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Home My WebLink About06-19-15 (2) REV-1 t B2 EXP 1-55� W MN�ONW EPLTH OF 4ENNSVLVANiP OECPPTMENi OF PWENVE 9VRFAU OF INDIVI�UP�fAXE6 phP'.200601 pENNSYLVANIA HAFN59VFG.�P V120-0fi01 INHERITANCE AND ESTATE TAX NO. CD 020861 RECENED FROM: OFFICIAL RECEIPT SHUGHART MARK E 55 KELLY ROAD SHIPPENSBURG, P/> »z5� ACN AMOUNT ASSESSMENT CONTROL NUMBER __. -.. ,°'° � 15127986 � 588.68 � SSN: 162�48-]4]� ESTATEINFORMATION: I FILE NUMBEP: 21141004 I oeceoeN7 NaMe: SHUGHART CHERYL LYNN I DATEOFPAYMENT: OB�1J/?O1S I POSTMARK DATE: 06/17I2015 I couN7v: CUMBERLAND I DATE OF DEATH: 08/22/2014 I TOTAL AMOUNT PAID: 588.68 REMARKS: CHECK# 118 INITIALS: �� RECEIVED BY: LISA M. GRAYSON, ESn. sE"� REGISTER OF WILLS TA%PAVER - ;` pennsylvania a�xrnu oF iNo�viow� rnxE� P2f1f15Y�V3f112 �f1hEflt2flGB TdX I � o[Pnarncrvi oF aEVErvuE Po eo. �aosa� Information Notice .,.,,�, �o.=�,��.��. "pRRjS°°""" „'�a-0601 AndTaxpayerResponse Fi�ENo.2i�4-�ooa RE ,. _�.� �� . .. - �. ncNisi2�ses _ , .. i ,. DATE C5-222015 ��5 ��I `u �Q �� 1 ��3 Type of Pccount Savings �,�.. Esiate of CHERVL L SHUGHART Checkmg - ,. S.SN 162-48-7477 Tmst � � '�i� - ',Dale 2z-z014 Certificate �� Cpun� CUMBERLAND MARK E SHUGHAHT CU!•�.:'-' �.. .. � Y 55 KELLV RO SHIPPENSBURG PA 17257-9622 pCNe eANK 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. Remit Paymenl and Forms to: Account No.9B2&tiz8 pEGISTER OF WILLS Date Establishetl 11-21-1996 1 COURTHOUSE SOUARE Account Balance $3,94130 CARLISLE PA 17U73 PercenlTaxable X 50 Amount Subjecl lo Ta�c $ 1,970.65 Tax Fale %0.150 NOTP: If tax paymen�s are made within three months of lhe Polential Tax Due $295.fi0 decedenPs dale of death,deduc�a 5 percenl discount on lhe tax Wi�h 5%Discount(Tax x 0.95) $( e NOTE'1 due. Any inheritance lax due will bewme delinquent nine months atter the date of death. PART SteP 1 : Please check the appropriate boxes below. 1 n ❑No tax is due. I am the spouse of the deceased or I am fhe parent of a decedent w o was I21 years old or younger at date oi death. Pioceed to Sfep 2 on 2verse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. g �Theinformalionis The above informalion is correc�,no deductions a:e being taken, and payment will be senl correct. with my response. Proceed to Step z on reveise. Do not check any other boxes. � FTIThetax rate is incorreci. � q.5% I am a lineal beneficiary (parent,cM1ild,grandchild etu)of the deceased. ��` (Selectcorrecttax mte at right,and complete Part � 12% I am a sibling oi�he deceased. 3 on reverse.) � �5/ All other relationships (including none). p ❑Changes or deductions The inbComplete Part 2 and p h 3 e sapproprate onthe b ck o(this Porl m. lis�ed. E ❑qssel will be reported on The ahove-identified asse�has been or will be reported and tax paid with the PA Inheritance Tax inheritance tax�orm Remm filed by Ihe eslate represenlaSive. REV-1500. Proceed to Step Z on reverse. Do nol check any other boxes. Please sign and date the back of the form when finished. PART z Debts and Deductions Allowable debts antl deductions musf ineet both oi the following criteria: A. The decedent was legalty responsible for payment, antl the estate is insufficient to pay the deductible items. B. You paid fhe dehis after ihe death of the tlecedent and can furnish proof o�payment if requested by the tlepatlment. Q/addi�ional space is required, you may atlach 8 1/2"x 11^sheets of paper.) Date Paid Payee Description Amount Paid Total (Enter on Line 5 of Tax Calculation) $ PART a Tax Calculation If you are making a correction to the establishment date(Line 1)account balance(Line 2),or p¢rcent taxable(Line 3), please obtain a written corre<�fon from�he financiai institution and atlach it to this form. 7. Enter the date ihe account was established or titletl as it existed at ihe tlate of tleath. 2 Enterthe total balance of ihe account inclutling any interest accrued at ihe date of death. 3. Enter the percentage of the accoun[tha� is�axable�o you. a First,determine the percentaqe owned by the decedent. i. Accounts tha�are held "in tms�for"anothei or others were 100%owned by�he tlecedent. ii. For joint accounts established more than one year prior to the tlate of death,the percentage t�able is 100%tlividetl 6y�he to�al number o(owners includinq�he tlecedenL (For example:2 owners=50%,3 owners=33.33%, 4 owners = 25/,etc.) b. Nex�, divide the decedenPs percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determinetl by mWtiprying ihe account balance by the percent taxable. 5. Enter the rotal of any debts and detluctions claimed from Parl 2. 6. The amount taxable is determined by subiracting ihe tlebts and deductions from the amount subject to tax. 7. Enter[he appmpriate tax rate from Step 1 based on your relationship to Ihe tlecedent. If indiwting a tliRerent tax rate,please s�ate your relationship to ihe decedent `�R� �. � �� Q�j(�(�� y� : �,: 1. Date Established 7 �� - �� —� ^� � 'Iiep � ��?� �- Account8elance 2 $ 3q '1� '3(+� {s��'��*��"��p f�fi+r jt�q tt��C;,�.�� 3. PercentTaxeble f << � - X � o/ � t 'tr�' d. . t� � 54... . -+ y.� g ,;. . .: , F��a 4. Amount Subject to Tax 4 $ ( Q� ](� 6 2� '�" �.x ,Y' � "�. � 3 �� i �, � - � � . �rW., 5. Debta and Deductions 5 - � ;s� _ �' �, �f�." � �� 6. Amount Taxable 6 $ � (.� 'ZCj. }'+ " �: .*�iK' ,.�"V,-.. ,� 5t �',.. ' � i�-u =� . 7. Tax Ra�e 7 X `l. Tj 4b 6 ��-� � *' �:., a" '3s��, � :�' za::u; ",.: 8. Tax Due g $ g � 7 „ w ��.G' �..z, � � 9. w�m s i oiscoum �Tax x.sa) s x $ � �' �",�� , �. �, ,,, ._ . ,. . .. n.. . .� ,�s ,. Ste(� 2; Sign and date below. ReNm TVJp completed and signed copies to the Register of Wills listed on Ihe front of ihis form,w along with a check/or any payment you are making. Checks must be made payable to Register of W lls,AgenL" Do not sentl payment directly to the Department o�Revenue. Under penalry of perjury, I dedare ihat ihe facis I have reported above are hue,correct antl complete to the best of my knowledge and belief. y�� Work — /` A 1' �� Home 77G 78va �i.ne 6 ,?c+/S Taxpayer Signatur Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-7g7-g3p7. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-g00-447-3020