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Home My WebLink About07-09-15 commorvw��m ov veNms'ivaNu eEv-1 t 62 Ex0 Lse1 oEvnaimerv.or aEvcrv�e eoeenu oF irvoivioun�:aves �EGT 300601 HnAAiseoae,va n,xe-osm pENNSVLVANIA RECEIVED FROM: INHEAITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 020950 CORREALE SHARON J 1821 WILLOW ROAD CAMP HILL, PA 17011 ACN ASSESSMENT AMOUNT CONTROL NUMBER ---- _-- 15135260 � 597.45 ESTATE INFORMATION: ssN�. FILE NUMBER: 2115-0770 I �ECEOENr NaME: MOWERY MICHAEL A I DATEOFPAVMENT: 07/10/2015 I POSTMARK DATE: O�/1 O/ZO� 5 � CouN7n CUMBERLAND I DATEOF DEATH: 05/27/2015 I TOTAL AMOUNT PAID: 597.45 REMARKS: CHECK# 166 INITIALS: CJ sEA� RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS '�� pennsylvania euernu oF �Hmvcowi rnxes pennsylvania lnheritance Tax ��j �1� PO BO% �00601 pEPAPTMENTOF FEVENOF N>RRISBORG P1 1�129�06Y1 �nf0�ma��n ND�ICQ � ue-na n mmu �oe m And Taxpayer Response Fi�E No.zi �iS -c%"7'7u ACN 15135260 DATE 06-30-2015 Type of Accoun� EstateofMICHAELAMOWEFY Savings X Checking Date of Death OS-27-2015 Tmst SHARON J CORREALE CountyCUMBERLAND CehifiCate 1821 WILLOW RD �� CAMP HILL PA 17011-]453 p � � m�. c m p O O � 9 r � �, � � r NA � � r —� o rn m _ - m � � � - �° �� o 0 "o �t "Ti j � 3 � � ^ n _ . > W r m _ r S � � � tp rNc BANK NA 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. Hemit Payment and Forms to: AccountNo.5003300028 Date Establishetl 06-29-2009 REGISTER OF WILLS Account Balance $13,677.07 1 COURTHOUSE SOUAHE CARLISLE PA 77013 Percent Taxable X 16.667 Amount Subject to Tax $2,279.56 Tax Rale %0.045 NOTP: If�ax payments are made wi�hin�hree months of the Potential Tae Due $ 10258 decedenCs date of death, deduct a 5 percent discount on ihe tax With 5%Discount(Tax x 0.95) $(see NOTP) due. Any inheritance tax due will become delinquent nine months afler�he dale o(dea�h. PART St@P 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 disregartl the amount shown abova as Potential Tax Due. g �The inbrmation is The above information is correct, no tletluctions are being taken,and paymen[will be sent correcl. with my response. Pmceed to Step 2 on ieverse. Do nof check any ofher boxes. p �The�ax ra�e is incorrec�. � 4.5% I am a lineal beneficiary (paren�,child,grandchild, e�a)of�he deceased. (Select correct tax rate at right,and complete Part � �p� I am a sibling of ihe deceased. 3 on reverse.) � 75% All o[her relatlonships (including none). p �Changes or deductions The information above is incorrect and/or dehts and deductions were paid. listed. Complefe Part 2 and part 3 as appropnate on the back ol this lorm. E �Asset will be reported on The above-identified asset has been or will be reported and tan paid with the PA Inheritance Tax inheri�ance ta<�orm Fetum filed by the estate representative. REV-1500. Prxeed to Step 2 on reverse. Oo not check any othei boxes. � �i Please sign and date the back of the form when finished. PART 2 Debts and Deductions Allowable debts and deductions musl meet bo�h of the�ollowing criteria: A. The deceden�was legally responsible�or payment,and the esta�e is insufficien�to pay Ihe deductible items. B. Vou paid the debts aker the death of ihe decedent and can furnish pmof of payment if requested 6y the department. (If additional space is required, you may attach 8 1/Y x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If you are making a correction to the establishment tlate Line 1 accouM balance Line 2 ,or ( ) ( ) percent taxable(Line 3), pleau oDtain a written correction irom Ihe tinaneial instltWion antl attach i�to ihis torm. L Enter ihe date the account was establishetl or titled as it existed at ihe da[e 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 tha[is[axable[o you. a. First,determine the percentage owned by the decedent. i. Accoun�s�ha�are held"in�mst tor"ano�her or others were 100%owned by�he deceden[. ii. For joint accounis established more than one year prior to ihe date of death,the percentage tauable is 100%divitled by the total number of owners including the decedent (For example:2 owners=50%, 3 owners=33.33%,4 owners =25%,eta) b. Next, divide the decedenPs percentage ownetl by ihe number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by mWtiplying the account balance by ihe percent[axable. 5. Enter Ihe total of any tlebts and deductions claimed Gom Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from ihe amount subject to tax. 7. Enter the appropria�e tax rate irom S[ep 1 basetl on your relationship to the decedent. If indicating a dfferent tax rate,please state �,��Y� :" �i your relationshlp m me decedent ' • • '� ��. � �. 1. Date Established 1 '`' + � �"' Gr: ��.��4 44 4��t;�_� 2. Account Balance 2 $ PAD �. ; t .� �� , , "�. 3. Percen�Taxable 3 X � , h� r ,�.��" `�— � 4. Amount Subject ro Tax 4 $ � --n �-,-,��,,,�Y�� 5. Deb�s and Deductions 5 - 4 , �,} ;a ' s 6. AmountTaxable 6 $ 5 �� 7. Tax Ra[e 7 X 6_� �6me5 xs�%�."',e'w,� .fi 8. Tax Due 8 $ � � �� 8 *A d}t'3 h k "f"'Y�. ^YY 9. With 5%Discount(Tax x .95) 9 % �` �� „,�� ...t�..y�... _ . ._. ....._,«�vr�.s.,,..u...«�....: .St2p 2: Sign and date below. Retum TNO completed and signed copies to the Register of Wllls listed on the front of this form, along with a check tor any payment you are making. Checks must be made payable to"Register of Wilis,AgenL" Do not send payment directly to the Department of Revenue. ,_�� Under penalty of perjury, I declare[hat the facts I have reported above are true,correct and complete to the best of my knowledge and belief. ' / Work Home � ! /� 7 � �..5 Taxpayer Signa re 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_ _ , ! ➢ Z � �i) f_5 L) A (fl ('..1 {ft - tl) � r- -� a = C „ �i � � v, � W D r � - - ^ >� Y� _ [� - ^1 � -- v`1 ;L. _ �d " v� ariVi2138W�� „- = iano� ,s��vHdao � � ,�,� � _ dOl'?J31� sh � Wd 6 li1P SIOi �� SIIIM, j0 2J;1S193y � � ' d �o aai��o aaoaoo3a �� e .