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Home My WebLink About02-04-15 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 N0. CD 020215 REIGLE CODY D 108 S FREDERICK ST FLOOR 1 MECHANICSBURG, PA 17055 ACN ASSESSMENT AMOUNT CONTROL NUMBER __""'_ fold '_____"" 14159147 � 5126.53 ESTATE INFORMATION: ssN: � � FILE NUMBER: 2115-0137 � DECE�ENT NAME: REIGLE KAREN J � DATE OF PAYMENT: 02/04/201 5 � POSTMARK DATE: 02/O2/2O1 5 � COU►vTY: CUMBERLAND � DATE OF DEATH: 1 O/1 6/201 4 I � TOTAL AMOUNT PAID: $126.53 REMARKS: CHECK# 800 INITIALS: HMW SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS BUREAU oF INDIVIDUAL TAXES Pennsylvania lnheritance Tax � �� PennS�/�Vd1118 PO BOX 280601 DEPARTMENT OFREVENUE HARRISBURG PA 17128-0601 Information Notice ' " REV-1543 E%UocEXEL (OB-12) And Taxpayer Response FILE NO.21 ' �- d �� ACN 14159147 DATE 10-30-2014 Type of Account Estate of KAREN J REIGLE Savings Checking Date of Death 10-16-2014 Trust CODY D REI6LE County CUMBERLAND Certificate FL 1 108 S FREDERICK ST MECHANICSBURG PA 17055-6307 ,-,� _�:� � �-'�-• u M.7 � ,� ��"a S r'1 � ;w';.� �J � <,'> �'� i,,:7 '� r-�, C"�7 :.7 ' ..- ,....� c::�5 _ � ._ .�., ; �'t'j . ' ...0 ._ _._.�.._. ; ;. .j _C�? _:'i ,_w ..� . "+i FIRST Na oF MIFFLINTOWN provided the department with the information below indiGating th'at`at�hE��i death of the above-named decedent you were a joint owner or beneficiary of the ac�ount iden�ified.;;� � Remit Payment and Forms to: Account No.61058020 Date Established 10-25-2002 REGISTER OF WILLS Account Balance $30,638.79 1 COURTHOUSE SGIUARE CARLISLE PA 17013 Percent Taxable X 16.667 Amount Subject to Tax $5,106.57 Tax Rate X 0.045 Potential Tax Due $22g.gp 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 fo Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potentia/Tax Due. g �The information is The above information is correct, no deductions are being taker,and payment will be sent cor�ect. with my response. Proceed to Step 2 on reverse. Do not check any ofher 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 � �2% 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. Comp/ete 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 � � � mP a C . �l / . b k I I �►1 Total (Enter on Line 5 of Tax Calculation) $a a y�6 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), piease obtain a written correction fr�dm 4he financial institutiol and at�a�h 6t ta this forrn. 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 ��\��\\�� `� � �� "�\y\��"��`�\\�� \� \� � � \��`��\\\��o our relationshi to the decedent: ��"�� o�\�� `�' ,�� , �� `�� Y P �� ,\„��\�� \ ��\ � ��`\�\��\��.k�t��, ��.��.�� .��\�� 1. Date Established 1 I6-aS-aoo2 �,��\��\��\�\�\\�\\��\��\��\��\ \�\��\\�\\\\��\��\��_ .��\� �0 63�:7q �� ,�\� ��,, , 2. Account Balance 2 $ . ��\��\�� \��\��`��`��\\��\\� ��\�� \ �� 0 ��s�� 3. Percent Taxable 3 X I6. 66) ��`��,��\��`��y\��,��\�\��` ,..� " �\ \ �� \ �� ,� � , 4. Amount Sub'ect to Tax 4 $ S ��b.S7 ��\�\��\�o��\��\�\\�\G�\��\�� `�\��`�\� �� "� �\\�\��\�� \\�� \��\ ��\ �\��\\�\\\� ��\� ��`. �� \\\��\\�\\\\ \�0��\\�\,��\�� 5. Debts and Deductions 5 - 2 ,�G/J 76 ��` � � \\ \ \�\\\�\ \\\�\ \ � ! 7' �� \ �� o��\ �\ ��\�� \�� \�\�o�; � \��\\�� \\�\�\\�\��\��: \\�� \�\��\��\\�\��`� ��\�� 6. AmountTaxable 6 $ a.g�1,�� \\��\�\�\��\��\��. ��\a\�\\��\��\\\�\�� \��\�� \\��\��\��\�� \�� 7. Tax Rate 7 X b.OKS �� \\��\��o � �� \� ��\ � �\ �� \\\��\\\��\ ��\ \\ 8 $ �2 3 ��` �� A� �� $. T$X �U@ __ ��.—__ �f��VA�.�� ti�` A� �A\�A�o�A\ A � � �s�� a� V� A�� t� X 'FJ��.AV��\\A A��V��o - Ao�� A��c�� \�� 9. With 5% Discount(Tax x .95) J ��a�.�0\�\\.�\\��\��\\��\\��a��\��\O\\��v.:�� \\��Q�\\\\\\�\\��:��\��\��\� 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 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 717-yq7-�a l/aq/ad►5 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 �he Brich.tavern Inn 2�6� N Bethlehem Pike �uaker*ot�n, PA 1$95i �X��***�*�*��*��*�**�**�� Qate ; No��01 ' S4 08 : lOPM Ca�d TYPe : �ISGOVER �e�t # : �XVXXXXX;�XX��583 Ga�d Entry: Sk�drPED � � �'�arts Type : PURGHRSE Auth i.a:ie : 00 i05R Check : 26;8 T�b1� : 6/ � Check �D : �aux /2516 Server : 52� LISA S ��r� � �au� Su�atota3 ; 3 � 8 . 11- 6 Ti� _..,.____----------�—T—– � , , . T 0�d� �--------------��_1�Y_--- I agi�ee to pay �bove total �ccor4iri� -o my card issuer acreement . * � * * Cus�ar�er Copy * * � � , lj�'11��.�.F�I �1 . �11.�.1�1�.1.� � �fi��.l�. 1�'� .I 1�1��'l.� 2�Ji3 �al�.;pl�� .�venuf� Marys�ril�E�, ��:jnncyfvar�ic� 1;'Q�3 17)-95�7-2077 Michael J. Shalonis, Uwner Phone (717 We Care About Service To You ober 17, 2014 � Douglas Reigle � Road, )ale, PA 17090 e, >r selecting our funeral home to provide services for your family during your time of bereavement. I hope i so far, to be of the highest standards that we always try to achieve. The following is a summary of the ser :plained and provided in written form on the services for: KAREN JOY REIGLE Total Funeral Service Selected SPECIAL SERVICES Direct cremation $ 1895.00 TOTAL SPECIAL CHARGES $1,895.00 CASH ADVANCES Certified Copies of Death Certificate $ 48.00 Local Newspaper Notice Patriot News $ 173.30 Two keepsake urns $ N/C CASH ADVANCE TOTAL $221.30 LESS: Credits granted $200.00 Discount allowed $200.00 TOTAL OF SERVICES $1,916.30 BALANCE DUE $1,916.30 � �� ^ � � � ~ � A�� ` � � � � � .�� ;A 41" 'i.-. ,..��. 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