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Home My WebLink About05-11-15 s��.��, �/ euREnu oF innivinun� TnxEs P2t1t1Sy�Vclllla Illh2fltlnC@ TaX �� ,� p��5.7 �Van�a PO BOX 280601 �� DEPARTMENT OFREVENUE HARRISBURG PA 17128-0601 Information Notice And Taxpayer Response REV-1543 Ex oo�EXE� �oe-�2> � FILE NO.21 '"��'�� ACN 14162377 DATE 11-19-2014 Type of Account Estate of FRANCES C WARNER Savings X Checking Date of Death 09-05-2014 Trust DORIS J BLUME County CUMBERLAND Certificate 43 WILDWOOD RD NEWVILLE PA 17241-9713 �'�J � f�r1 � � � b ��7� � � fa�? (,"j I.:.f."7 �� 1 ._._ ('.."� __ �"'�1 --C �:.'"f .��;3 - i. . ��, L',D ACNB BANK provided the department with the information below indicating that at th�deatli of�trte � � above-named decedent you were a joint owner or beneficiary of the account identified. � } Remit Payment and Forms to: � -�r Account No. 132950 �--' `� Date Established 09-17-2008 REGISTER OF WILLS �-� ��' �r� 1 COURTHOUSE SGIUARE �"�' �" � Account Balance $3,541.62 c� �f Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $ 1,770.81 Tax Rate X 0.045 Potential Tax Due $79.69 NOTE': If tax payments are made within three months of the decedent's 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 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 to Step 2 on reverse. Do not check any other 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 � 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. Complefe 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 Sfep 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. � .��n7V 1111,1�. }I��ll , 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 L��, �e�I C'�a,Y.,.�, i .- Total (Enter on Line 5 of Tax Calculation) $ J U--� 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), pleasz obtain a written correcfion from the f9na��cial institutior�and attach it to this fcrm. 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 �, ��;�, �� J��S��t� ��`��\� � your relationship to the decedent: ��, �� :a ��; �� \��\ \ �� 1. Date Established 1 ��`��`� ,�� `��\��' � - ��\`��.��\� ��\��\\�\�� \ �� 2. Account Balance `� $ • �� \�\�� \�� \�\�\��\�\\� �� \\\ �� `\��\��\`�\\��\�� \O\��\��\�� 3. Percent Taxable 3 X �� ` � �� ` \� � �� .0A �� `V�� `��A �� . 4. AmOUnt SUbJeCt t0 TaX 4 $ �� , � �� V�� ` .. � \ �\�� \ \ \�\\�� \��\��\�q�\��\��\\�� \ 5. Debts and Deductions 5 - ;�. �� \e �� \�� \ �� \�� ` ��\�� \��.� �� 6. Amount Taxable 6 $ ` � �� ``�oA A A�\ AA� A\\\�� V��'V��A A\V A� 7. T?x Rate 7 X � � � �V��\�� '�� A�� `\\�� \�� A� �� \�� VA � �\��A A��\V�o VO� �� A�\ _�� A��pA �� 8. T3X DU2 8 � � �� V�\��e�\\�\� A� � o`�� \�\\�� \ a� �� \�\\��\�\��\\��\\ �. 9. Wlt�l rJ% �I$r.�Uflt�T[�X X .9�J� 9 X . .a.....,........a.��a��\�v..a--, �.,AAm� ��:��. ....A�:� ��\��..�t....A:�\\o�v` Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to"Register of Wills, Agent." Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true,correct and complete to the best of my knowledge and belief. Work Home Taxpayer Signature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 �� .. � MAINOFFICE BtltAMCX.'DI°i:ItiE 3 First Street �f1?13�rc li Ir::e� -j"� �� S nn BroohTwp.,PA 18444 S�r<�rti�n PF��ii505 'I sx�AT��aT iUR p g(5701842-3098 f5!.�'!3a3-oa13 B�;anMhurShauch.0�menFD- Cano�PrcnSha�u�:�,.!�u�+�msa ru vucnt iiuw�_.:.�'w rnnrn�sr.u�i c r.. 1-g��'2�9"9844�1NYVW.$t(2llChflllli'!(��:1�1C'If'.S.C�fTI STATEMENT OF FUNERAL GOODBI,AN S�RVI ES SELECTEO Charget ue ony 1m those dems that you se�ected a that are iequs �t we re reuuii by iaw or by a cemetery or�rematory io use any�r r +�w�;i r.� ;�n tt�e�eason m wnong ee�aw u yuu seiect�•�n fmcerai lhal may repuire em0alming,such as a furterBl v�ewinQ.you�ay hav,to D�Y�r embalmmF You do not hare to Ofi�or embalmmF I n r��o'ip�r��;r.d Wu selected arrangements such as Uur,ct cremahon a immediale 6unal If we ch3�QeU b��b3�mmg,we w�A iam w�y oe�ow G� _ '�(,.� , , u ,��a a�� -- 5 FMtneServ�ceot _._£��L�S . ,__�) ��'N1� _ __- --------- + -_- __ , �l f I�J:' _... ..V U,'�1� I Andre.;... _.__ ... � �. };l.� 1 �� e �� `� 5 t . _ - -- `�� ^' 'I�t w �_�_ � _ _ - s„tP--_ . _ Cnaige w _... —-- Name A.CHARGE fOR SERVICES SELECTEO ', I Monument. ._...__. _. _.....__. .._.$______. Services of funeral Director/Statt.... .,..._. _. ._ 5(__ --- - - • — �" r-- __............. ....S Ir—.._ .� .___ CTHER_.— _ _ _..�_— $— - Embalming....... , . .. � Other preparation oi body. ... ...5 L-_- __.._ .. - _.. --- - Viewmg(Visitation/1Make1._,.. - , __ ___ TOTAL MERCHANDISE SEtl�F.,C7hC� .......... _...8 3 ___ _...$� Funeral ceremony...___.._ .___.. ................:__......_,..$''�� ---- C.SPECIAL CHAR6ES Memonalservice. _ SG---- _-- , _ Unmediate bunal........... _.. _ ,....$_-- Gravesideserv�ce _... ... S�--- --- S��/� D�rect crematio�..... . . Otheruseoftacilities.. _....... ... .._,..... .' ....._ .....5j--, --- Package or Tribute selected _.,.._. _. ----- Vehicle to iransfer remams to Funeral Home I i , � _—._. _. ...-- .._� - --- locai..... . ._. __..._ _......_. ,. .._ .....Si--- - -- _i Hearse lCasket Coach) 5__— � — - ..__ .-- --/ local . ._._ .... . ...._.,__ ........,.__ ��---- - ---- SUBTOTAL OF SPECIAI GH�1RiGE.� _C$_1 L��7__ C ...... Serwce j Vehicies_.....__.._.._.__.__..._.._. ,.... .;i_......._...5��---- -- --- D.CASH ADVANCED Flovre�car ot floral disposihon '� ;, �pening grave_....... ._ _ _ ,_..___...._...._5 Local $I__.__ Cemeterye0mpment...._. . ..,. . .., ._....... .. ......5_ - _... _. ....p..... _........_ i....._ .... , Newspaper nahces-Laai . _.... _..__ S _ Laalcar sernce and/or rocession vehicle i $i---. _- -- Newspape�noUces-Ou!-^f-lo rar�-.- -......-......$— _... --- Clergy/mass oifering.. _. _._ $ Out-ot-towntransportaUon._ _ I 8____ _._ ..... _$,____ _ Certified copies of the deatl��E�rt�t¢ah�� 1�5 $ G� ----- � --------- i TOTAL OF PROfESSiONAI SERVICES,FACIU IES i Flvwers... ._._..... _ -5 — AND AUTOMOTIVE EtiU1PMENT.......... � i A$ — Monument compiet�on. _ _..._ _. __..S B.CHAR6E FOR MERCHANDISE SELECTED Coroners fee. .......... _ _ ._ _ ...... _... .....5 _ Footeriee .__.....,... ._ .._ _ _...__.._.__....5. Casket __ ..__...:..... __...... S�,--- --- _.__.,...... ' I Veteran RYtual Team......___ _......... .... ........ -- i Hairdresser................. . ..._ _ .. __........_..............$ � _ 4_ 5, Organist........ . ... _ __ . _......... . .. .._...S -- Outer bunai contamer _..._..... ....,.._...... —- - ---- ' � _ S ._ Acknowledgementcards.. ... _ � !�---- _ ._. _._...�,5— - _ --_-__ ---------- Reg�ster book(s).... ........ .. _ _...___ _ .— .... .. ---- [. � SUBTOTAL OF ADVANCES,_ , �$-�-_.. Prayercards...._... ........... __ �_� i -- Keepsake video tribute _.._ �— --- SUMMARY OF CHARGES Thumbie°DkeePsake _. _. . � ---- ---- A.ProfeSsionalSerwces F3cili�;�esaEilwpment PrmtedPackage _ _ i..._ , andAutomotiveEqu�pne�r __.. ._ _ ._.,5_--�--.._ __ ---- --__� Lammateobituanes . .__. �. .._ _ SI--- - -_ B.A9erchand�se_..._. __._ 5__.--- Heepsakependant............... _... . ._ .. �___ __.__ L SpecialCharges.. S 1�)�IS� 4 ` KeeDsake um._.. __ . i ----- 0.Cash Advanced/ihird Par^,�Ch�pr�t ... 5 __---�.� _ . _ ,., . S!_._- Um apDhque...... _ ' ...._... . S�i---- --- TOTAL OF ALL SECTIOP�S. __ ......5 _1_`?1�— Cremahon um__. ......_..... �. ._.. . _ ',.---- ---- PAID AT TIME OF OR PNilO�IR 1,0 �'� ARRANGEMENTS �'..'4�..I : �.PI.I....___ ...5�_.�-- __ -------- i , G � I BALANCE DUE. _ _._._... ............5 ' __ ,i I agree Inat I have eaammed t�e dems ol goo0s anG serncei�Nectnl a6ove Iml foun them to�e ccnett and accordmg to Ihe arrangemenls I +w�inl��sted.�acknowkd6�retnp�ol a topy o!t��Slaie�n�m oi Funere�Goods and Servkes Selected.I represent thal I suflre t lu�avada e lor paymeni oi thecash pnce torthe goods a�d scrv�� seu�E.I�also agree to make D�Y�^en1 ot S�_ i a g r e e ro D e p�n t ry a n d s e v e r a l y h a D M v n t�a r ry o n e�I s e w�o 'g n s b w.A Ilte cnar ol 15%per month amaunbnQ to 18%pet Year m+l�d i;,�ontM he unpa�tl 6alance Degmnmg 3�days`rom Me�ate nt tlusagreement.IvnllaisoD�YlatheFuneral0uectaalireas0 Dlero IspaidpYihefu ralDrtectarocollectainountslrnreundertA�sapr��ei,�..�1 f l�o��:�ae t s m a ym c l u d e a t t o rn e y s'1 e e s.rn u rt c o s t s a n d ot h e r cosis.Wry add�tronal smvices M merchanNse or etl or reqi�s�e0 a:er ihe�tate nf I e agreemmt wtl10e considereQ part oi th�s agreP��,ol n u31 ie i .�. thereof reill De relkcteC on tlie:�nal Odl or slatement (�f8�) � ,� ,'� �...� �,I � YJ � ,..r .._..../ ——-- � — �l0ate)"�_.__�--_—_ � (Pure ser� (SeaU - � _»— � - _ __ _ .. __ �_ urchaserj , � � .,:, ,�;Date) �i ---- � �iS—� , , , , cs�zi� ._ _ '� I .� ;; �?Jl llll l!-P,I_Rll_ll_ , � � Acc:;a�nt# XXXXXXXX2950 o � �tatE�:ment Date 04/05/15 AC� F"a�r; 1 of 2 PO Box 3129 B A N K Gettysburg PA17325 � Temp-Return Service Requested I��i�lil�l�rli�i�i�ill��il��nl��il�il��ll�n��l�lil��ll � 000301 0.5098 AV 0.381 TR00001 � FRANCES C WARNER See page 2 for � OR DORIS J BLUME important information a 45 WILDWOOD RD 9 9 Y m about mana in our � NEWVILLE PA 17241 account. Special offers available on select home equity loans anti lines. Consolidate bills, refinance your credit cards or make home innprc>vements. Stop by an office or visit acnb.com to apply today! Equal Housing Lender. Member FDIC. Relationship Checking Accnunt# XXXXXXXX2950 Beginning Balance on 12/15/14 $1,775.28 + Deposits &Other Credits $0.00 -Withdrawals &Other Debits $0.00 - Service Charges $0.00 + Interest Paid $0.00 Ending Balance on 04/05/15 $1,775.28 Days in Statement Period 2� �, 0 � ,� Overdraft Charges/Refunds Summary o ------ o This Cycle ____ N� � Total Returned Item Fees $0.00 $0.00 � Total Overdraft Fees $0.00 $0.00 � Total Fees Charged $0.00 ._ $0.00 0 0 � This Cycle _ n� � Refund of Returned Check Fees $0.00 $0.00 M Refund of Paid Check Fees $0.00 u____ $0.00 o�, Total Fees Refunded $0.00 .____ $0.00 o� � M .--I.--I O I� O Ol Q N END OF STATEMENT m� �� acnb.com • 717.334.3161 • Toll Free 1.888•3r�I,4,.�"�,C;NB (2262) ,,,.,,��,� ,��,� ,