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Home My WebLink About11-19-14 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX�11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 1 7 7 28-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 019936 HERBERLIG WAYNE F PO BOX 386 MT WOLF, PA 17347 ACN ASSESSMENT AMOUNT CONTROL NUMBER "'_____ fold '______"' ______" 14161589 � 595.67 ESTATE INFORMATION: ssrv: � FILE NUMBER: 2114-0996 � �ECE�ENT N,4ME: HEBERLIG MILDRED C � DATE OF PAYMENT: 1 1/1 9/201 4 � POSTMARK DATE: 1 1/1 8/2014 � COUNTY: CUMBERLAND � DATE OF DEATH: 1 O/01/2014 � � TOTAL AMOUNT PAID: 595.67 REMARKS: CHECK# 8834 INITIALS: CJ SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES Penns Ivania lnheritance Tax � Der11'1Sv lvania PO BOX 280601 y r J HARRISBURG PA 17128-0601 � DEPARTMENT OF REVENUE � � c�-�n t' n Notice R�C��l ��E REV-1543 E%DocE%EC (OB-12) Arn�d�,.��p er Response �E�y� -- , ;? i� FILE NO.2114-0996 ACN 14161589 DATE 11-12-2014 fU i., v f �E �;,;; [;;�� Type of Account �(��;�;�°,�; � :,; ;;T Estate of MILDRED C HEBERLIG Savings ��,-„4, . ,s, Checking `Date of Death 10-01-2014 Trust WAYNE F HEBERLIG CountyCUMBERLAND X Certificate 225 S FIFTH ST PO BOX 386 MOUNT WOLF PA 17347-0386 ORRSTOWN BANK 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.20040614 Remit Payment and Forms to: Date Established 06-06-1991 REGISTER OF WILLS Account Balance $8,057.32 1 COURTHOUSE S�UARE Percent Taxable X 8.333 CARLISLE PA 17013 Amount Subject to Tax $671.42 Tax Rate X 0.150 Potential Tax Due $100.71 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 St@p 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 orrect. 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 � 12qo 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 financiaf institution anci ai�ach ii 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. � � �, . � � �. ,s,� �� If indicating a different tax rate,please state `�� `�� ,�� ,��' �� ` �� your relationship to the decedent: ��5� �� 1. Date Established 1 � � �.�� ,, V � �, �� s 2. Account Balance 2 $ �� . �� \ � , , � � � � 3. Percent Taxable 3 X � ` � � � �� -� � 4. Amount Subject to Tax 4 $ � �� ; � � , 5. Debts and Deductions 5 - �� ,�� ` � V ` �� 6. Amount Taxable 6 $ �'� � �`�� \ �A � �\ � - 7. T8X Rdt2 7 -X---- �0�V1\ � � � � \��;. \�� . �c.:. �� \�� ."��a�.a\�� V�� ,A� ��. ��. . , 8 � �� \� \ \ 8. Tax Due � �, �`� � .� � � �\ 7 �� 9. With 5% Discount(Tax x .95) s X R 5. 6 ��,�„��,�� s��„��,�� ,�,��;,��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 �6`�-Z(o�O- �SZ� � � . �- Home 7L`1—Zlvlv —3S'S'� Taxpa er Signature Telephone Number Date /�-�-�_Zp�c� 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 HEARtNG AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 1 V � E:Cfa;��. ,"riC�� flr F� r ,�� s-� C� �. � ;� � F�,.; �L a� � � � y�� 1� ►��U 1? �i1 3 �2 �ff � �. ` i$�€�� r:f _:�, .. - .. �� `V'' } , , CU��:��':.. , , ' � � 1'". �> ' � � �rf s�:^ � w.. l� ." � �� Qo ;:> �r . _,, �,�y M i ,�� , � v _. ; � xj � � � _ � � � ti. 0 �' ---� .. �:�, � � —}— _ � �;•t : � `� L'�s ; t�p ��'� � , J . „ i=i i " 0 '�'} f �U 's�y � � � v �'' , �. --,. ' ti J � i � t. J � \' !, t S � n Of v � M � •d r t a i = a a LL�o �M� 1 C p �m G aW � � ?d L� �((��