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BUqFAO 0FN01°1°'""^�ES Pennsylvania lnheritanceTax �, •a � PennSyLVdllld
PO 6ox 200601 OEPAPTMENT OF PEVENOE
HPRRISBORG PA V12B�0601 Iniormation Notice ��..L�
_ . - - , And Taxpayer Response Fi�E �uo.z� _��°°<E,a jo,-��,
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"� . ACv 14160999
�. DATE 11-10-2014
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� ' Type oi Acroum
-' � Estate of BERNWE J WACKEF Savings
r - , Checking
��' Dateo�Deathl0-1&2014 Trusl
TIMOTHY E WACK�ER���� - CounlyCUMBEFLAND X CetlifiCa�e
6199 VETERANS WAV
NEWPORT PA 1]0]4-8429
MEMBERS isr Fcu provided the depariment with Ihe iniormation below indicating that at the death of [he
above-named decedent you were a joint owner or beneficiary of the account identified.
Remit Payment antl Forms to:
Attount No.386475
Da�e Establlshetl 06-29-2013 REGISTER OF WILLS
Account Balance $2,69479 1 COURTHOUSE S�UARE
Percen�Taxable % 16.667 CARLISLE PA 17013
Amoun�Subjec�lo TM $449.14
Tax Rate X 0.045
Potential T� Due NOTE': If tax payments are made within three monihs of ihe
$Z�.Z� decedenYs date of death, deduct a 5 percent discount on ihe tax
With 5%Discount(Tax x 0.95) $(see NOTE') due. Any inheritance tax due will become delinquent nine monihs
after ihe 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.
Proceetl fo Step 2 on reverse. Do not check any other boxes and disregard Ihe amount
shown above as Potential Tax Due.
g �The information is The above information is correct. no deduc�ions are being�aken, and payment will be sent
correct. wi�h my response.
Pmceed fo Step 2 on reverse. �o nof check any other boxes.
p �The tax rate is incorrecL � a.5% I am a lineal beneficiary (parent,child, grendchild, etc.)of the deceased.
(Selec�correct tax ra�e at
righL. and complete Part � �p� I am a sibling o�the deceased.
3 on reverse.�
� 15% All o�her rela�ionships(including none).
p �Changes or dedudions The informa[ion above is inwrrect and/or debis and deductions were paitl.
listed. Complete Part 2 and part 3 as appropriafe on the back o/this torm.
E �sset will be reported on The above-identified assel has been or will be reported and tae paid with the PA Inheritance Ta<
heritance tax�orm ReNm filed by�he estate represen�ative.
REV-1500. Proceed ro Sfep 2 on reverse. Do not check any other boxes.
\
Please sign and date the back of the form when finished 7�
PART Debts and Deductions
2
Allowable debis and deductions must meet both of ihe following criteria:
A. The decedent was legalty responsi6le for payment,and the estate is insuflicient to pay the deductible items.
B. Vou paid the debts afler the death of the deceden�and can furnish proot of paymen�i�requesled by Ihe department.
Qf additional space is required, you may attach B 1/2"x 11"shee�s of pape�J
Date Paid Payee Description Amoun� Paid
To[al (Enter on Line 5 of Tax Calcula�ion $
PART Tax Calculation
3 N you are making a correHion to Ihe establishment date(Line 1)account balance(Line 2),or percent taxable(Line 3),
please obtain a written correc�ion from ihe financial insti:ution antl attach itto this form.
1. Enter the date the account was established or titled as it existed at the date of death.
2. En[er the to[al balance of the account including any interest accmed at ihe date of death.
3. Enter ihe percentage of the account that is�axable�o you.
a. First, determine the percentaqe owned by the decetlent.
i. Accounis ihat are held "in tmst for"another or others were 100%owned by the decedent.
ii. For joint accounis established more than one year prior to ihe da[e of death,ihe percentage taxable is 100%divided
by the total number of owners including�he decedent (Por example:2 owners=50%,3 owners=33.33%, 4 owners
=25%, etc.)
b. Nex[,divide�he decedenYs percentage owned by the number ot surviving owners or beneficiaries.
4. The amount sublect to�ax is determined 6y mWtiplying�he account balance by�he peroent�axable.
5. Enter the�o�al of any debts and deductions claimed from Part 2.
6. The amount�axable is determined by sub�racting[he deb�s and deductions irom the amoun�subject�o tax.
7. Enter[he appropriate tax rate imm Step 7 based on your relationship to the decedent.
If indicating a differen[�ax rate,please sta�e mFIG'ddl I�SC�f71Y Q pqF -
your relationsnip ro tne decedenc . pq�Departm�It of��.Aevenue
1. Date Established 1 �
2. Account Balance 2 $ PAD
3. PerceniTaxable 3 X � �`�
2
4. Amount Subject ro Tax a $ 3 .. -
5. Debts and Deductions 5 - Q -�
6. AmountTaxable 6 S 5
i. Tax Raie ] %� 6 � .
8. Tax Due 8 $ 7 �
8
9. With 5%Discount (Tax x .95) 9 X
St2P 2: Sign and date below. ReNrn TWO completed and signed copies to ihe Register of Wills listed on the front of ihis form,
along with a check for any payment you are makinq. Checks mus�be made payable�o"Register of Wills,AgenL" Do not send
payment directly to the Depariment of Revenue.
Under penalty of perjury, I declare th �ne facts I have reported above are tme,correct and complete to ihe 6est of my knowledge and
belief.
� Work
� Home � �� ��
Tax 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 HEARWG AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020
n�R�,� or �xo:��ow� ,a.Es Pennsylvania lnheritance Tax �`� ����� PennSy�Vdll18
XP R�5 uRG6VA � � OEPFFTMENTOF PEVENOE
R a ���ra�osa, Information Notice
And Taxpayer Response "�-""
� -� - - - Fi�eNo.erl�{�I��rG
..__ " — •. ' ACN14161001
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—�� � �"� � ' ` Type ofAccount
� " � Estate of BERNECE J WACKER Savings
,,,.,� � . . � Checking
"-� � � Date o�Death 10-13-2014 Tmst
TInOTHV E WACKER(`li�,�,�;.'��� CountyCUMBERLAND X Cetlificate
6199 VETEHANS WAV` � � �
NEWPORT PA 17D74-8429
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 accouni identified.
Remit Paymen[antl Forms�o:
AccountNo.386475
Date Established 09-28-2013 REGISTER OF WILLS
Account Balance $2,687.09 1 COURTHOUSE SQUARE
CARLISLE PA 17013
Percen[Taxable X 16.667
Amount Subject to Tav $447.86
Tax Ra�e X 0.045
Potential Tae Due g zp.�5 NOTE': Ii tax paymen�s are made within three months of ihe
decedenPs date ot death,deduc[a 5 percent discount on ihe tax
With 5%Discount(Tax x 0.95) $(see NOTE') due. Any inheritance tax due will become delinquent nine months
atterthe date ofdea�h.
PART St2P 1 : Please check the appropriate boxes below.
1
/+ �No tax is due. I am the spouse of the deceased or I am the parent of a decedent who was
27 years old or younger at date of death.
Proceed to Step 2 on reverse. Do not check any other boxes and tlisregard Ihe amount
shown above as Potential7ax Due.
g �The informalion is The above information is correct, no deduc�ions are being taken,antl payment will be sent
correct. with my respanse.
ProCeed to Step 2 on reverse. Do not Check any other 6oxes.
p �7he tax rate Is lncorrect. � 4.5% I am a Ilneal beneficlary (parent,chlld,grandchild,etc.)of the deceased.
(Select correct tax rate at
right,and complete Pan � �p� I am a sibling of the deceasetl.
3 on reverse.)
� 15% All other relationships (including none).
p �Changes or deductions The information a6ove is incorrec�and/or deb�s and deduc�ions were paid.
listed. Complete Part 2 and part 3 as appropriafe on the back ol this lorm.
E �Asset will be reported on The above-identified assel has been or will 6e reporled and tax paid wi[h Ihe PA Inheri�ance Tax
I-k`nheritance�ac form ReWm �iled by the estate representative.
AEV-1500. Pmceed to Sfep 2 on reverse. Do not check any other boxes.
Please sign and date the back oi the form when finished \ /
�l
PART
2 Debts and Deductions
Allawable tlebts and deductions must mee�bo�h of(he following cri[eria:
A. The decedent was legally responsible for payment, and ihe estate is insuflicient to pay the deductible items.
B. Vou paid the debis aRer the dea[h of ihe decedent and can furnish prwf of payment if requested by ihe department.
Qf atldltional space Is required,you may atlach 8 1/2"x 11"sheets of paper.)
�ate Paid Payee Description Amount Paid
Total En�er on Line 5 of Tax Calculation $
PART Tax Calculation
3 If you are making a correc�ion to the establishmen�tlate(Line 1)account balance(Line 2), or percent taxable(Line 31,
please obtain a writlen correc[ion irom the financial insti[ution and attach it to this form.
L Enter ihe date the account was established or titled as it existed at the tlate of death. .
2 Enter the btal balance of the account including any interest accmed at the date of death.
3. Enter the percentage of ihe account that is t�able to you.
a First,determine[he percentage owned by Ihe deceden[.
i. Accounts that are held"in�mst for"another or o�hers were 100%owned by the decedent.
ii. For joint accowts established more[han one year prior to ihe tlate of death,ihe percentage taxable is 100%divided
by the�otal number of owners including�he decedent (For example:2 owners= 50%, 3 owners=33.33%,4 owners
=25%, atc.)
b. Nex�, divide�he decedenPs percentage owned by�he number of surviving owners or beneficiaries.
4. The amount sublec�to tax is de�ermined by multiplying Ihe accoum balance by the percen�taxable.
5. Enter the�otal oF any dehts and deductions claimed from Part 2.
6. The amount�axable is determined by subtracting�he debis and deductions from the amount subject to[ax.
Z Enter Ihe appropriate tax rate from Step 1 based on your relationship to the decedent.
If indica�ing a differen�tax ra�e, please s�ate Qf#jCjal USEOnIy QAAF
your reiationship to the decedent pA Department ni<R3vCnuB
1. Date Es�ablished 1 .
2. Account Balance 2 $ PAd ��
3. PerceN Taxable 3 % � �
4. Amount Su6lect�o Tax 4 $ Z
3
5. De6ts and Deduaions 5 - �}
6. Amount Taxable 6 $ 5
7. Tax Rate 7 X S -
8. Tax Due 8 $ � � � �
9. Wi�h 5/ Discount (Tax x .95) 9 X $
StOP 2: Sign and tlate below. Retum TWO completed and signed copies to the Register of Wills listed on�he front of this form,
along with a check for any payment you are makinq. Checks must be made payahle ro"Register of Wills,AgenL" Do not send
paymen�direcity to the Department of enue.
Under penalty of pe ' , I declare t t �e facts �have reported above are tme.. correct and complete to the best of my knowledge and
belief.
Work 2 t
_ � Home ,1 �.t �S�
Taxp 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
$i4A6S I.Ft1sl0�IC�, LLC
i29 SOUTH ISTO STRF.F,T PHONE: 717-730-7310
CAMPHILL,PA 17011 FAX: 717-730-7371
E-mail: mikcbanes'u:vcrizon.cel
MICHAEL L. BANCS,At�orne}-xt-I.aw WILLIAM E.MILLF.R.JR.
WENDV K. STRAUB,Paraleqal OtCounsel
March 13, 20I5
Lisa M. Giayson, Registec of Wills
Cumbcrland Coun[}�Courihouse
Ore Courthouse Square
Carlisle. PA 17013
RE: Estate of Bemece J. Wacker
1°ile No. 21-14-7066
Uear Ms. Grayson:
Ftnelosed vou will find [wo sets of PA Inhe�itance Tax Information Notices that I 6le on behalf of
Timothv E. Wacker.
ycry tmly yoors,
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