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Home My WebLink About05-04-15 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 1 7 1 28-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 020613 HIPPLE RONALD L 7 VILLAGE DRIVE LEOLA, PA 17540-1855 ACN ASSESSMENT AMOUNT CONTROL NUMBER __"____ fold __"""" ___"'__ 151 19085 � 5101 .18 ESTATE INFORMATION: Ssrv: 20o-22-s45� I FILE NUMBER: 2115-0500 � �ECE�ENT rvAtviE: HIPPLE JOSEPHINE � DATE OF PAYMENT: 05/04/201 5 � POSTMARK DATE: 04/30/201 5 � COUrvTY: CUMBERLAND � DATE OF DEATH: 02/06/2015 � � TOTAL AMOUNT PAID: 5101 .18 REMARKS: CHECK# 1632 INITIALS: CJ SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS BUREAU oF INDIVIDUAL TAXES Pennsylvania lnheritance Tax �i �� pennsylvania PO BOX 280601 �� DEPARTMENT OFREVENUE HARRISBURG PA 17128-0601 Information Notice REV-1543 EX DocEXEC (OB-12) And Taxpayer Response FILE NO.21 ACN 15119085 DATE 04-08-2015 Type of Account Estate of JOSEPHINE HIPPLE � Savings SSN 200-22-6457 � � X �he`�king Date of Death 02-06-2015 � c� r�r PERCY D HIPPLE County CUMBERLAND � � -�.�—,, 23e�icate 264 ROTH RD �;'� �.: � '� `-'� � NEW BLOOMFIELD PA 17068-8545 `"':� � ��` e e-'� r .. „.�, 1 ��l " —� ' .7 <.� _ �.) . , , -, r:�? .� 4� �,;-� � �� "_�1 . :I �._a ''' C'3 �`"' �„ti,� _. �,_ t—�+ C!� Q W �`1 PNc BANK NA 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 and Forms to: Account No.5005818891 Date Established 01-09-2009 REGISTER OF WILLS Account Balance $12,947.55 1 COURTHOUSE SDUARE CARLISLE PA 17013 Percent Taxable X 50 Amount Subject to Tax $6,473.78 Tax Rate X 0.045 Potential Tax Due $291.32 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 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 ch,nu�n a�+��r??g PntPn.tial T�x nue. 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 Sfep 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 �anges or deductions The information above is incorrect and/or debts and deductions were paid. listed. Comp/ete 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. 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 ��- -4+� N a �✓o -`Y� � � - � - t`S Fv �.Y, �'� t F�,�h ��.( s�.��.� :� -� s'3 � u c� Total (Enter on Line 5 of Tax Calculation) $ �(j PART Tax Calculation 3 If ou are makin a correction to the establishment date Line 1 account balance Line 2 or ercent taxable Line 3 Y 9 � ) � )� p � )� please obtain a written correction from the financial institution and attach it to 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°/a, 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 cieductions 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: �`� ;;```��\��,�� \�\\�,��`�� \\�j� \ �� ,�\��\\�� a .\ \\��\�� \\\�`�� 1. Date Established 1 �t O ��p � \ �\� �\��\�� \\�� \��;��\ �o\\\��\��\�� \�� \\�� \�\\��\�\ 2. Account Balance 2 $ �,� �Y 7..5�� ;� \��\\\ \�\\\\��\��\�� \\��\�\�\\\\��\\�\\\��\\\�\\\\\\\��\\ ��A ��VAAA� �A�, �� A�� AA �� 3. Percent Taxable 3 X S�O � � ��A � �� V��VA�V� ��\��A�� \�AA ��AAA �� \�� a�� A\�� \VA��V\\�A��\VA�� 4. Amount Sub�ect to Tax 4 $ (c Y 7 3, 7� �� . 7 � V oA\� \��V ��A��V�\�� VA\� �V A\A�� A AA�\��VA 5. DebtS 8nd DedUCtIOnS 5 - � j O`� �� y�AvA\ o� ��v��y �b i:. � �� 6. 14f1lOUtlt T3X8b�8 6 $ ..0 �� CO.� �q � ��: � �y�� A�� A �V�� y��y �\�\�� Lr � � A �� - V��\�V��V\��V �\ /� �d�. �A�� V�� A��V A��0��\VA��A�\ � ��A\� /. i c3X �c1fB 7 ^ ��I� � � ��p"� ��\.� A��\��V��\��\��V�� o� �� @ �� o\�� \ �� \�� \\\\�\��\��\�� 8. Tax Due $ W ��✓aJ� \�\ �D\\�� \\� �\ \��\�� \\� \ �� \ � ,,� � �� A� �� V��\ 9. With 5% Discount(Tax x .95) 9 �� X .Q � � ..: S�\o�.....:\��a��.�.\\\�\\�\\\\...: ��\o�,.,.:::.��\\\\\\\\v.aa\oo0\\\��o�\\\\\�O�\\\a��..��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 r < Home 1t'� y �� j � �{ -- 3� - / 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 III 1 IIIIII11 . 1 CONTRACT , Bracl�endorf Memorials PHONE AREA CODE 717 2347909 2131-2143 H REET HARRISBURG,P:A. 1'7I03 .. Pricc _......:�.��Memorial Datc..... . •J-�-- -FdJ•.�.�Phone ��`'' ..h.O./-� , ..........�.��. Ccmctety Charge In agreement with..... ...��7......��r.L�......... _\� � r^ � /� •---..... _.. Strct[. ...._... ".."`�!�....1.��.�....�...�l�..._....._. ..........��. Total � City.�r�!"...�I�.�.�� .�C.�ncoa� ....�.ZLl.�P�. �U � Cemetery ----••.......•-•.....� . . ...... .. ...��.0:•••................................................................... �c,�,� ( - �s� , Lot Owner.:... . .�. �-�1 lL�:.L.�.p.�91e6�efi ..............••••--•.......__.. Lot No_ ........-••-••-•-- 6�%� Please check lettering carefully,if in error call as at once. Material INSCRIPTIOi�i �� U �- 2 �� ( Z` - � ��l- ��--� D�� os �� 9-�.. Co �,r.-- �t�� J 1 s� " � �� --- [ �.�C,.�-� � �.Q - �� ' r Lettering � � 1 (�� U� � (�� "�i QVL l, � " 4 � • Siu ......�.�...... length .........t.�...... width ......�......... heigh[ � � 3ize .................. length ...... widch _............_...... height �nish ToD .....�.... Facc .Yl�.............. Ends ..�z?�,�(.�. �J The said mcmorial is guaranteed by you against any dcfect in workmanship.Thc said memorial, with tide thereto and right of possession thereof,shatl rcmain your personal property until I have paid for it in fu{l.In dcfau[t of any payment thcrcundcr I license you to reposscss and removc the said mcmorial without guilt of•t[espass or ocher wrong,and authorize and empower you,in my name and on my behalf,to apply to thc managcment of said Cemctery or other prunises for a permit for its removal and to take any ochcr steps you may dcem neccssary or cxpedicn:and further agrcc to save you harmlcss from and under any entry,rcpossession and removal;you may then rc_ain said memorial or dispose of it at your own discretion without being answerablc to mc for it or for any procccds thcrefrom. Agrccmcnt of payments _ � I will inform you hcrewith of any change in my address prior to the Final ( payment henunder. There is no agreement regarding this order other than contained herein. S................. down paymcnr This order is no�subject to carieellation after acceptance. �.._. . .. ... _ w thc mcmorial is r for Purchas - . ...... /:� .. --...... ...�-'•-•� .� . e[tering; v — ACCE D:D e....... ...�.�.�.�.�I.�.._......... $................. within t�n days af n f said - memorial. B .......... ... _._..�QX.._..1................. Y• � e ove p ::e oes � 'nclude any future Iettering. i � im�i i 1P lllL IC'Il�l�l�71 ll71�ll�CEa I��IC' 1P�a1 Illl.CE'IC'a`3l�� __ _ _ --- 59 W.Main Street, Leola, PA 17740 1C�ilip �i'. J['urman ll''rancia 1[S. lArianer ll'aasmn�nnJ['�an�m�¢�ll7l�uu�.��uan �ic�a�l .�. �roc�. ��enta�m�n� �nr�TE�nu�� (717) 656-6833 Ronald L. Hipple February 19,2015 7 Village Drive Case# 15-019: Leola, PA 17540 For the Funeral Services of: Josephine L. Hipple PROFESSIONAL SERVICES Direct Cremation $ 2,189.00 MERCHANDISE Aur. Milano Pink $ 287.00 CASH ADVANCES Opening Grave $ 525.00 Certified Copies of the Death Certificate $ 36.00 Coroner Gemation Permit Fee $ 30.00 Newspaper Notices(out of town) $ 286.00 TOTAL CHARGES $ 3,353.00 PAYMENTS & ADJUSTMENTS �� 3,353.00) February 19,2015 PercyHippleJr#403(J.Hipple;#15-019) ($ 3,353.00) BALANC� DUE: $ o.00 , _ : .y��. u__ � I 1111� �� ; � ' ,�`'i �'litit�;'P� �;-(�Iln+� �F I �r`:" �+�i S �'ti�' `i p�l I 13 �.� �'�� (1 p`L . , - . . y i O I t f�(. •- . �, . ... �:�� GUM��:�: _ � � � -- �.� . _ .�a. � �� --e �r ��: ��= ! �. ^; ; {y" ;�; � �"''. �4,A ww ��.s 2 Y� �i� 4/' � t`� �..{�. r�' >'� ..�J. w•Y j�ti �, r;; �� -.. _m � � -� M _ � � � � � �� G� 4`y � ! �� iJi � {it � � �1? � � � t�, s�t � � � s=� � .�.� �, _ � �::_ � a � .ri u � � � — � `� � � �s gr � � � � � � _ cr � —�'' � .t ;- .� � � � F � � �l ""'"lllll9''J11111f'�. �