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Home My WebLink About04-08-15 GOMdAcnW EALTH OF PErvrvSVLVANIP REV-1162 E%('"JB) PPi1dEM OF PEVENOE BUFFAU OF I\DIVI�UBL TAXES �E T 20060� �wsooaa.Pn nae-ocm pENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 020472 KAUFFMAN BEVERLY A 115 5 PRINCE STREET SHIPPENSBURG, PA 17257 ACN ASSESSMENT AMOUNT CONTROL NUMBER _---- ---- 15116303 526.80 ESTATE WFORMATION: ssN: FlLE NUMBER: 2115-0248 oECEOENr rvnmE: KAUFFMAN EDWARD A I DATEOFPAYMENT: O4/OH/2015 I POSTMARK DATE: O�F/OE/201 5 I cauNrv: CUMBERLAND I DATEOFDEATH: 02/15/2015 I � TOTAL AMOUNT PAID: 526.80 REMARKS: CHECK# 268 INITIALS: CJ sEA� RECENED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS , 90REA0 OF IH�IVIOWL .A,Es `�� pennsylvania po aox zaoso� Pennsylvania lnheritance Tax w,rzx�seuxa aa n�ze-oco� Information Notice oevnninerviovAevervue AndT�xpayerResponse Fi�ENo. 2ii5-o2agk� ��et31 RECORC ` 70FF10E0' onreos�zezois i � 2015 P�PR 8 F(� i2 `. �' rvPeo�n��o��t EstateotEDWARDAKAUFFMAN Savings �L2� � � X Checking ORPH",N5 "- - oa�eoroeamoz-u-zoi5 rr�sc B15ESLPRINCENSTE CUMBFILt �� CoUn[yCUMBERLAND CerlifiCate SHIPPENS9URG PA 17257-1921 oRasrowN BANK provided the department with the information below indicating that at the death of�he above-named decedent you were a joint owner or beneficiary of the account identified. Account No.103001868 Remit Payment and Forms to: Date Established 06-16-2000 HEGISTER OF WILLS Accoun�Balance $35733 1 COURTHOUSE SOUARE PercentTauable X50 CARLISLE PA 17013 Amount Subject to Tax $P8.67 Tax Rate X 0.150 Potential Tax Due $26.80 NOTE': If tax payments are made within three months of the decedenfs date of death,deduct a 5 percen�discount on�he�ax With 5%Dlscount(Tax x 0.95) $(see NOTE') due. Any inheritance tax due will become delinquent nine months afler�he da�e of death. PART St@P 1 : Please check the appropriate boxes below. 1 A �No tax is due. I am ihe 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 other boxes and disregaitl the amounf shown above as Potential Tax Due. y � 7he information is The above information is correct, no deductions are Ueing takeq and Gaymen[will be sent correct. wi�h my response. Pmceed fo Step 2 on reverse. Do nof check any other bozes. � �The tax rata is incorrect. � 4.5% I am a Ilneal banaficiary(perent,chlld, 9randchild, ete.)o�the deceased. (Select correct tax rate at righ[,and complete Part � �p� I am a sibling of the deceased. 3 on reverse.) � 15% All other relationships (including none). p �Changes or deduc[ions The information ahove is incorrect and/or debis 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-iden�ified asset has been or will be reported and tax paid with the PA Inheritance Tax inheri�ance�ax form ReNm filed by the eslate represen�ative. REV-1500. Proceetl fo Sfep 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART Debts and Deductions z Allowable debts and deductions must meet both of the following criteria: A. The decedent was legalty responsible for payment.and the estate.�s.insufficient to pay ihe deductible items. B. Vou paid the debls aker ihe tleath of ihe decedent and can furnish proof of payment if requested by the department. Qf addi�ional space is required, you may attach 8 1/2"x 11"sheets of paper.) Date Paid Payee Description Amount Paid Tolal Enter on Line 5 of Tax Calculation) $ PART Tax Calculation 3 Ii ou are makin a correction to ihe establishment tlate Line 1 account balance Line 2 , or y g ( ) ( ) percent taaable(Line 3), please obtain a writ�en correttion from the financial institution antl at�ach it to ihls torm. L 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 inclutling any interest accruetl at the tlate of death. 3. Enterthe percentage of ihe account[ha[is taxable to you. a. First,tletermine the percentage owned by the decedent. i. Accounis ihat are held"in tmst for"another or others were 100%owned by the decedent. ii. For join�accoun�s es�ablished mare�han one year prior to the da�e o�death,the percen[age�axable is 100%divided by the total number of owners including the decedenL (For example:2 owners=50%,3 owners=33.33%,4 owners =25%.etc.) b. Nex[,divide the decedenPs percen�age owned by the number of surviving owners or beneficiaries- 4. The amount subject b tax is tletermined by multiptying ihe account balance by the percent taxable. 5. Enter the total of any tlebis and deductions claimed from Part 2. 6. The amount taxable is determined by subtractinq the debts and deductions imm ihe amount subject to tax. 7. Enter the appmpriate tau rate from Step 1 based on your relationship to ihe decedent. u Indlcating a diflerent tax rate, piease state OffiCi31 Use ONy[]AAF :�; your relationship m the decedent pA S?f.##gv¢nUe - 1. Date Established 1 , ,�' • �� ' PAD h 2 Account Balance 2 $ � 3. PercentTaxable 3 X 2 a. Amount Subject b 7ax a S 3 . 5. Debts and Deductions 5 - q 6. Amoum Taxable 6 $ S � 7. Tax Ra�e 7 X s �:;; d. 7ax Due 8 $ $ 9. Wi�h 5% Discoun�(Tax x .95) 9 X . . . St2FI 2: Si9n and dale below. ReWm TWO completed and signed copies to Ihe Regis[er of Wills lis�ed on�he Gon[of lhis form, along with a check for any payment you are making. Checks mus�be made payable to"Register of Wills, AgenL" Do not send payment directly to Ihe Department of Revenue. Under penalty of perjury, I declare ihat Ihe facts I have reported above are true,correct and complete to the best of my knowledge and belief. � WOrk ,/��Z^��i.�'�' Home � � Taxpayer Si � ature 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 SPECIAI HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 � � � FtECORDED OFp�pE ' y m REBIST�=,9 - �,,�ILL� q N � _ �., ?OI5 P,PR 8 Fl� 12 53 9 r � CLc�;�� , :. �� ORPHA�;;� ' JURT ;,CUMDERL;:; � Cn,.,'n, �C ^ \ � �� (('' �� rn �j,` �e � ;i ) �.n � � \ � � ;n �11 � � ' /,.. l � �� V � i _ a _ � � � - � � �� 'r _ \� = r � - x _ �. _ ;� _ � . r _ � _ �° = t'l� ' _ ,��.°,t ;i�¢�,` _ ) ek E �'�F� t t2.. id