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Home My WebLink About04-08-15 �� B�R�,� oF INDIVIDUAL TAXES Pennsylvania lnheritance Tax `�� pennS�/�Va111a PO BOX 280601 DEPARTMENT OFREVENUE HARRISBURG PA 17128-D601 Information Notice � REV-1543 EX DocE](EL!(��12) And Taxpayer Response FILE NO.21 �� _.- ,.. ACN 15105195 DATE 01-30-2015 Type of Account Estate of WALTER J STIPEII Savings SSN X Checking Date of Death 01-03-2015 Trust ANTHONY W STIPE CountyCUMBERLAND Certificate 3480 HORIZON DR LANCASTER PA 17601-1112 N � � � �� c�"J � ,-~� �_ .,___ --- '� � � �.,.��_ - �,.�, y �' ,r,,� r" s� T� � Cp � C7 �. � �� rv� � FULTON BANK NA provided the department with the information below indicatin tF�at at�fie d�a�nof the above-named decedent you were a joint owner or beneficiary of the account id t�d.� � c'� .:y �� + r., Remit Payment and Form�t0:j � � Account No.3623 .�,,� "� � "� Date Established 03-08-2008 REGISTER OF WILLS Account Balance $6,140.89 1 COURTHOUSE SC�UARE~ Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $3,070.45 Tax Rate X 0.150 Potential Tax Due $460.57 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 1 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 correct. with my response. Proceed fo Step 2 on reverse. Do not check any other boxes. � �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 � 12% 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. ,..i i��,i i r in�nr , PART 2 Debts and Deductions 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 � (d d.�J1'j L�MnU•�Vt.�'�� Jh YtY Yir�4' f,J(>„✓1 CI'Jr..�! }'A M!n J.�3�.v ( Total (Enter on Line 5 of Tax Calculation $ 3 Z��i. 0�7 PART TaX Cc1ICUlclt1011 3 If you are making a correction to the establishment date(Line 1)account balance(Line 2),or percent taxabie(Line 3), � pleas�ubtaBn a v�rdtten carrecti;,r frorn 4Fe f��a�cia�iTstitut'sar a��atta�ts it t�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. If indicating a different tax rate, please state \ �, ��\�� `�� \` `�` �\��` your relationship to the decedent: . ��, �\�� \��`; � �� ` �� \�� \\�� \ \�� . . � �i ��\\��\` �: 1. Date Established 1 �3��`d ��O �� \�\�o� `\\�\` �� \�� \ �� \�� \�\\� ��\\��\\\�\�� \\\�\\\ \�\�\��\�\� : \\� ��\�� \��\\�\��\\�\\\�� \��\ �\ 2. Account Balance 2 $ (, �N�• 4� � � �� ' "��V��AVA\\��A�A��\��\��\��AA�� 3. Percent Taxable 3 � � �� X S P � \\�� `� �� A�VVAAVAA � V� A�� A ��V� ��\ �VAO�� 4. Amount Subject to Tax 4 $ 3,G�7�. HS � � � �� A� V�� vy �� v� �� v�Vv��yvOv� A�v�v� �� \�\\� � �� \�\\ �� \��\� � �J. �@bt$af1C� �@C�UCtIOfI$ �J � •�-•-�� ' CJ� \��V� � � �A �� ,.��AAV��V��O�� V�� \\A\�A��`VA�� 6. Amount Taxable 6 $ " ��b`��6�-- � �� t �+ / � \��\��\��\\��\��0�\� ��\ �\\��\��\�\\\�� . Te�X {�fltc 7 � "1 .-J �/.s �� _ ��V� � �\\�V��V A�\VA �.ti o�AV�� \ 8. 1 C1X ��.1e �.�0 �� V A� ��VAA� ��.�V�VA��A� A��\�AA A�� OVVA� ��o�� 8 $ ��y � vv� � v � �\�A��V�� \��AV��V�� \\�� \\� ��\�� o\\�� \�� \\ �� 9. With 5% Discount(Tax x .95) 9 X ��.��\\\\\��o��.��.�: ��.�..::��`�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 �� -3�-,-ss�s ._. 7- ��--� Home ,►�-��ta-�2�s o:�f��:zc;�s 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 ,!�� pennsylvania DATE: 1/12/t5 DEPARTMENT OF FUBI iC�ti'FLFARE CUENTACCOUNTINFO REIMBURSEMENT OFFICE icF-ao5so� SOUTH MOUNTAIN RESTORATION CENTER 10058 SOUTH MOUNTAIN ROAD . _ SOUTH MOUNTAIN,PA 17261-0000 AMOUNT � ENCLC)SF_Cl KINDLY RETURN THIS PORTION OF STATEMENT WITH REMITTANCE Ail c#ier.;k:s and money orders to be rAnthony Stipe � madf� p�3�;�<�ble to Commonwealth of PenriSylvzinia. 3480 Horizon Drive Mail ��il rernittances to the Facility LanCaSter, PA 17601 Reiml�urs�:;nient Office. at the above mer�t�urue�ri facility. � � SEE NC►TICE OF RIGHTS ON REVERS� 51DE. p�� GES DAYS �SzE PA�S BESElP� PF.�II CREDIT AA�Q�LLZ BECENED ��ft AD,lUSTMENT A�lUSTMENT 1/12/15 OC12014 4,459.63 Nov 2014 4,459.63 Dec 2014 4,459.63 Jan 2015 1,080.00 Back CRM is owed(or October and November 2014. We are in the process of billing for December 2014 this week. Two days will be owed for January 2015. This will be the complete bill. SUMMARY: BEGINNING QE@lI SSEQII �� @� CHARGES P��FNTS ADJUSTMENT ADJUSTMENT � 8.919.26 5,539.63 0.00 0.00 0.00 i4,458.89 �PeymeM aue 2o days rron,dare a n,�s bu� PAY THIS AMOUNT: $ 14,458.89 �``� t�10N ' ' ' ' ,_ �^°i�a�,.,_. r rrirrn.,. , , so-» WALTER J. STIPE II 313 � 6 2 8 saea�opizoN a�. �nNeasT�a,PA 17601 oA.�� l��s + ' i � pRDEROF F �wrr+o++wtA�T't e� PCrlr+ry[Yqr1i A I �R �i+�J'1 . �� , a s h�rt� T a�+jAr� �wo 1tvn�rtd ir+� f'�vr ��A�f ""'�"�D�()LLARS t!J �� _ � Fulton � �it�o� � a� -� Q �ISTENING 15 JUST THE BEGIHNING� C�' MEMO __ � A!r �:03L30L422�: 3623 69954�i' 0628 �F i---�, c' :� b � I�� T �Z m a�j ` s � O X m . �� f7 � - <7�p Q r , � N : � � � _e'l3+Ef4 ��24'��E�l&t_ �l.�.�'Plf. �t!" �d = .�.�- "�-�� '� � � k °� ,�� m 3 '-�° �� „y� m �, � • • y1� `° D� �� C i = n C� � q� �� G . « � ; a � _ � c `'' �G� C ` t -� _ +��'�`F ( J r C m �� X''� _ ' n w i 1.:�� • d�J �� R � � �� ' � � �' t V7..{ N, � x� r ` A u r'7� ]i'c. � ;0 �, i �'(!1 m�s � — 41 i , . _ " �v°� �- � fi�l� _ n� f�tl :...�n..�u u.i...r.,.rirrn.,.. � . �' va +� � � � Y '� � y �' M. 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