �-} 12%1� |amasibling nfthe deceased. 3onreveme.) ^-� �-| 15% All other relationships (including none). D Changes ordeductions The information above ioinumrmu and/or debts and deductions were paid. 1^/!isted. Complete Part 2and part 3aoappropriate onthe back ofthis form. F-1 Asset'-i||boreportednn The abuve'�en�iedasset has been orvvi||berepo�»dand�xpa�whhthe PA|nher�anceTax � L-Jinheritance tax Return filed bythe estate representative. REV'1500. | Proceed/oStep 2onreverse. Donot 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. 7fz (If additional spacejs required,you may attach 1/2"x 11"sheets of paper.) oa Date Paid Payee Description Amount Paid -/ a.l-; 10-11w ,A00, 00 9- -/� - o To I (Ent on Line 5 of ax 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"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 `\ ` your relationship to the decedent: 1. Date Established 1 .rte- q-a o\ \ \\ \ 2. Account Balance 2 $ ,�.53 f, ai w ` V "� ,v 14 3. Percent Taxable 3 .fo V ��� v �y vmoi- OL, -006 411, Nw v 4. Amount Subject to Tax 4 $ Xv vy 5. Debts and Deductions 5 - •5/1 O-6- 4 \ \ o g` � \ 6. Amount Taxable 6 $ — 7r!/. .5 _ "vyvy \\\ s\\ \ �� \ — \ \\ \ \ e 7. Tax Rate 7 X — v �v v. ¢ \ \ a\ � ovo \VO v o A� � �� A�� �� VAA ``V �\A ��t 8. Tax Due $ _$ _ Off\ OAA .. t �Q _ ��\ Vvy�AA' ���\\V AAA M IN �\O\� �A� gyp` \e \ \ \\\ 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. G� Home T/7- - 4,6V(:F /a- 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 SARA HAYS s�2.2 7213 KENNETH C.HAYS POA 313 122 VILLAGE SQUARE '7 CHAMBERSBURG,PA 17201 PAY TO TH5 ORDER OF DOLLARS MEMO TRUST _.fmtrustonljnexom W ,1:03130430D: 30-11SCAGO 7213 7 SARA HAYS 60-43022 7214 KENNETH C.HAYS POA 313 122 VILLAGE SQUARE CHAMBERSBURG,PA 17201 DATE PAY TO lea co T E ORDER OF' A," DOLLARS d-14 TRUST www.fmtruslonlinexom vl MEMO 1:0313043061: 301111569030 7214 SARA HAYS 60-43022 7215 KENNETH C.HAYS,POA 313 122 VILLAGE SQUARE CHAMBERSBURG,PA 17201 DATE "y�f,6,7t, PAY TO TH ORDER OF DOLLARS TRUSTw�.fmtrustonllnexom MEMO NP 1:0 3 1301. 3061: 3011115E39 6 Ill ? 2 1 S lVD) �by i CUSToAf //�� R4zD�slCy '(ge> WEDDINGS•HOME•BUSINESS D ORDERsY nadvewbATs 1ADDASESS eLDmCRAPT# s e T W T F r7 ZIP SPEpAL Od5TAUCTtON: , .3 j WIRE Fm TF CODES ❑m ❑our D ❑ FLORIST PHONE ADDRESS CONTACTPEASON ARRMG8AB4r SY�ATHY 13PLANT.,❑GOASA(3E-..::t2GUT PDAs' OOTHER QUAHitfYJ 7 . IIE.4Y:si►F'TtON AMOUNT r Le ❑BIRTHDAY nN4SE3dTMENT _ 3BABY :.G= �fiE1:1} L -: iAL - G Q OSYMPATHY ❑ANAtNERSAW : HOLIDAY;.,; ,:'- iiE - ;:;.:.-=RB;p1•..E,-._ CARD UMMGE oe ORDERED BY CTiY.STATE ZP'GODE' MC V AX DC OTESEA CREDiTCARONWBER DATE. AUTIi.n q' R 7 2 0 u 6 a Cl) aa a w $ � 7 ! \ \ \ \ \ | � § » 2 §2 _/ \ z y \ § . / k a § w . \ \ § .. / z F w W2 w m z z g e u Z m z \ \ m � \ / / R \ 0 % ) . © \ 2 § k � - / { \ jƒ LD L _ 0 w \ m 2 \ / \ / \ \ \ o )LU 00$ \ a i } \ / w 4 \ $ # § § R \ ) \ z o CO CO CO / \ / / CO LU Lli CD e c LL \ / / \ \ j = a § \ 5 5 pg7A Page 3 Account: 3015696 20 South Main Street TRUST R � PO Box 6010 �� Chambersburg,PA 17201 SARA HAYS KENNETH C.HAYS POA m�3D22 7 213 122 VILLAGE SQUARE CHAMBERSSBB/URRG,PA 17201 DAr. P-'Q/5L PAYrof/�jL.,awl �_yLJ —� I $ lee,00 rn rn oaneR oc ee DOLLARS a' --- FM � ��'+''T MEMO � •_��<-�C/__`_G� ,1:011303061:430-1569B1i• 7213 09/24/2014 7213 $100.00 SARA HAYS KENNETH C.HAYS POA "�"22 7 214 CiAMLRSBURG,PA CHAMDERSHURG,PA 17201 unTE 3 PAY 1T1 $ BOO, E OAO RJO{f J /JI /f FM � � /!�/ /1 A .(//�//� 1 A i✓ ,ZU DOL ARS a �r 3 r MEMO "�1� 1:03L3043061: 30w15696m 7214 09/24/2014 7214 $10000 SARA HAYS KENNETH C.HAYS POA °;,9°22 7215 122 VILLAGE SQUARE CHAMBERSBURG,PA 17271 / DArE Q� PAYTO ,( �LL P. —•:f:—, I $ Icfl-fK2 r T1 OROER Of ,00 FM TRUST MEMO / 41:03L3043061: 30-15696R• 7 2 L 5 09/08/2014 7215 $100-.00 SARA HAYS KENNETH C.HAYS POA313 22 7216 122 VILLAGE SQUARE CHAMBERSBURR�G,PA 17ZDI /�_ pATc�j,�C Jf Jp/�t pp� 1PEAie ro..§Ra— /7 $���"'��'I.90..... �1."�.tliw�I1.� i.V✓,{.T ZL. ,C TRUST a1:03&30430&1: 30-1 5 6 9 61` 7216 09/11/2014 7216 $227.90 SARA HAYS KENNETH C.HAYS POA --l-3 7 217 / 12.VILLAGE SQUARE 11 CHAMBERSBURG,PA 17201 $ %Yum/KCTLYItE.e�AC1�l�✓+L LA(%�G�l4Cdr� Mll/ 2�I/SDOLL RS er �— TRUST MEMO �muwniuw nm _.1J=�r.4LL. v._L._•_'S / r +:0313043061: 30-ISP.96n' 7217 09/11/2014 7217 $1,853.15 William F. Sellers Funeral Home Inc. 297 Philadelphia Avenue Chambersburg, Pennsylvania 17201 Phone: Payment Summary Effective: October 20, 2014 Sara L Hays Contract Number: 94-71-2014 Contract Date: 08/25/2014 Contract Details Contract Total Less Discounts Additional Additional Original Balance Purchases Discounts $13,093.40 - $0.00 $0.00 - $0.00 $13,093.40 Payment, Discount and Adjustment Details Date Pay Method/Check No Type Applied To Received From Amount 9/29/14 Check#0700435 Payment Contract Amerisery Trust and Financial $12,963.40 Total $12,963.40 Current Balance Due ----- -- Original Balance Less Payment&Adjustments Refunds Plus Late Fees Amount Due $13,093.401 $12963.40 + $0.001 +$0.001( $130.00 Buyer Information: i ON 120 l iq 0-1 CQOYCII-�- V) -Q— 011-r)0A bl-lc) t SARA HAYS 60=43022 7218 KENNETH C.HAYS POA 313 122 VILLAGE SQUARE //� CEIAMBERSBURG,PA 17201 DATE Je- a P_AY TO �,, � T E ORDER OF „ 2� tDOLLARS L'J A = • TRUST v .rrustonllnexom MEMO• .� :A � __1_�%'�-,��4? R%�.�c. + M' -4:031304306!: 3011tiS6961a' ? 218 f r o� A r n � tom. _ � - A _-::�, ,. 3 r - :::5 i w Z x . I ;;:. � . _ �, _. � ��. �F- _ - � �: __ IF. I r y� - � . .. d�y' .. -. i � � �a �^�"5""\ ..