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Home My WebLink About03-26-15 coMMovw�n�.narvervrvsv�vaNin aEv-iisz Exiii-3si uEPaa.Merv.or AEVENue e�nea�or iNorvio�a�.arEs oerr.zecso� �naaiseunc.an n�ae osm pENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 020417 POPLASKI HOLLY A 12 MORARI DRIVE DILLSBURG, PA 17019 ACN ASSESSMENT AMOUNT CONTROL NUMBER - - - -- 15115464 � 5217.27 ESTATE INFORMATION: ssN: � FILE NUMBER: 2115-0223 � oECEOErvr NannE: BAHN ROBERT E I DATEOFPAVMENT: O3/2B�2O�5 I POS7MARK DATE: 03/24/2015 I courvrr. CUMBERLAND I DATE OF DEATH: 02/14/2015 � � TOTAL AMOUNT PAID: 5277.27 REMARKS: CHECKk104 INITIALS: CJ sen� RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS �� eua�.+u or �xomvun� raxEs Pennsylvania lnheritance Tax � � � PennSyLVdllid PO 60x 100601 k�� pEPAP FMENiOF PEzEN�E NRRRISBORG PA llII8-O601 Information Notice REG�R� '1 ��T�c�#erResponse Fi�ENo.ziis-o22s 7__ . p. ACN15115464 R��^I; . . "!'_Lo oAreoa-za-eaie 2015 flnfl �6 °�I 1 `i3 Type of Accoun� � �'': ^r Estate of ROBERT E BAHN Savings �t�nA`� Checkmg . Date of Death 02-14-2a15 Trust HOLLV A POPLASKI ��M -� ` CountyCUMBERLAND CertifiCate 12 MORARI DR OILLSBURG PA 17019-1555 aNc BANK NA provided the department with the intorma[ion below indicating that at the death ot the above-named decedent you were a joint owner or beneficiary of the account identified. Remit Payment antl Forms to: Accounl No.5005130.553 Date ESWblished 04-25-2007 REGISTER OF WILLS Account Balance $ 10,164.96 1 COURTHOUSE S�UARE CAFlLISLE PA 17013 Percen�Taxable %50 Amount Subject to Tac $5,082.48 TaxRate %0.045 Potential Tax Due $ppg]� NOTE': If tax payments are made within three months of the decedenYs date of death, deduc�a 5 percen�discount on�he�ax With 5%Discount(Tax x 0.95) $(see NOTP) due. Any inheritance[ax due will become delinquent nine months �� 7, � 7 anertne date ofdeatn. PART StEP 1 : Please check ihe 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. Pioceed ro Step 2 on reverse. Do not check any ofher boxes and disregard the amount shown aheve as Yotentiz!T:a�Due. g �The information is The above informa[ion is correct, no deductions are being taken, and payment will be sen[ correct. with my response. Proceed to Step 2 on reverse. Oo not check any other boxes. p ❑The�ax rele is incorrec�. � 4.5% I am a lineal beneficiary(paren�,child,grandchild,etc.)o��he deceased. (Select correct tax rate at righ�, and complete Part � �p� I am a sibling of the deceased. 3 on reverse.) � 15% All other rela[ionships (including none). p �Changes or deductions The intormation above is incorrect and/or debts and deductions were paitl. listed. Complete Part 2 and part 3 as appropriafe on the back ol this lorm. E �Asset will be reporled on The above-identified asset has been or will be reported antl tac paitl with the PA Inheritance Ta�c inheritance tax form Retum filed by Ihe estate representative. REV-1500. ProceedroStep2onreverse. Donotcheckanyofherboxes. Please sign and date the back of the form when finished. PART Debts and Deductions 2 Allowable deb�s and deductions must mee�both of the following criteria: A. The decedent was legally responsible for payment,and ihe estate is insuificient to pay ihe deductible items. B. You paid the deb[s aker ihe death of the decedent and can turnish proof of payment if requested by the depariment. Qf additional space is required.you may attach 81/2"x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation) $ PART Tax Calculation 3 If ou are makin a correction�o�he establishment tlate Line 1 account balance Line 2 ,or y g ( ) ( ) percenitaxable(Line3), please obtain a written correction from the tinancial ins�itution and attach it to this form. L En[er the date the account was established or titled as it existed a[the date of death. 2. Enterthetotal balance ofthe accountincluding anyinteres�accrued atihe tlate otdeath. 3 En�er�he percen�age of�he accoun�that is�axable�o you. a. First,determine the percentage owned hy the decedent. i. Accoun�s�hat are held"in trust for"ano�her or others were 100%owned by the tlecetlent. ii. For joint accounts established more than one year prior to the date of death,ihe percentage taxable is 100%divided by�he total num6er of owners including the decedenL (For example:2 owners=W%,3 owners=33.33%,4 owners =25%, e�c.) b. Next, divide the decedenPs percentage owned by the number oi surviving owners or beneficiaries. 4. The amoun�subject�o ta�c is de[ermined by multiplying ihe account 6alance by ihe percent taxable. 5. En�er�he m�al ot any debts antl deductions claimed irom Pah 2. 6. The amount taxable is determinetl by subtrac�ing the debts and deduc�ions imm Ihe amoun�subject to tax. 7. En[er[he appropriale�ax rete irom S�ep 1 based on your relationship ro ihe decedeM. Ii indicating a diHerent tax rate,please state �j�jy�(j��y ❑� , yourrelationship�othedecedent ��i��Y�#:,A��UB. � 1. DateEstablished 1 PAD�, ;.cfr., y �, ., ,.,„�,„r„.: 2. Account Balance 2 $ � �+i 4" , 3. PercentTaxable 3 X �� 4. Amount Subject to Tax 4 $ 2 �� Yy� 5. Debts and Deductions 5 - .1 � 6. Amoun�Taxable fi $ 5 �� Z Tax Rate 7 X 6 �� , a r r- 8. Tar Due 8 $ �8 �, „� � �.,� �� 9. With5%Discount(Taxa .95) 9 X .. . . StCP 2: Sign and da[e below. Retum NJO completed and signed copies to ihe Register of Wills lis�ed on the front of ihis form, along with a check for any payment you are making. Checks must be made payable to"Re9is�er of Wills,AgenL" Do not send payment directly to the Department of Revenue. Under penalry of perjury, I declare Ihat Ihe facts I have reported above are tme,correct and complete to[he best of my knawledge and belief. U��ud�'� wo� �� 7- 90/ - ( 53 7 �d0-C.�1ClY'' Home7l7- 5�5- G� 385 3 � 3-I5 Ta�cpaye� Telephone Number Da[e 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 REG�R^�'_' `�FfICE BF -itE6(5" ..� .� ;'L�S o z a�� pt� fiflfl 26 '-'f� 1 `i3 � ;_ �_ _ CLEE. � _ . �� G�PHAt�%' _" > CUtd^,E?i! ,' "' � _ �.� G v 4! 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