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Home My WebLink About06-11-15 COMMOrvwEALiH Oi PErvrvSVLVANIA REV-11fi2 EXI11-96) �EPAWMENT OF PEVENUE BUPEPO OF INOi VIDVAL TA%ES �EPL.180601 Hnnmsaunc,aA�nxaoso� pENNSVLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL FECEIPT NO. CD 020816 CONNOLLY MEGAN LYNN 817 FLINTLOCK RIDGE ROAD MECHANICSBURG, PA 17055 ACN ASSESSMENT AMOUNT CONTROL NUMBER ----- ---- 15112284 � 545.89 ESTATEINFORMATION: SSN: FILE NUMBER: 2115-0652 I oECEDENi NnnnE: HERMAN HELEN I DATEOFPAYMENT: O6/11/2015 I POSTMARK DATE: O6/11/2015 I courvrv: CUMBERLAND I DATEOFDEATH: O1 /20/2015 I TOTAL AMOUNT PAID: 545.89 REMARKS: CHECK# 1019 INITIALS: CJ sEA� RECENED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS FEGISTER OF WILLS {a'�� a�R�•� °' '�°,°'°""� *"'E� Pennsylvania lnheritance Tax ``� ��' PennSy�Val118 r�o eox zaoco� ��Si' OEPAPTMENT OF PEVENIIE RRISBVRG PA ll120�0601 Information Notice And Taxpayer Response Fi�E NO.zi �',C��,��•.��, REC .n�,,._....'. ' ��- �.,,._ OF li f ACN 15112284 R' DATE 03-10-2015 �„J JJIV j1 �I '� 1 � C� TypeofAccount �I_ � EstateofHELENHEFMAN Savings 0�' ., _ Checking 'ii I Date of Dea�h 01-20-2015 X Tms� MEGAN CONNOLLV CUF� : . �� GAuntyCUMBERLAND Certi�ica�e Bll FLINTLOCK BIDGE R� �' � � MECHANICSBORG PA 1]055-4919 SANTANDER BANK provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or beneticiary ot[he account identified. Remit Payment antl Forms to: Account No.8102061634 Date ESWblishetl 03-27-2009 REGISTER OF WILLS Account Balance $1,019.82 1 COURTHOUSE SQUARE PerceniTaxable X50 CARLISLE PA 170t3 Amount Subject b Tax $509.91 Tax Rate X 0.1 W NOTE': If tax payments are made within three months of ihe Potential Tax Due $76.49 decedenCs date of death, deduct a 5 percen�discount on ihe tav With 5/Discount (Tax x 0.95) $(see NO7E') due. Any inheritance tax due will become delinquent nine months after the date of tleath. 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 ro Sfep 2 on reverse. Do not check any ofher 6ozes and disregard the amount shown above as Potenfial Tax Due. g uThe information is The above information is correcl, no deductions are being�aken,and payment will be sen� correct. with my response. Proceed to Sfep 2 on�everse. Do nof check any ofher boxes. l"(�The tax rate is incorrecL ��4.5% I am a lineal beneficiary(parent,child, grandchild,etc.)of the deceased. �(Select correct�ax ra�e a� 1 right, and comple�e 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 above is incorrect and/or debts and deduaions were paid. listed. Complete Part 2 and part 3 as appmpriate on the back ol this lorm. E �Asse�will be repotled on The ahove-identified asse�has been or will be reported and�ax paid wi�h Ihe PA Inheritance Tax inheritance tax form Retum filed by Ihe estate representa[ive. REV4 500. Proceetl ro Step 2 on reverse. Do not check any other bozes. Please sign and da[e the back of the form when finished. PART Debts and Deductions 2 Allowable debts and deduc[ions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient�o pay the deductible items. B. You paid the debis after the death of the decedent and can furnish proof of paymwt if requested by the department. Qf additional space is required, you may attach B V2"x 11"sheets of paper.) Da�e Paid Payee Description Amoun� Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 It ou are makin a correction to the establishmen�tlate Line 1 accouM balance Line 2 , or y g ( ) ( ) percent taxabie(Line 3), please oblain a wntten torrecfion irom lhe financiai institution antl atlach it to Inis form. L Enter ihe date the account was established or titletl as it existed at the date of death. 2. En�er�he total balance of the accoun�including any interes�accmed at�he date of death. 3. Emer ihe percencage oRhe account�hat is[axable to you. a First,determine ihe percentage ownetl by the decedent. i. Accoun(s Ihat are held"in imst for"another or others were 10o%owned by ihe tlecedent. ii. For join[accounts established more than one year prior to lhe tlate of tleath, (he percentage tavable is 100%dividetl by�he total number of owners including the decedenL (For example:2 owners= 50%, 3 owners=33.33%,4 owners = 25%, etc.) b. Next,divitle ihe decedenYs percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tan is determined by multiplying the account balance by ihe percent taxa6le. 5. Enter the to�al of any debts and deduc�ions claimed from Pah 2. 6. The amoun�taxa6le is determined hy subtrac�ing�he deb�s antl tletluctions from the amount subject to tax. 7. Enter the appropriate lax rate tmm Step 1 based on your relationship to the decedent. If indicaNng a diflerent tax rate,please state �(('jpyj[J�y{��y�qqF your rela�ionship to the deceden�: l�J(x 1�r1/l'1 l r� . ' PA �e�BnVe �. 1. Da�e Establishetl 1 `>I2'r � 200� ��;. 2. Account Balance 2 $ I C�I�G..P 2 PA�� 3. Percent Taxable 3 X i P (` � 2 4. Amount Subject to Tax 4 $ �L �� . �1 2 3 5. �ebts and Deductions 5 - Q 6. AmounlTaxable 6 $ $- 7. Taxaate 7 X •C�'� 6 � ._____ _ ____ __ 7 � �_ . a. 7ax Due 8 $ � 5. �C� a ..... � 9. Wi�h 5% Discount(Tax x .95) 9 X . . St2P 2: Si9n and date below. Retum TWO wmpleled and signed copies to ihe Regis�er of Wills listed on ihe front of this form, along with a check for any payment you are making. Checks must be made payable to"Register of Wills, A9ent" Do not send payment directly to Ihe Department of Revenue. Under penalty of perjury. I declare that ihe facis I have reported above are tme,correc�and complete to the best o(my knowledge and belief. � / Work ��i L "�,�� =�(� U � � � Home TaxpayerSi ature � v TelephoneNumber ��7)Sii -�`IiHlDate (yI.S � S 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: t-800-447-3020 RECCRC;^ F=',�° OF REG!cT.. . - - " LS ?,715 JUN 11 Fil 1 22 c�',-': . �� ORP;I,;'i",' COU;r CUMO[P.'...r -. . � .. , ,, n � C ` � � r � � . 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