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Home My WebLink About11-14-14 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 019908 ADAMS PATRICIA A 140 AIRPORT DR CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold __________ -------- 14114301 _______14114301 $27.14 ESTATE INFORMATION: SSN: FILE NUMBER: 2113-0113 DECEDENT NAME: WEIGLE DELORES L DATE OF PAYMENT: 11/14/2014 POSTMARK DATE: 11/13/2014 COUNTY: CUMBERLAND DATE OF DEATH: 01/12/2013 TOTAL AMOUNT PAID: $27.14 REMARKS.: CHECK# 1002 INITIALS: DB1 SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS BUREAU OF, INDIVIDUAL TAXES Pennsylvania Inheritance Tax '.� A EnnS Lvania PO BOX 280601 Y �� HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE And Taxpayer Response REV-1543 E%DocEXEt (08-12) FILE NO.2113-0113 ACN 14114301 DATE 03-17-2014 Type of Account Estate of DOLORES L WEIGLE Savings SSN Checking Date of Death 01-12-2013 Trust PATRICIA A ADAMS County CUMBERLAND Certificate 140 AIRPORT DR CARLISLE PA 17013-1105 O rn C7 fry %J A rrt ;-r r r I C ;z :=� ra WELLS FARGO provided the department with the information below indicating that-atjheydeath of'tkie above-named decedent you were a joint owner or beneficiary of the account identifi'ed:i -3 Account No.3000017819294 Remit Payment and Forms to: ---q 'v r- rrn Date Established 08-17-2000 REGISTER OF WILLS 'M o � Account Balance $1,914.44 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $957.22 Tax Rate X 0.150 Potential Tax Due $ 143.58 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 taxis 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 Poleniial Tax Due. _- B El 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% 1 am a lineal beneficiary(parent, child,grandchild, etc.)of the deceased. (Select correct tax rate at right,and complete Part F-1 12% 1 am a sibling of the deceased. 3 on reverse.) ❑ 15% All other relationships (including none). D F�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 F-]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. ,\r� i a 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 O� ar v P� Q/ Total (Enter on Line 5 of Tax Calculation) $ 1211 dp PART Tax Calculation 3 If you are making a correction to the establishment date Line 1 account balance Line 2► or Y 9 ( ) ( 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 w� 40MCI your relationship to the decedent: D3arCCt8i11 �( ue \ I. Date Established 1 �� °� An V ' 2. Account Balance 2 $ g\ 3. Percent Taxable 3 X ri�5� � � - 4 3M 4. Amount Subject to Tax 4 $ JQ/S�S/f `� �� '� 5. Debts and Deductions 5 - /3/X GC) 4 777 3 � 6. Amount Taxable 6 $ ��3�,Y Nit 7. Tax Rate 7 X J-' 8. Tax Due 8 $ �?7./� -22V --i 9. With 5%Discount(Tax x .95) 9 X Q, 3:M, „u. t; _.\__Z ._.,a ._A ... ...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 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 ��- �l�f �Zs) Home _ 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 I ; , s t. 'I OCRP110TCC 009028 Questions? �rrir�rtirll�igtlll�illlhilll�irlrlllui�l�w�ntll4rdllr DOLORES L WEIGLE Available by phone24 hours a day,7 days a week- PATRICIA eekPATRICIA A ADAMS 1-800-TO-WELLS {14s)o-869-3557) 140 AIRPORT DR TfY: 1-800-8774833 CARLISLE PA 17013-1105 En espanol- 1,877-727-2932 0 1-800-288-2288(6 am to 7 pm PT,M47 Online:wellsfargo.com Write: Wells Fargo Bank,N.A.(345) P.O.Box 6995 ..._- --- -._._.__--- •---:....._^._.-- -" --"--- _______._R..._..-..___.,--�.,...--�-.... _r-- ._. . -....Po—tr l�rid,'DR"97228995-- -" --..--- -- _,. .._ Q 1 n r:. 0 You and WAs'Fargi � 9 Getting ready for tax season can be a Hassle!Creating a checklist,and"preparing in advance will set you up for a successful meeting with t9 your rax preparer.Remember to bring your deposit routing and account"number when preparingyour taxes and you may be able to take z ( advantage of using direct deposit for your tax refund into one of your Wells Fargo checking or savings accounts, z z z z .Activity summary Amount number 3000017819294 z Beginning balance on 1/1 $1,715.90 DOLORESL WEIGLE z Deposits/Additions 19854 PATRICIA A ADAMS z Withdrawals/Subtractions - 1,432.00 PennsylvanivoccountimmsandconditionsaMly z 0 Ending balance on 1131 $482,44 For Direct Deposit and Automatic Payments use o Routing Plumber(RTN):031000503 N m 0 Interest summary CD Interest paid this statement $0.01 Average collected balance $1,17250 Annual percentage yield earned 0.01% Interest earned#his statement period.., _.M-...., :.ASO U:1>_ _ interest paid this year $0.01 Total interest paid in 2012 $0.13 Transaction history Deposits! Iithdrawalsl Ending daily Date Description Additions .Subtractions ante 1/2 Carlisle Corpora Peru Pmts Jan 13 xxxxx9370 Weigle,Dolores _ _ 19853 1,914.43 1116 Withdrawal Made In A Brandi/Store 10.00 1116 Withdrawal Made In A Branch/Store G ~ �,311.00 593A3` - r G�3r-1 0088163 1124 CASHIER'S CHECK . = ` r.sERu Office AU# s8ssoo2is . 1210(8} ,:. ACCOUNT#'.4861-wTm ` . Purchaser: PATRICIAAADAMS - PurdmerAccouN 3000017819294 Operator I.D.: pa002289 PAY TO THE ORDER OF `WESTMINSTER MEMORIAL GARDENS**.* January 1.5,�� ***tine thousand three hundred eleven dollars and no cents*** WELLS FARGO BANK,N.A. NOTICE TO PURCHASER—IF THIS INSTRUMENT IS LOST, .VOID IFqVERUS-$'.1.311A0 604 E HIGH ST STOLEN OR DESTROYED,YOU MAY REQUEST CANCELLATION CARLISLE,PA 17013 AND REISSUANCE.AS A CONDITION TO CANCELLATION AND NON-NEGOTIABLE FOR INQUIRIES CALL(460)W43122 REISSUANCE,WELLS FARGO&COMPANY MAY IMPOSE A FEE AND REQUIRE AN INDEMNITY AGREEMENT AND BOND. Purchaser Copy y F8004 wm 12362263 Qv� ae V S n C C/) A m M ;Z1 D QZ) 01 Q ZB rn �l w O QV ,A D V M- Y C