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Home My WebLink About06-09-15 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUFEAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 020801 BONEMA ANNE L 3603 WANSFORD RD MECHANICSBURG, PA 17050 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold 14168445 � 5258.29 ESTATE INFORMATION: sSN: I FILE NUMBER: 211 5-0644 I DECEDENT NAME: BONEMA MARK I DATE OF PAYMENT: 06/09/2015 � POSTMARK DATE: 06/06/201 5 � COUNTY: CUMBERLAND � DATE OF DEATH: 09/22/2014 I � TOTAL AMOUNT PAID: 5258.29 REMARKS: CHECK# 4973 INITIALS: HMW SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. ' REGISTER OF WILLS REGISTER OF WILLS � BUREAU oF INDIVIDUAL TAXES Pennsy�vania lnheritance Tax �y?� � � �� pennsylvania PO BOX 280601 DEPARTMENT OF REVENUE HARRISBURG PA 17128-0601 Information Notice ��'�, And Taxpayer Response REV-1543 Ex oo�ExE< <oe-�2� FILE NO.21 ,—��_Q��,f� ACN 14168445 � DATE 12-25-2014 Type of Account Estate of MARK BONEMA Savings Checking Date of Death 09-22-2014 Trust ANNE L BONEMA County CUMBERLAND Certificate 3603 WANSFORD RD MECHANICSBURG PA 17050-9128 � Y ; " c� �' � METRO BANK provided the department with the information below indicating that af�3h�,death`tSPth�� above-named decedent you were a joint owner or beneficiary of the account iden�i�i �- :� � � ..:_ ,,.-, .,:_ ; , .�. Remit Payment and Forms to: � ^ ' Account No. 10777720 c� ' � 7 Date Established 04-10-2009 REGISTER OF WILLS Account Balance $ 11,479.75 1 COURTHOUSE SGIUARE "c� Percent Taxable X 50 CARLISLE PA 17013 -� r _�i Amount Subject to Tax $5,739.88 �`� t� Tax Rate X 0.150 Potential Tax Due $860.98 NOTE*: If tax payments are made within thre�onths o`fithe 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 �hos�n. abo�e as?o!en!ial 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 ofher 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 �t�' 'ght, 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. PART 2 Debts and Deductions Allowable debts and deductions must meet both of the foliowing 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 Total (Enter on Line 5 of Tax Calculation) $ PART Tax Calculation 3 If ou are makin a correction to the establishment date(Line 1 account balance Line 2 , or Y 9 ) ( ) percent taxable(Line 3), 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%, 4 owners =25%, etc.) b. Next, divide the decedent's 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,�.�tate � �� `� o� ��; �� \�� \\�\��\��\�p�\ � your relationship to the decedent: -10�e+'�1� �,,C] ��\�� \ � ` � �� \��\��\\�\�� \\��\\\��\�\��\\��\�\\\��\��\�� \��\��\�� 1. Date Established 1 W"��"2w � � �� + �7 ��y��\�� \�� \ S\�a�� 2. Account Balance 2 $ �1� �� { ��\\�\�� o�� `�\\��\ ��\��\\ � �\ � V� � � ��t V� �� AV \\ �� A\ �y\��A��V��4�� A A�� A �� 0� � �/ � � �� V�0�� V�� '. � V � � \\�\a��\\��VA��A� 3. Percent Taxable 3 ��D` � ��, � X ll�� y„� ��A��V\��V�V`\\VA��V�� h��VA ��` ��C��V� ��\V�\\o� �^',. �i�A �A�� A�� A�\V� ��\��V��\�\�\�� A 4. AIT10Uftt SUbf@Ct 10 T3X 4 $ �, 7 ��.�� `�� `� �`\�`\��V`�V��A��A`o��\�o � � VA� � ��. A � \V�� .: �A�� A��V��V��\��V��\ 5. Debts and Deductions 5 - � � � � � �� A��A V�A�A�V�V ��A\V �V��\A��VA A�V �� V�� \��\�A\� A�V�� \\�� \�� 6. AmountTaxable 6 _$ �'J�� ?Ja' �\�� ` ��\��\�;�\�� \�\�\ ��s��r�`��: 7. T3X �8T8 j %� �L'� �� A��y��A��`\V��\� ��V��O�� @ •�j � �A � � � � �� V� � -�� A�� 8 W '� 7�} �7 p : �� A� �� \�A� ��A��A ��, � ��Y� �� $. T8X �Ue . 4.-1. �� AV�\o�\V��V��\V��\\\ �'�� X � � ��A �� `�� V�V��V�\��\ 9. With 5% Discount (Tax x .95) 9 �.�.:.:� .....::�� .,..��:� ,.��..�:.��;��,��?��,�� a,....�� ..�.�� Step 2: Sign and date below. Returr�T�WQ,�pmpleted and signed copies Io the Register of �Ias li�Xed on the front of this form, along with a check for any payment you are making. Chtl�ks'must be"macle payable to"Register��Vit1s;Agenit." 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 � 7�7 �a�" ,�� i�,ti�Ll�L2�� Home � `��'T" '��,�' 7�00 � 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 ,a� �� ^��.^�r. _ ..... war,e.t��,�,z�;c �,s. x, 1.1113.911111I�I�IJ I f~ � f'� � f"�"� s�i" .. �i�� . . . � ^,� t�,t' � p �a r,�.�,f� . •C"a S�o :��',�: _ �A � � !��5 �� (� ��T � ii� do ti,c�o ,, , ,_ �A,� = __ w,,,, Aid t0 �:'t . '. � �,, � a a �(1�'4 ��. ;� ,..�. ' , ....4 , f��1 f{i �:! ^ ""7�� i P � �. � v �;,� '^\� 3it � � /f /�i .k � O � , � � � V � � ___ �� i; , � O/� � ,�`` (�� 1 `M , r� j'(� r� '� % .» O �lJ � { � C r � V" �' "Y. � � ,w�. � 4C %�� 8 �'s�i,�E y#�,��.�'I,'�4j�L 5 � �� ,� .c'.tl ....».. t � � :� � . i � }` 9.ass 4 ,w �. f C { s, ._ � � i : �. "a . ..��I�I��IIII'I�,I�