HomeMy WebLinkAbout04-08-15 euxenu or xeorvmw� raxes Penns Ivania lnheritance Tax �� Pennsylvania
PO BO% 280601 Y 1.�
NRRRISBIIRGPL V138-Y601 �nf�fm$�IQn1Y0[ICe � DEPNFTMENTOFPEVENOE
AndTaxpayerResponse Fi�ENo.ziis-onsF���• '�,
REC�RDED OFFICE OF onreos�osiois
?U15 PPR 8 Pt� 12 54 TYPe of Account
Es�ate of DONALD S BRANOFF Savings
CLEfi�; OF SSN172-24-gg86 Checking
Date of Death Ob21-2015 X Tms�
JAMES P eHANOFF ORPH.ANS' COURT CountyCUMBERLAND CehifiCate
25 E DAUPHIN ST 'CUMBERLAN��' �-�� "
ENOLA PA 17025 � � � � �•
MEMBERS isr Fcu provided the department with the information below indicating [hat at ihe death of the
above-named decedent you were a joint owner or beneficiary of the account identified.
Account No.250904 Hemit Payment and Forms to:
Date Es�ablishetl 09-13-2004 REGISTER OF WILLS
Account Balance $420.36 1 COURTHOUSE SOUARE
Percent Taxable X 100 CARLISLE PA 17013
Amount Subject to Tax $42036
Tax Rate X 0.045
Potemial Tax �ue g �g.gp NOTE': If�ax payments are made within�hree mon�hs of the
decedenfs date of death,deduct a 5 percent discount on the tax
With 5%Discount(Tax x 0.95) $(see NOTE') due. Any inheritance tax tlue will become delinquent nine months
afler ihe 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
27 years old or younger at date of death.
Proceed fo Step 2 on reveise. Do not check any ofher boxes and disregard fhe amounf
shown a6ove as Potenfial Tar Due.
B �The information is The above information is correct, no deductions are being takeq and payment will 6e sent
correct. with my response.
Proceed to Step 2 on reverse. Do not check any other boxes.
� �The tax rate is incorred. � 4.5% I am a lineal beneficiary (parent,child,grandchild,e[c.)of the deceased.
(Select correct tax rate 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 inwrrect and/or dehts and deductions were paid.
listed. Complete Part 2 and part 3 as appropriate on the back ol this lorm.
E Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax
eritance t�form ReWm filed by the estate represen[ative. �
REV-1500. Proceed fo Step 2 on reverse. Do not check any other boxes.
0
Please sign and date the back of the form when finished.
PART Debts and Deductions
2
Allawable debts and deductions must meet both of the following criteria:
A. The decedent was legally responsible for payment, and the estate is Insuflicient ro pay Ihe deduc[ible items.
B. You paid the debis aRer the death of the decedent and can fumish prwf of payment if requested 6y ihe department.
(If additional space is requiretl, you may attach 81/2"x 11"sheets of paper.)
Da�e Paid Payee Description Amount Paid
To�al (Enter on Line 5 of Tax Calcula�ion) $
PAflT Tax Calculation
3 N you are makin9 a correction to the establishment date(Line 1)account balance(Line 2),or percent laxable(Line 3),
please obWin a writlen cortectian:rom the financial institution and attach it lo this torm.
1. En�er�he date Ihe accoun�was es�ablished or ti�led as it existed a�the da�e ot death.
2. Enter the total balance of ihe account including any interest accrued at the date of death.
3 Enter the percen�age oF the accoun��hal is�axable lo you.
a. First,determine the percentage owned by the deceden�.
i. Accounts ihat are held "in tmst for"another or others were 100%owned by ihe decedent.
ii. For joint acwunts established more than one year prior to the date of death,ihe percentage[axahle is 100%divided
by Ne[olal number o�owners includin9�he decedenL (For example:2 owners=50%, 3 owners=33.33%, 4 owners
=25%,e�c.)
b. Next,divide the decedenfs percentage owned by Ihe number of surviving owners or beneficiaries.
4. The amount subjec[m tac is delerminetl by multiprying the accoun[balance by ihe pement taxable.
5. En�er the total of any deb�s and deductions claimed from Pah 2.
6. The amount taxable is de[erminetl by subtrec�ing the deb�s and detluclions from the amouM sublect to tax.
7. Enter ihe appropria�e tax rale from Step 1 based on your relationship to the decedenl.
If indicatinq a different�aa rate,please stale �f(�ICI��SE 4fl�Y�AAF
your relationship to the decedent P/�QQPp�'[m0fif Of�fl@Y2f1U8
1. Date Established 1 �
2. Account eaiance 2 S �Afl
3. Percen�Taxable 3 x �
�
4. Amount Subject ta Tax 4 8 � � �
5. De6ls and Deductions 5 - 4
6. Amoun�Taxable 6 $ 5
7. Tax Rate 7 x 6 `-'='
8. Tax Due b $ g ;
g W'�h 5% D'scoun� (Tax x 95) 9 x - -
StOP 2: Sign and date below. Return TYJO completed and signed copies to the Register of Wilis listed on the fronc of this form,
along with a check for any payment you are making. Checks must be made payable to"Fe9is[er of Wills, AgenC' Do not send
payment directly to Ihe Department of Revenue.
Under penalty of perjury, I declare ihat[he facts I have reported above are irue,correct and complete to the best of my knowledge and
belief.
/' � � WOrk
��,,,..�.� � �,nn,�i///i Home �—� — ���
Taxpayer Signature �7 Telephone Number Date
IF YOU NEED FURTNER 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
auxvno or �Horvrow� lnxes Penns Ivania lnheritance Tax ���� pennsylvania
vo eas eeoso� y 1.�
WIMRISBORG P1 lllte-o[ol �fl(Oflfl'dtl�fl IVO�IC2 �� �EPAPTMENTOFPEVENUE
And Taxpayer Response Fi�E N0.2ii5-ons e
RECORDEO 0 FICE OF acN isniss3
DATE 03-09-2015
2015 PPR 8 �� 12 Jy Type af Account
Estate of DONALD S BRANOFF �Savings
CLERKOf SSN172-24-9986 cne�k��9
ORPHC.NS' COC2T Da�eofDeath01-21-2015 x r��sc
JAMES P BRANOFF _ CountyCUMBERIAND CertifiCale
25 E DAUPHIN ST GUMBERLA��� � •`
ENOLA PA 17025
MEMBERS isr Fcu provided the department with ihe information below indicating that at the death of the
above-named decedent you were a joint owner or beneficiary of the account identified.
Hemit Payment antl Forms[o:
AccouniNo.250904
Date Establishetl 04-25-2012 REGISTEH OF WILLS
Account Balance $30,02370 1 COURTHOUSE SOUARE
Percent Taxable X 100
CARLISLE PA 17013
Amount Subjec[to Tax $30,02370
Tax Rate X 0.045 NOTE': If�ax paymen�s are matle within three monihs of[he
Potential Tax Due $1,351.07 decedenfs date of death, deduct a 5 percent discount on the tax
With 5% Discount(Tax x 0.95) $(see NOTE') due. Any inheritance tav due will become delinquen�nine months
aker Ihe date ot death.
PART S1Ep 1 : Please check the appropriate boxes below.
1
A �No lax is due. I am the spouse of the deceased or I am the parent of a decedent who was
27 years old or younger at date of death.
Proreed to Step 2 on reveree. Do not check any other boxes and disregard the amount
shown above as Potential Tar Due.
g �The information is The above information is correct, no deductions are being taken,and payment will be sent
correct. with my response.
Pmceed fo Step 2 on reverse. Do not check any ofher boxes.
� �The tax rate is incorrecL � 4.5 o I am a lineal beneficiary(parent, child,grandchild, etc.)of the deceased.
(Select correc�lax rate e�
right,and comple�e Part � �p o I am a sibling o�the deceased.
3 on reverse.)
� 15% All o�her rela�ionships (including none).
p �Changes or deduc�ions The information above is incorrect and/or debts and deductions were paid.
listed. Complete Part 2 and part 3 as appropriate on fhe 6ack o/this lorm.
E Asset will be repohed on The a6ove-identified asset has been ar will be repohed and t�paid wi[h ihe PA Inheritance Tax
inheri[ance tax form Retum filed by[he estate representa�ive.
EV-1500. Proceed to Step 2 on reverse. Do not check any ofher boxes.
IP
Please sign and date the back of the form when finished.
PART Debts and Deductions �
2
Allowable deb[s and deductions must meet both of the following criteria:
A. The decedent was legally responsible for payment, antl the esta�e is insuMicient to pay[he deductible items.
B. You paid the debts atter�he death o��he deceden�and can fumish proof of payment if requested by�he department.
(If additional space is required, you may attach 8 V2"x 11"sheets of paper.)
Date Paid Payee �escription Amount Paitl
Total (Enter on Line 5 of Tax Calculation $
PART Tax Calculation
3 If you are making a correction to the establishment date(Line 1)account balance(Line 2),or percent tazable(Line 3),
please obtain a written correction from lhe tinancial insii:ution antl a�tech il to this form.
1. Enter Ihe date ihe account was established or titled as it existed at the date of death.
2 Enter[he�a�al balance of ihe acwun�including any interes�accrued at lhe da�e of dealh.
3 Enter�he percen�age of the account�ha�is taxable to you.
a. First,determine ihe percentage owned by ihe decedent.
i. Accounis ihat are held"in trust for"anolher or others were 100%owned by the decedent.
ii. Por join�accounts established more than one year prior�o�he dale o�death,Ihe percentage�axable is 100%divided
by the total number of owners including the decedent (Por example:2 owners= 50%,3 owners=33.33%,4 owners
=25%,etc.)
b. Next,divide the tlecedenCs perceMage owned by the number of surviving owners or beneficiaries.
4. The amount sublect to tau is de�ermined by mNtiplying[he account balance by the percent taxable.
5. Enter the�o�al oF any debis and deductions claimed from Part 2.
6. The amount taxable is determined by sublracting lhe debts and deduc�ions imm�he amoun�su6ject to tan.
7. Enter the appropriate tax rale from Step 1 based on your relationship�o the decedent.
If indicating a diflerent tax rate,please state �� Q(fj�jy� �5e Qp�[3qpF
yourrelationshiptothedecedenC � � pR��yKm��f,�Qy�g� �.
1. Date Established 1
2. Account Balance 2 8 P�
3. Percent Taxable 3 X �
2
4. Amount Subject to Tax 4 $ 3.. � �
5. Debts and Deduc�ions 5 - 4 ' '- �
6. AmounlTaxable 6 $ � � �
Z Tae Rate 7 X �
8. Tax Due 8 $ 7
8
9. Wi�h 5% Discoun�(Tax x .95) 9 X ��
St@P 2: Sign and date below. Retum 7W0 completed and signed copies to ihe Register of Wills listed on the fmnt of this form.
along with a check for any payment you are making. Checks must be made payable to"Register of Wills,AgenC' Do not send
payment direc�ly to ihe Department oi Revenue.
Under penalry oi perjury, I declare ihat the tacts I have reported above are tme,correct and complete to the bes[of my knowled9e and
belief.
� �� Wark
// •- - � �.� �/!i Home � —Z— /�j
axpayer 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 HEARWG AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020
eoxenu or �xorvrouu raxcs Pennsy�vania �nheritance rax �� . Pen�1S�/LVa1110
GO e0x ta05o1 DEPAPTMENTOFREVENOE
INRRISBORG PA VBB-4601 q�d Information Notice
EGORDEDOFFICEOFnse Fi�ENo.ziis-ansF� �•• ,��
REGISTER �F WILLS ^CN i5iii95a
DATE 03-09-2015
T015 PPR Q p� 12 �3
Type of Account
C��i?K Q;EstateofDONALDSBRANOPF �Savin9s
ORPHdNS' r,.;p�ooea�no86�i-zois xT�sik�n9
JAMES P BRANOFF ��M�Ei��.:.1�,_. �COuqty�CUMBERLAND Certificate
25 E DAUPHIN ST � '
ENOLA PA 17025
NEMBERS 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.
Account No.250904 Remi� Payment anC Forms to:
Date Establishetl 06-11-2012 REGISTER OF WILLS
Account Balance $ 10,46922 1 COUR7MOUSE S�UARE
Percen�Tauable X 100
CARLISLE PA 17013
Amount Subject to Tax $ 10,46922
Ta�c Ra�e X 0.045
Potential Tax Due $q7�,�� NOTE': If tax payments are made within�hree mon[hs of[he
decedenPs tlate of death, deduct a 5 percent discount on ihe tax
With 5% Discount(Tax x 0.95) $(see NOTE') due. Any inheritance tax due will become delinquent nine months
aNer ihe date of death.
PART StBP 1 : Please check the appropriate boxes below.
1
A �No tax is due. I am the spouse of the deceased or I am ihe parent of a decedent who was
21 years old or younger at date of death.
Proceed ro Sfep 2 on reverse. Do not check any other boxes and disregard the amount
shown above as Pofentia/Tar Due.
g �The inbrmation is The above information is correc[, no deductions are bein9 taken,and payment will be sent
carrec�. with my response.
Pmceed to Step 2 on reverse. Do not check any other boxes.
� �The tax rate is incorred. � 4.5% I am a lineal beneficiary(parent,child, grandchild, e�c.)of the deceased.
(Select correct tax rate at
right,and complete Pan � �p o I am a sibling of ihe deceased.
3 on reverse.)
� 15% All o�her rela�ionships(including none�.
p �Changes or deductions The iniorma�ion above is inwrrect and/or tlebis and deduc[ions were paid.
lis�ed. Complefe Part 2 and part 3 as appropriate on the back o(this torm.
E Asset will be reported on The above-identified asset has been or will be reported and tav paid with the PA Inheritance Tax
nheritance tax form ReNm filed by the estate represen�ative.
V-1500. Proceed to Step 2 on reverse. Do not check any other boxes.
�Please sign and date the back ot the form when finished.
PART Debts and Deductions
2
Allowable debts antl deductions must meet both of the following criteria: �
A. The decedent was legally responsible for payment, and the eslate is insufiicient to pay�he deductible items.
B. Vou paid the debts atter ihe death of the decedent and can fumish proof of payment if requested by ihe tlepartment.
Qf additional space is required,you may attach 8 VZ'x 11'sheets of paper.)
Date Paid Payee Description Amount Paid
Tolal En�er on Line 5 of Tax Calculation $
PART Tax Calculation
a Ii you are making a correction to the establishment date(Line 1)account balance(Line 2),or percent taxable(Line 3),
please obtain a written correction irom ihe financial institution and attach it�o this form.
t Enter the date the account was established or titled as it existed at the date of death.
2 Enter the total balance of Ihe account including any interest accmed at the date of death.
3. Enlerlhe percenlage oithe accoun[thatistaxableto you.
a. Firs�,de�ermine the percenta9e owned by�he deceden�.
i. Accounts that are held"in trust for'another or others were 100%owned by the decedent.
ii. Forjoint accounts established more than one year prior m the date ot death, ihe percenta9e taxa6le is 100%divided
6y the total number of owners including the decedent. (For example:2 owners=50%,3 owners=33.33%,4 owners
=25 0,etc.)
b. Next, divide the decedenfs percentage owned by the number o(surviving owners or beneficiaries.
4. The amount sublect to taz is determined by mWtiplying the account balance by the percen[taxable.
5. Enter Ihe total of any debis and deductions daimed irom Part 2.
6. The amouN taxable is determined by sub�racting Ihe deb�s and deduclions Gom�he amount subjec�b lax.
Z Enter the appropriate�ax rate irom S�ep 1 based on your relationship lo the decedent.
If indicaling a diflerent tax rate, please s�ate � �0(f'ICI�US8�X�AAF .
your rela�ionship lo�he decedent: PJ{Qy�}��j�pypf UfRBVBfN6
1. Date Es�ablished 1 "
2. Account Balance 2 $ P� �
3. Percent Taxable 3 X 2
4. Amount Subject[o Tau 4 S +� �
5. Debts and Deduclions 5 - d �
6. AmountTaxable 6 $ 5
Z Tax Rate 7 x 7
8. Tau Due 8 $ �g
9 W'th 5%Dlscount(Tax x .95) 9 X
SteP 2: Sign and da�e below. ReWm TWO completed and signed copies ro Ihe Fe9ister of Wills listed on ihe front of this form,
along with a check for any payment you are making. Checks must be made payable lo"Register of Wills, Agent" Do not send
payment directly to the Department of Revenue.
Under penalry of perjury, I declare that ihe facts I have repohed above are irue,correct and complete to tM1e best of my knowledge and
belief.
/ti � �,rt.�,.�, � Ho e �—� — ��
axpayer 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
°°"�^° °° '"°'°'°�" T•*Fs Penns Ivania lnheritance Tax .� ennsVlvania
Y11 BOX 380601 Y � +
NaRxis6VRG PR V130-n601 �flfOfRl'Lt10f1 N021CP. �EPAFTMENT OF PEVENUE
And TaxpayerResponse FILE N0.2115-0176kL �oe �_�
RECOR�E OFFICEOF ACNisiiisss
oare os-os-zoi s
?015 PPR 8 FI� 12 53 Type of Account
Estate of DONALD S BRANOFF Savings
��[�'.;�( �� SSN172449gg6 Checkmg
JAMES P BBAN�FF �RP{i;�!IS� �`���.''," �Da�eofDeath0l-2L2015 X Trust
25 E OAOPHIN Si CountyCUMBERLAND Certifica[e
ENOLA PA 17025 CUMBE::I • •.... . ,
MEM8ER5 isr Fcu provided the department with the information below indicating tha[at ihe death of the
above-named decedent you were a joint owner or beneficiary of the account identified.
Account No.250904
Remit Payment antl Forms to:
Date Establishetl OS-20-2012 REGISTER OF WILLS
Account Balance $20,153.84 1 COURTHOUSE S�UARE
PercentTaxable X100 CARLISLE PA 17013
Amoun�Subject to Tax $20,153.84
Tax Rate X 0.045
Poten�ial T� Due $906.92 NOTE': If tax payments are made within Ihree months of the
decedenPs date of death,deduct a 5 percent discount on the tax
With 5%Discoun�(Tau x 0.95) $(see NOTP) due. Any inheritance tax due will become delinquen�nine months
akerthe date ofdeath.
PART St@P 1 : Please check the app�opriate boxes below.
1
A �No tax is due. I am the spouse of ihe 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 othe�boxes and disregard the amount
shown above as Potential Tax Due.
g �The information is The above informa�ion is correct, no deductions are being taken,and payment will be sent
correc�. with my response.
Proceed to Step 2 on reve�se. Do not check any ofher boxes.
� �The tax rate is incorrecL � 4.5% I am a lineal beneficiary (parent, child,grandchild, etc.) of ihe deceasetl.
(Seled correct tax ra[e at
right, and complete Part � �p� I am a sibling of ihe deceasetl.
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 appmpriate on the back ol this lorm.
E Asset will be repohed on The above-itlentifed asset has been or will be reported and tax paid wi[h ihe PA Inheritance 7ax
inheritance tav form ReWrn filed by the esta�e representa�ive.
REV-1 W 0. Proceed to Step 2 on reverse. Oo not check any other boxes. �
Please sign and date Ihe back of the form when finished.
PART Debts and Deductions - -
2
Allowable debts and deductions must mee�both of the following cri�eria:
A. The decedent was legally responsible for payment,and the estate is insufficien�to pay the tleductible items.
B. You paid the debts after ihe death of ihe decedent and can furnish proof of payment if requested by ihe depariment.
Qf additional space is required,you may attach 81/2"x 11"sheets of paper.)
Da�e Paid Payee Description Amount Paid
Total (Enter on Line 5 of Tax Calculation $
PART Tax Calculation
3 Ii you are making a correction to the es[ablishment tlate(Line 1)account balance(Line 2),or percent taxable(Line 3),
piease obtain a writlen correc:ian from ihe finandal inst%u:icn anC attach it to this form.
1. En�er the date the account was es�ablished or ti�led as it existed at the date of death.
2 Enter the�otal balance of Ihe accoun�induding any in�erest accmed at�he date of death.
3 Enter the percentage of Ihe account ihal is taxable to you.
a. First,determine the percenta9e owned by the deceden[.
i. Accounts Iha[are held"in trus�for"another or others were 100%owned by the decedent.
ii. Por join�accounts es�ablished more�han one year prior to the da[e of tleath, ihe percentage taxable is 100%divided
by the btal number ot owners including the tlecedenL (For example:2 owners=50%, 3 owners=33.33%,4 owners
=25%,etc.)
b. Next.divide Ihe decedenCs percentage owned by Ihe number of surviving owners or beneficiaries.
4. The amount sublect to tau is determinetl by mWtiplying Ihe account balance by[he percent taxable.
5. Enter the�o�al of any debts and deductions daimed irom Patl 2.
6. The amoun�taxable is de�ermined hy subtrading the deb�s and detluc�ions from the amount subject�o lax.
7. Enter ihe appropriate tan rete from Step 1 based on your relationship to the decedent.
If indicating a different tax rate, please state DIflC121�C Only�Ap� fr �
your relationship to the deceden�: � ' ' P/{��tD1 RBYQ�AUB
1. Dale Established 1 �
2. Account Balance 2 S P��
3. Percen[Taxable 3 X �
2
4. Amoun�Subjec�toTax 4 $ 3����
5. Debts and Dedudions 5 - 4
6. Amount 7axable 6 $ 5
7. Taz Rate 7 X s .
8. Tax Due 8 $ I$
9. Wi�h 5% Discoun� (Tax x .95) 9 X f �
.St@�.1 2: Sign and date below. Retum TWO completed antl signed copies to the Register of Wills lisced on Ihe imnt of this form,
along with a check for any payment you are making. Checks must be made payable to "Regisler oi Wills,AgenL" Do not send
payment directly to the Department of Revenue.
Under penalry of perjury, I declare that the facts I have reponed above are irue,correct and complete to the best of my knowledge and
belief.
//� Work �/
/�. f� � Home " I "Z—�S
axpayer 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
euaenu or �xornow� lnxes Penns Ivania �nheritance 7ax � � � G1@�1�1Sy�V0111a
vo eox aeoso� Y
ruxz�seuus an inxe-osm Intorma�ion Notice oePnarmervrorneveHue
And Taxpayer Responsa �F�-"""°."„` `°° ",
RECORDED Q rICE OF Fi�ENo.2iis-ons
ACN 15111956
REGISTEP, 0 YlILLS �nreos-os-zais
?O15 PPR 8 F�I 12 S3 Type of Accoun�
C LE R'C C F Estate of DONALD S BRANOFF Savings
SSN 172-24-9986 Checkin9
ORPHAHS C��;RT DateofDeathOb2b2015 x r��sc
JAMES P BRANOFF CUMBERLA..:D � ,., i�A CountyCUMBERLAND Cehifica�e
25 E �AIIPHIN ST
ENOLA PA 17025
MEMBERS isr Fcu provided [he department with the informa[ion 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 to:
AccountNo.250904
Date Established 11-20-2012 REGISTER OF WILLS
AccouniBalance $33,178.83 1COURTHOUSES�UARE
Percen�Taxable X 100 CARLISLE PA 17013
Amoun�Subject to Tax $33,178.83
Tax Rate X 0.045 NOTE': If tax payments are made within Ihree months of the
Potential Ta< Due $1,493.05 decedenfs date of dea�h,deduct a 5 percent discount on the tax
With 5% Discount(Tax x 0.95) $(see NOTE') due. Any inheritance�ax due will become delinquent nine months
akerthe date ofdeath.
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 fo Step 2 on reverse. Do not check any other boxes and disregard the amount
shown above as Pofential 7ax Due.
g �The iniormation is The ahove information is correct, no tleductions are being taken, antl payment will be sent
correct. with my respanse.
Proceed to Step 2 on reverse. Oo nof check any other boxes.
p �The�ax rate is incorrecL � 4.5% I am a lineal beneficiary(parent, chilQ grantichild, etc.)of�he deceased.
(Select correct tax rate at
right, and complete Part � �p� I am a sibling of ihe deceased.
3 on reverse.)
� 15 o AIl other relationships (including none).
p �Changes or deductions The informalion above is incorrect and/or debts and deductions were paid.
listed. Complete Part 2 and part 3 as appropriate on the 6ack ol this lorm.
E�sset will he reported on The above-identified asset has been or will be repohed and taz paid with the PA Inheritance Tax
inheritance tax form Retum filed by ihe estate representative.
EV-7 500. Proceed to Step 2 on reverse. Do not check any other 6oxes. �
•
Please sign and date [he back of the form when finished.
PART Debts and Deductions
2
Allowable debis and deductions must meet both of the followinq criteria:
A. The decedent was legally responsible for payment,and the estate is insufficient to pay the deductible items.
B. Vou paid the debts aker the death of the decedent and can furnish pmof of paymen�if requested by the department.
Qf atlditional spaw is required,you may attach 8 1/2"x 11'sheels of paper.)
Da�e Paid Payee Description Amount Paid
To�al En�er on Line 5 of Tax Calculation $
PART Tax Calculation
3 tl you are making a correction to the establishment tlate(Line 1)account balance(Line 2),or percent taxable(Line 3),
please ob[ain a wtltten correclion irom the tinancial instttution antl attach it to this form.
L Enter[he da�e�he account was established or titled as it existed a�the da�e of death.
2 Enter the total balance of the account including any interest accrued at the date of death.
3. Enter ihe percentage ot Ihe account ihal is taxable to you.
a. Firs�,de�ermine the percen�age owned by[he 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 da�e of death,the percentage tacable is 100%divided
by the total number of owners including Ihe decedenL (For example:2 owners= 50%, 3 owners=33.33%,4 owners
= 25%.eta)
b. Next, divide the decedenCs percentage owned by�he number of surviving owners or beneficiaries.
4. The amounl subject to tau is determined by multiplying ihe accoun�balance by lhe percent taxable.
5. Enter the iotal of any debts and deductions claimed from Part 2.
6. The amount taxable is determined by subtracting�he debts and deductions from the amount subject to tax.
�. Enter ihe appmpriate tax rate from Step 1 based on your relationship to the decedent.
If indicating a diRerent tax rate,please state .�f('1C131 US@�Illy[]AAF
your relationship to Ihe tlecedent � PQ�yr(�}g�t O(fjByC{Al{g ..
1. Date Established 1 �.-
2. Account Balance 2 S PA� � �* r
3. PercentTaxable 3 x Z ���
4. Amount Subject b Tax 4 8 3 � .
5. Deb�s and Deductions 5 - 4
6. AmountTaxable 6 $ 5
Z Tax Rate 7 X 8
8. Tav Due e $ r �
$
9 W'th 5%Discount(Tax x .95) 9 X ��
St2P 2: Sign and date below. ReNm TWO completed and signed copies to�he Register o(Wills listed on Ihe imnt of this form,
along with a check for any payment you are making. Checks must be made payable to"Register of Wills,Agenc." Do not send
payment directly to ihe Department of Revenue.
Under penalty of perjury, I declare that ihe facts I have reported above are tme,correct and complete to Ihe best of my knowled9e and
belief.
/' //�J'� Work �t
/��'✓Z � �.�"I.ovi v��� Home / — Z —��
�azpayer 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
euacno or ivorv�ow� axes Pennsylvania lnheritance Tax �� ' PennSY�Val118
PO B�X 390601 DEPAPTMENTOFREVENIIE
HFRRISBIIRG Pi V129-0601 Information Notice
And Taxpayer Response "�-""`•"""" �••."�
RECOR ED OFFICE OF FILEN0.2115-0176
ACN 15111957
REGIS E' Or" WILLS onTeos-os-zois
?O15 PPR 8 Ff� 12 `3 7ype of Account
CLEP.F; OF esca�eofooNn�oseanNOFF �Savings
SSN 172-24-9986 Checking
ORPHAt�S' ���'.,'R� oaceoioeamoi-zi-2ois x r�us�
JAMES P BRANOFF CUM�iEf�����:c' �� �'?CountyCUMBERLAND CertifiCate
25 E DAUPHIN ST � � "
ENOLA PA 17025
MEMBEkS isr Fcu provided the department wi[h the information below indicating [hat at the death of the
above-named decedent you were a joint owner or beneficiary of the account identified.
Remit Payment antl Forms�o:
Account No.250904
Date Established 0425-2012 REGISTER OF WILLS
Account Balance $23,346.02 1 COURTHOUSE SOUARE
PerceniTaxable %100
CARLISLE PA 17013
Amount Su6ject b Tae $23,346.�2
Tax Rate X 0.045
Potential Tax Due $ 7,050.57 NOTE': If tax paymenis are made within Ihree months of the
decedenPs date of death,deduct a 5 percent discount on ihe tax
Wi�h 5%Discoun�(Tax x 0.95) $(see NOTE') due. Any inheri�ance tax due will become delinquent nine months
after ihe tlate of death.
PART SteP 1 : Please check the appropriate boxes below.
1
A �No tax is due. I am the spouse oT 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 nof check any other bozes and disregard the amount
shown above as Potential Tax Due.
g �The information is The a6ove information is correct, no deductions are being taken, and payment will be sent
rorrect. with my respanse.
Pmceed to Sfep 2 on reverse. Do not check any other boxes.
� �The tax mte is incorrect. � 4.5% I am a lineal beneficiary(parent,child, grandchild, etc.)of ihe deceased.
(Select correct tax rate at
right,and complete Part � �p� I am a sibling of�he deceasetl.
3 on reverse.)
� 15% All other relafionships (including none).
p �Changes or deduc�ions The information above is inwrrecl and/or debts and deduc�ions were paid.
listed. Complete Part 2 and part 3 as appropriate on the back of this lorm.
E�sset will be repotled on The above-identified asset has been or will be repotled and tax paitl with(he PA Inherilance Tax
��'lqheritance ta<form Retum filed 6y ihe estate represen[ative.
REV-1500. Proceed to Step 2 on reverse. Do not check any othei boxes.
B
Please sign and date [he back of the form when finished.
PApT Debts and Deductions
2
Allowable debts and deduc[ions must meet both of the tollowing criteria:
A. The decedent was legalty responsible for payment,and the estate is insafficient to pay the tleductible items.
B. Vou paid the debts after the death of the decedent and can fumish proof of payment if requested by ihe department.
Qf additional sDace is required,you may atlach 81/2"x 11"sheets of paper.)
Date Paid Payee Description Amount Paid
To[al En�er on Line 5 0�Tax Calculation $
PART Tax Calculation
3 If you are making a correction to the establishment date(Line 1)account balance(Line 2),or percent tarzable(Line 3),
please obtain a wdtlen correcfion from ihe financial instifution and attxch it to this icrm.
L Enter the dale lhe account was es�ablished or�itled as it exis�ed al�he date of dealh.
2. Enter Ihe lolal balance of the acwunt including any in�eres[accrued at ihe date of death.
3. Enter ihe percentage of the account ihat is taxable to you.
a. First,determine Ihe percentage owned by[he decedent.
. Accounts[hat are held"in trust for"another or others were 100%owned hy the decedent.
ii. For joint accounts established more than one year prior to the date of death,the percentage taeable is 100%divided
by the�o�al number of owners including the decedenL (For example:2 owners=54%, 3 owners=33.33%,4 owners
=25%,etc.)
b. NexL. divide�he decedenYs percen�a9e owned by[he number of surviving owners or bene�iciaries.
4. The amount sublect to�a�c is determined by mul�iptying�he accoun�balance by the percen�taxable.
5. Enter the total of any debis and deductions claimed irom Part 2.
6. The amount taxable is determined by subtracting the debis and deductions Gom ihe amount subjec[to tax.
7. Enter the appropriate tax rate from Step 1 based on your relationship to ihe decedent.
If indicating a ditferent lax ra�e, please sta�e Qj('Aqa� (JS£�fll�,0qqp
your relationship to ihe decedent PA DeP�km2�tt�f H8�8nilB s ,.
1. Date Established 1
2. Account Baiance 2 $ PAO �
3. Percent Taxable 3 X � � -
4. Amoun�Subject to Tax 4 $ 3 ' �
5. Debts and Deductions 5 - 4 t . .
6. AmouniTaxable 6 $ S
7. 7ax Rate � X 6 .
B. Tax �ue 8 $ �
$
9. With 5%Discount(Tax x .95) 9 X �
.St2P 2: Sign and date below. ReWm 7W0 completed and signed copies ro Ihe Regis�er of Wills listed on the iront of this form,
along with a check for any paymen�you are making. Checks must be made payable to"Register of Wills,AgenC' Do not send
paymem directly to the Depanment of Revenue.
Under penalry of perjury, I declare that the fads I have reported a6ove are tme,cortect and complete to the best of my knowledge and
helief.
///J �/ �,j � WOrk
`.,Pt'�nn+ �l (�2�yir� � Home �—� — ��
��
��axpayer 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 HEARWG AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020
euxcau or �xomow� raxEs Penns Ivania lnheritance Tau �� � ennS�/lvania
ra eox zeozm y P J
w,xa�seuas r. i��ze-ow� Inf0�m2ti0n NOtlCB � oErnArneNrorREVEHue
And T� ayer Response Fi�E No.2�is-ons � `��,�,
RECORDED OPFICE OFP ACN isiiissa
REGISTE:^, OF 4.'ILLS �nreos-aazois
2015 PPR 8 Ff� 12 `4
Type of Account
��E(�'^{ �i' Es�ateofDONALDSBRANOFF Savings
SSN 172-24-9986 Checkin
ORPHANS' COL " 9
JAMES P BRANOFF ��MdEF'�!."` " � '- DateOfDeath0l-2b2015 X Trus�
. � CountyCUMBERLAND Certificate
25 E OAUPHIN ST
ENOLA PA 17025
MEMBERS isr Fcu provided [he department with the information below indicating that at[he death of the
above-named decedent you were a joint owner or beneficiary of the account identified.
Account No.250904 Remit Payment and Forms to:
Date ESWblished 07-07-2014 REGISTER OF WILLS
Account Balance $10,059.ffi 1 COURTHOUSE S�UARE
Percent Taxable X 100 CARLISLE PA 17013
Amoum Subject�o Ta< $10,059.82
Tax Rate X 0.045
Po[ential Tae Due $452.69 NOTE': If tax paymenis are made within three months of Ihe
decedenfs tlate of death, deduct a 5 percent discount on the tax
With 5%Discount(Tax x 0.95) $(see NOTE') due. Any inheritance�ax due will hecome delinquent nine months
after the da[e of death.
PART $teP 1 : Please check the appropriate boxes below.
1
A �No tax is due. I am ihe spouse of the deceased or I am ihe parent of a decedent who was
21 years old or younger at date of death. �
Pioceed 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 informa�ion is correct, no deductions are being(akeq antl payment will be sent
correc�. wi(h my response. �
Pmceed to 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 ihe deceased.
(Select correct tae rate a�
right,and complete Part � �p� I am a sibling of ihe deceased. �
3 on reverse.)
� 15% All other relationships (including none).
p �Changes or deductions The in�ormation above is incorred and/or debts and deductions were paid.
lis�ed. Complete Part 2 and part 3 as appropriate on the back ollhis lorm. .
E Asse�will be repotled on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax
eritance tax �orm Fetum filed by ihe estate representa�ive.
REV4 500. Proceed to Sfep 2 on reverse. Do not check any o[her boxes.
�Please sign and date Ihe back of Ihe form when finished.
PApT Debts and Deductions
2
Allowable debts and deductions must meet both of the following criteria:
A. The decedent was legally responsible tor payment,and the estate is InsuHicient to pay lhe deductible items.
B. Vou paid ihe debis atter the death of the decedent and can fumish pmof of payment if requested by the department.
(If addi�ional space is required,yau may attach 8 V2"x 11"sheets of paper.)
Da�e Paid Payee Descriplion Amount Paid
To�al En�er on Line 5 of Tax Calculalion $
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),
please obtain a writlen correction from the financia!inslitution antl attsch it to this form.
1. Enter ihe date ihe account was established or titled as it existed at the date of death.
2. Enter the total balance of Ihe account includin9 any interes�accrued at the date of death.
3 Enier the percentage of the accoun[that is taxable�o you.
a. First,determine ihe percentage owned by[he decedent.
i. Accoun�s�hat are held"in trus�for"anolher or others were 100%owned hy the tlecedent.
ii. For joint accounts established more than one year prior m lhe tlale oi death,the perceNage tauable is 100%divided
by the lolal number of owners including the decedent. (For example:2 owners= 50%.3 owners=33.33%,4 owners
=25%, e�c.)
b. Next, divide the decetlenfs percentage ownetl by ihe number of surviving owners or beneficiaries.
4. The amount subject to tac is determined by multiplying the accoun�balance by the percent�axable.
5. Enter the total at any debis and deductions daimed from Part 2.
6. The amount taxable is determined by subiracting the debis and deductions irom the amount subject to ta�c.
Z Enter Ihe apDropriate[ax rate fmm Step 1 based on your relationship to the decedent.
If indicating a different tax rate,please sta�e Offlq1� US80Np'�N1F
your relationship ro the decedent PA D@p2rt�nCfit of R@1+80U8*
1. Oate Established 1
2. AccountBalance 2 $ PA��
X �
3. Percen�Taxable 3 2 .
4. Amount Subject ro Tax 4 $ 3 -
5. Debts and Deductions 5 - '1
6. AmountTaxable b $ 5
7. Tzc Fate 7 X � ..
8. Tax Due 8 $ $
g. Wi�h 5% Discount(Tax x .95) 9 x � '
StQP 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listetl on Ihe front oi this form,
along with a check for any payment you are making. Checks must be made payable to"Fegister of Wills,AgenC' Do not send
payment directly to ihe Department of Revenue.
Under penalty of perjury, I declare that the facts I have repotled above are irue,correct and complete to the best of my knowled9e and
belief.
WOrk /,,l
�. - � � � Home / `Z— �`5
✓
T xpayer Signature Telephone Number Date
IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE
DISTRICT OFFICE, OR THE INHEflITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR
TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020
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