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Home My WebLink About03-24-15 a�a�� F ��o��oW� ,axEs Pennsylvania lnheritance Tax �TM� �� PennSYLVdll18 Piuxre�SBUR66PA ll128—ozol Information Notice DEVpRTFM➢N1 OF PEVENOE And Taxpayer Response Fi�E No.zi - �S-C-.'�:i �..� ...-.. . " � � � - - ACN 'S115009 " � .� '- � ' DATE 03-20-2015 - - ��1 =�i , „ �; �3 TypeofAccoun� EstateofMARYLOVARMAN Savings -- Checking Date of Death 03-0&2015 7mst RANOY L DYARMAN - C011ntyCUMBEflLAND Certifica[e 50 qUARRY HILL RU � "' - NEWVILLE PA 17241-9403 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 account identified. Remit Payment antl Forms�o: AccouniNo.334856 Date Established 07-19-2008 REGIS7ER OF WILLS Account Balance $ 16,519.53 1 COURTHOUSE SOUARE CARLISLE PA 17013 Percent Taxable X 50 Amount Su6ject to Tax $8,25977 Tax Rate X 0.045 NOTP: If tax payments are made wi�hin three months of the Potential Tax Due $371.69 decedenPs date of death, deduct a 5 percent discount on the tax With 5%Discoun�(Tax x 0.95) $(see NOTE') tlue. Any inherilance tax due will become delinquent nine months afterthe date ofdeath. PAAT St2P 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 ro Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. g �The informa�ion is The ahove intormation is correct, no deductions are being taken, and payment will be sen� correct. with my response. Proceed to Step 2 on reverse. Do not check any other boxes. p �The tax rate is incorrect. � 4.5% I am a lineal beneficiary (parent, child,grandchild,etc.) of the tleceased. (Select correc�lax ra�e at right, and complete Part � �p� I am a sibling of ihe deceased. 3 on reverse.) � 15% All o�her 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 appropriare on the back of this form. E �Asse[will be reported on The above-identified asset has been or will be repotled and tax paid with the PA Inheritance Tax inherilance tae form Retum filetl by[he eslate representative. REV-1500. Proceed ro Step 2 on reverse. Do not check any ofher 6oxes. �Please sign and date the back of the form when finished. PART Debts and Deductions 2 Allowable deb�s and deductions must meet bo�h of�he�ollowing criteria: A. The deceden�was legally responsible for payment,and the esta�e is insufficient to pay the deducti6le items. B. Vou paid the debls after the death of the decedent and can fumish proof o(payment if requested by the departmen�. (I(edditional space is requiretl,you may atlech 8 1/2"x 11"sheets of paper.) Date Paid Payee Description Amount Paid -��-� � - era Is ovo. 3/ -�J-I`0-I�j c '� f fe � � c \ -p-rJi C-2— �C Total (Enter on Line 5 of 7ax Calculation $ 3 p, Pp'pT Tax Calculation 3 I( ou are makin a correction to ihe establishmen�tlate Line 1 account balance Line 2, or Y 9 ( � ( ) percent taxable(Line 3), please obtain a writlen correction trom ihe financial institution antl atlach it to�his 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 acemed at ihe date of tleath. 3. Enter the percen[age ot the accoun�that is�axahle to you. a. Firs�,determine Ihe percenta9e owned by the decetlent. i. Accounts that are held"in tmst for"another or others were 100%owned 6y the decedent. ii. For joint accounis established more Ihan one year prior to ihe date of death,the percentage t�able is 100%divided by the�otal number of owners including the decedenL (For example:2 owners= 50%,3 owners=33.33%,4 owners =25%,ab.) b. Ne�ct, divide Ihe decedenPs percentage owned by the numher of surviving owners or beneficiaries. 4. The amount subject ta tax is determinetl by multiplying the account halance by[he percent tauable. 5. Enler Ihe�otal of any deb�s and deductions claimed from Part 2. 6. The amount taxable is determined hy subtracting ihe debis and deductions from ihe amount subject to tax. Z En�er�he appropriate tax rate from Step 1 hased on your relationship to the decetlent. If indicating a differen�tax ra�e, please state �(Ipj2� �JSO�filp ❑pqp your relationship ro the decedent Sor� �+p pypa�fipp,nt6f RevgJlUB r 1. DateEs�ablished 1 7-19-L'i( 2. AccountBalance 2 $ Iw Si453 PAD ' $ � r:v 3. Perceni 7axable 3 X S C � a. Amount Subjea ro Tax 4 $ S, a55. 77 � �.. 5. Debts and Deduc�ions 5 - I 3 i I`�'G � � I 4 6. Amoun�Taxable 6 $ � 5 �- Tns Rate � X 8 e. Ta�c Due e $ C� a .*,v,: 9. WithS%Discoun�(Taxx .95) 9 X ��'. f StBP 2: Sign and date below. ReWrn TWO completed and signed wpies to the Register of Wills lis�ed on ihe front of this brm, alonq with a check for any payment you are making. Checks mus�be made payable to"Regis�er of Wills, Agent" Do not send payment directty b�he Departmen�o(Revenue. Under penalty of perjury, I declare that the facts I have repotled above are Vue,correct and complete ro[he best of my knowledge and belief. � -uverk l ell 503-�Fo3�% � /�/ � ��- Home /��7� 77�-7(�34 Taxpayer ignature 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 FOGELSANGER - BRICKERFUNERAL HOME 11T WEST KING STREET,SHIPPENSBURG,PA'11257(717�532-Y211 DATE Merch 11,2015 SERVICE NO. a�ae29 DECEASEO NAME Mary L."S s"Dya'man DATE OF DEATH March e,2015 PLACE OF DFATH Residence oi Relative CM1a es are only Noee ilems MM xl��p o Ma�am2p ui2E. Imxe are repuireE by lan o�by a remMery w a rrema�wyto uu an I�ems,vre will e�lain��e reas�s In wrNnp bebw M you se�a iune �I Nat may�equ �alminp,sucM1 as a Nna21 wltY�vlewl�g,you may have topay fa Kmoalm��g.You ao iw1 nave ro pey lor emUaMing you EIO wt appmve d}rou uiechtl artanBamenb sucn as a tlnM cramation or Imme0late Eurial.ttwe cnarge0 fw embalmhq,we vn0 explain x1ry Lelmv. STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED A. CHARGE FOR SERVICES: C, SPECIAL CHARGES: Professional Services Forviartling of Remains lo BASIC SERVICES OF iUNERAL�IRECTOR 8 -0. FORWFRDING OF REMAINS $ -0- EMBALMING $ _Q_ OTHER PREPARATION OF THE BODY § _p_ RECEIVING REMAINS $ � Tratlitional Funerel Package $ 5600.00 DIRECT CREMATION(As Selactetl) $ -0- 5 -0- IMMEoIATE BIIRIAL(As Selectatl) $ -0- b -�- $ -�- E -o- f � Equipment E 5,600.00 D. CASH ADVANCES: $ � Fur�eralCeremony(conaupeaatFuneialHome) E -D- GraveOpening E 73000 VisNaHon I VWwing(contludetl at Funeral Home) 5 -0- Newspape�No�ir»s Sentinel $ 3i].51 Memonai 5ervica(wnducfetl at Fune�al Home) $ -0- Newspaper Notices Public Opinion 5 792.40 $ -0. Clergy Honorenum $ 2D0.00 Funeral Ceremony(ConOuctetl at another tacildy) $ -0- Cert�ed Copies E 60.00 $ -0- Flowers E 36040 Automo[iveEquipment OrpanisiHomrarnrnm $ 7500 ( MIk3T�ensporte0) $ -Q $ _p. CaskalCoach�Heeree) S -�- g _p_ $ 0- s a $ a s -0- s o $ a s o $ o s o- s -a $ 4 a 5 -a B. CHARGES FOR MERCHANDISE: We charye you for our services in obtaining: Caskat $ 3 995 W Going Hame SWinless Steel 8 1.995.31 Ou�ermntainer E �.3000o SUMMARYOFCHARGES: OutarContainer A. CHARGESFORSERVICES $ 5,600.00 Veult B. CHARGES FOR MERCHANDISE E 5 445.00 AltemaleConlainer E .p. C. SPECIALCHARGES $ A- AcknowleEgemeMCaMs E -0- D. CASHADVANCES $ 1.995.37 VisitorRegialer E -0- E. SALESTAX,IFAPPLICABLE S -0- Monument Engraving E 750.00 TOTAL iUNERAL HOME CHARGES S 73,Oa0.31 E -o- LESS CREDIT AND PREPAYMENTS: $ _p_ RantlyDyartnan S -13,Oa0.31 Wearing Apparel S -0- $ -0- g o. a -a 8 -0 5 -p- g 5,445.00 TOTALCREDIT $ 13,09031 BALANCE DUE b -0- e on warranry on me ras e a or outer una mn ner wl i Mark C. Filbum con�cEon w'nM1 Mis service Is tl�e eryreea wM@n xartenry, ifanY� 9�nte0 Nartreol NnerelMmere senh(ive hmemervrenuer. mi.�uirerainome�rexesnow�mN, a.vassor�mw�iea, PT wiM r%pecl m Me tesket anNw oNer Ounel conpiner. Billing To an y . yarman 50 Querty Hill Road We wish to ezyress our appreciarion for your Newvllle,PA 77241 (717�7767838 confidence,and sincerely trust that our seruice has been satisfactory to you. Adetailed FOGELSANGER-BRICKER FUNERAL HOME, INC. memorandum is mailed to families we serue. Ho,,,,,,,,,.a��,,,,s„p,,,.,,a Should any item on this memarandum not be 112 W. King Sfreet, P. O. Box 336 entirely clear to you, we ask that it be 6raught to Shippensburg, Pennsylvania 17257 our attention at once. (717) 532-2211