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HomeMy WebLinkAbout07-08-15 pennsylvania 1505614105 °Fy""`"—Mwlmffi EX(03-14)(FI) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File ..N.Y.m.be.r .............. INHERITANCE TAX RETURN PO BOX 280601 211 113 0549 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 'ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY .......... ..................................................... ............... ....... .................................................................................................... 04082013 107031955 ...................... ............. ............ ..................... ........................... .......... ........... ................ ................................ Decedent's Last NameSuffix Decedents First Name MI ............ SCHWARTZ COLLEEN (if Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI .......... .................. .................._.............................................. ....................................._.I :PAUL M SCHWARTZ ................ --- THIS ........ .................................................... .............. .................... ........... ...... .............. ......................................................... THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW OD 1.Original Return C=) 2.Supplemental Return CM 3. Remainder Return(date of death prior to 12-13-82) C=) 4.Agriculture Exemption(date of 5.Future Interest Compromise(date of C=D 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) O 7.Decedent Died Testate C=) 8. Decedent Maintained a Living Trust 9. Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) O 10. Litigation Proceeds Received C=D 11.Non-Probate Transferee Return C=D 12. Deferral/Electlan of Spousal Trusts, (Schedule F and G Assets Only) C=D 13. Business Assets C=D 14.Spouse Is Sole Beneficiary (No trust involved) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO! Name Daytime Telephone Number !PAUL M. SCHWARTZ 1(717)763-8178 ........................ First Line of Address 1207 CHEROKEE DRIVE Second Line of Address ................................................................... i__.._..,..._........._......_._............... ...................... .................................................. ........ ...........i City or Post Office State ZIP Code ............................................ MECHANICSBURG PA 17050 Correspondent's email address: REGISTER OF WILLS USE ONLY REGISTER OF WILLS USE ONLY C=> ryl C-- C-- F11 rlJ CID DATE FILED RPM c> -n PLEASE USE ORIGINAL FORM ONLY ry r- rn Side I C>-n CID 1505614105 j 1505614205 REV-1500 EX(FI) RECAPITULATION 1. Real Estate(Schedule A). ............................................ 1. 0.00 r 2. Stocks and Bonds(Schedule B) ....................................... 2. 0.00 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. 1 0.00 4. Mortgages and Notes Receivable(Schedule D)........................... 4. 0.00 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 0.00 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 0.00 7. Inter-Vilvos Transfers&Miscellaneous Non-Probate Property R (Schedule G) O Separate Billing Requested........ 7. 0.00 8. Total Gross Assets(total Lines 1 through 7)............................. 8. '', 0.00 9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 0.00 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. 0.00 11. Total Deductions(total Lines 9 and 10)................................. 11. 0.00 12. Net Value of Estate(Line 8 minus Line 11).............................. 12. 0.00 13. Charitable and Governmental Bequests/Sec.9113 Trusts for which - an election to tax has not been made(Schedule J) ........................ 13. 0.00 14. Net Value Subject to Tax(Line 12 minus Line 13) ........................ 14. 0.00 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.0- 15. 16. Amount of Line 14 taxable at lineal rate X.0- l 16. 17. Amount of Line 14 taxable; at sibling rate X.12 17. 18. Amount of Line 14 taxable at collateral rate X.15 19. TAX DUE......................................................... 19.1 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Under penalties of perjury,I declare I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Deol lion f preparer other,than the person responsible for filing the return is based on all information of which preparer has any kno ge. SIG E OF RESP IB E FOR FILING TURN DATE A RESS 207 CHEROKEE DRIVE, MECHANI URG, PA 17050 SIGNATURE OF PREPARER OTHER THAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE ADDRESS I 11111111111111111 q1Q1Q11q1t1g11l1lJ111111111 Jill Side 2 1505614205 REV-1500 EX (FI) Page 3 Fife Number Decedent's Complete Address: DECEDENTS NAME COLLEEN M. SCHWARTZ STREETADDRESS 207 CHEROKEE DRIVE CITY STATE ZIP MECHANICSBURG PA 17050 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 0.00 2. Credits/Payments A.Prior Payments B.Discount (See instrucctions) Total Credits(A+B) (2) 3. Interest (3) 4. If line 2 is greater than Line 1+Line 3,enter the difference. This Is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00 Make check payable to: REGISTER OF WILLS,AGENT. -�.......mw....a.., -.� -..- +za.:.N:slr. �: ..�. ;..r...: aaT'_�': ..dd..,:Arw.m.�.._-.ter.:�...�'.:..�d.."SS:�uw. '�.'u ,,.�: 2-151::-�..s PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN"X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred.......................................................................................... ❑ b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ c. retain a reversionary interest.............................................................................................................................. ❑ d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ 0 2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration?..................................................................................:........................... ❑ 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? ....................................................................................................................... ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, s..�a:r£�,.� 7:�..�'�3n:��=".�. :, x.� 5;. �.�..=7� .� .:, �..� y.,a.�'_ `�•" ;.:s - .:;s�i'��_s�s...,a�:�_..,�.5s.:�4�?.�}«u�.::�--_+G..w_t:.:'f.�$:a3 For dates of death on or after July 1,1994,and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent p2 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate Imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent or a step-parent of the child is 0 percent(72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)). • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1513 EX+(02-15) iffpennsyLvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: COLLEEN M. SCHWARTZ 21-13-0549 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1.2).) 1. PAUL M.SCHWARTZ SPOUSE 100% 207 CHEROKEE DRIVE MECHANICSBURG,PA 17050 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART 11—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ If more space is needed,use additional sheets of paper of the same size. pennsylvania i BUREAU OF COUECTIONS& DEPARTMENT OF REVENUE TAXPAYER SERVICES " PO BOX 2810.11 HARRISBURG PA 171..8.101 NOTICE OF OVERDUE INHERITANCE TAX RETURN REV-834 FO APPcoe.u� Date: 03/10/2015 Estate of.- COLLEEN f:COLLEEN M SCHWARTZ HERSHEY IRMA H SSN: 209-46-0087 207 CHEROKEE DR DateofDeath: 04-08-2013 MECHANICSBURG PA 17050-25.04 File Number: 2113-0549 ........... _._.._.... Department records indicate you are responsible for the settlement of the estate identified above or that you represent the responsible party. The estate is in delinquent status as the inheritance tax return became delinquent within nine months of the decedent's death,but has yet to be filed. Please file the tax return and remit payment of any tax due within 15 days of the date of this notice with the Register of Wills identified below. If this estate was opened for the purpose of filing a lawsuit,please provide the court term and docket number of the proceeding.in writing to this office. We encourage you to take this opportunity to address your tax delinquency. If you fail to do so, your account may be referred to a collection agency and additional fees up to 39 percent of the amount due j will be added to the liability. i If the requested return was filed recently,please-disregard this notice. Direct any questions.regarding this notice to: Harrisburg Call Center RETURNS SHOULD BE FILED 717-783-3000 AND PAYMENTS MADE AT 1-800-447-3020(Services for taxpayers THE REGISTER OF WILLS with special hearing and/or speaking needs) LISTED BELOW: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 . . .... _.._ ...._. -. BUREAU OF INDIVIDUAL TAXES Pennsylvania Inheritance Tax pennsylvania PO BOX 280601 "ARRISDURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE And Taxpayer Response en-FILE N0.2#70 Z1- 70¢c oeeEtEc M-121iz> ��J ACN 13124001 DATE 05-08-2013 Type of Account Estate of COLLEEN M SCHWARTZ - Savings SSN— ri.: Checking Date of Death 04-08-2013 A �''• rthgt IRMA H HERSHEY County CUMBERLAND d `"' ificate 207 CHEROKEE DR W Q MECHANICSBURG PA 17050-2504 rri c'1 -c cn -V r— i r � CO ;V L� pic O Q C7 C-1 O ,n C7 C n F-z rn PNC 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 be ficiaryof the account identified. Account No.5020008660 Remit payment and Forms to: Date Established 04-03-1989 REGISTER OF WILLS Account Balance $14,450.00 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $7,225.00 Tax Rate X 0.045 Potential Tax Due $325.i3 NOTE': It tax payments are made within three months of the decedents date of death,deduct a 5 percent discount on the tax With 510%Discount(tax x 0.95) $(see NOTE`)_ '#;2!a ' due. Any inheritance tax due will became delinquent nine months after the date of death. PART Step 1: please check the appropriate boxes below. 7 ' A �]No tax is due. l am the spouse of the deceased or I am the parent of a decedent who was 21 years ofd or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. BThe 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 other boxes. C E]The tax rate is incorrect. 4.5% 1 am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased. (Select correct tax rate at right,and complete Part F� 120% I am a sibling of the deceased. 3 on reverse.) u 15% All other relationships(Including none). D Changes or deductions The information above is incorrect and/or debts and deductions were paid. listed. Complete Part 2 and pari 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 Debts and Deductions 2 j Allowable debts and deductions must meet both of the following 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 81/2"x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If you are making a correction to the establishment date(Line 1)account balance(Line 2),or 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 fitted 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. J. Accounts that are held"intrust 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 =250/6,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 state Official Uie Only [3 AAF your relationship to the decedent: PA Department of Revenue 1. Date Established 1 2. Account Balance 2 $ PAD 3. Percent Taxable 3 X 1 4. Amount Subject to Tax 4 $ 2 3 S. Debts and Deductions 5 - 4 6. Amount Taxable 6 $ 5 --d 7. lax Rate 7 X 6� 8. Tax Due 8 $ 8 9. With 5%Discount(Tax x.95) 9 X Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to"Register of Wills,Agent.' Do not send payment directly to the Department of Revenue. Under penalty of pe jury,I declare that the facts I have reported above are true,correct and complete to the best of my knowledge and belief. z � Work Jam. d,f,�. Home 7/7`745-W7 Taxpayer Signature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA 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 pennsylvania BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX DEPARTMENT OFREVENUE INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE 2 PO Bax 260601 OF DEDUCTIONS. AND ASSESSMENT OF TAX ON NEW-1548 Ex AFP (12-12) HARRISBURG PA 1712E-1601 R E C 0 R ff Ttvt4 to UIFUST ASSETS R L U��.il l �'�' (j RF GF IATE 07-01-2013 STATE OF SCHWARTZ COLLEEN M DATE OF DEATH 04-08-2013 PM 11113 jut. 1 f M 1E NUMBER 21 13-0549 LINTY CUMBERLAND CLERK C rSSN/DC IRMA H HERSHEY ACN 13124001 207 CHEROKEE DR ORPHANS' COURT APPEAL BY DATE:08-30-2013 MECHANICSBURG PA 1705MUNOINLAND CO., P� OL-ermrseMemnderObjn*ons) mount Rsaltted F MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS-------------------------------------------------------------------- 4" REV-1548 EX AFP C12-12) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS. AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 07-01-2013 ESTATE OF:SCHWARTZ COLLEEN M DATE OF DEATH:04-08-2013 COUNTY:CUMBERLAND FILE NO. : 21 13-0549 S-S/D.C. NO. : 209-46-0087 ACN: 13124001 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK NA ACCOUNT NO.: 5020008660 TYPE OF ACCOUNT: O)SAVINGS C ) CHECKING C )TRUST C )TIME CERTIFICATE DATE ESTABLISHED 04-03-1989 Account Balance 14,40.00 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 7,225.00 UPPER PORTION OF THIS NOTICE Debts and Deductions - •00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 7.225.00 REGISTER OF WILLS AT THE Tax Rate x .045 ABOVE ADDRESS. MAKE CHECK Tax Due 325.13 OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (t) DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID 05-11-2013 CDC17597 16.26 308.87 TOTAL TAX PAYMENT 325.13 BALANCE OF TAX DUE .00 INTEREST AND PER. .00 TOTAL DUE .00 r IF PAID AFTER TRIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. r \ IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. v A f ~t O M p � .yyy +•. Q O �,d, �'O I► ddd • �' L L by� � y +M by • V y w O Q F '�•Ci'^r O ff• L+i hti M p ~ w C Op C �4 8 pw `F �A F y y • F q n'I dy, b *p � Y k • w d d w 7Y w t�Nrf $I yl ae O��p 1p 1'h' q "'i t ^+ yF y" •. yL" FrNM 4yw C n fi � ,y yY 0 Y N pIII-yF O C • j ��1Frr~ •• r ~A iII LL�� C Y +�• 'p.S _ M F v 'moi O .R'� Cn• �FM'aC � • • Rnp c �w ~ G ,w .G b L►wi t N w A� rri�•Lpai q^ t wL N f 1 A • �K N F y •« • 1 4 • "wY r r"n+'r R yj" pig 'SOA' a rf4 l,3�f i�iNo""� t ay„t P, •« p 0� oa,w •^+pi sr i�o a • • O '" G t P L •p Iy Ai F' Ac 4xl' • w r �• p A ~ " S b�` "'� 'jf�F~•� �V a4�j •o� a N�R �t .vp.�ii �C + rj N a pF' �� w7.wr w $ R� Z�w� yT� `r F�•Nw v. S p� • r „C F p ��•� 4'r ilc�! K!! 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'S • a r ry F O j M J� .7(fy� • v !r y p F q Fw •C G w Q C^ • O y 1 M o b" Y ~ t y b y 4 F k A t K Y n of ; r y b : ? o r p • �j C r M y, C C K£Oat 4u �f p F y ` 4 4 p : Y�y w �+O,pG,^y •a . w y '^� C p y..a a W CyS� '�"+.l F �M M p • +'M ]t F,FL+,t a n a t , p j�� «f ft �6� � � tr f i �. � �/ � KACO �� �6 �� •«� f Ow.yM ff � ��y 4S. p � '+y'� ii, �O F • M r t �y II rp s tp • • 77 W C�� .'�', � 4 p y ~ Q�t ,11� �G 4 pj^ O C 47 o y • 4G (u Sy o 4 N OF PEMSYLVANIA REV-1162 EX0 1-961 JF WE 01VIDUALTAXES i.PA 1712"601 PENNSYLVANIA ROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 017597 ERSHEY IRMA H .107 CHEROKEE DR vlECHANICSBURG, PA 17050 ACN ASSESSMENT AMOUNT CONTROL NUMBER 13124001 $308.87 ESTATE INFORMATION: SSN: FILE NUMBER: 2113-0549 DECEDENT NAME: SCHWARTZ COLLEEN M DATE OF PAYMENT: 05/13/2013 POSTMARK DATE: 05/11/2013 COUNTY: CUMBERLAND DATE OF DEATH: 04/08/2013 TOTAL AMOUNT PAID: $308.87 REMARKS: CHECK#6752 INITIALS: DMB SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES Pennsylvania Inheritance Tax pennsylvania PO SOX 280601 DEPARTMENT OF REVENUE HARRISBURG PA 17128-0601 Information Notice -- - it" -Iw a 8.ctac gas-it)And Taxpayer Response FILE Nore4-m Zt-(� -6q q ACN 13124000 DATE 05-08-2013 Type of Account Estate of COLLEEN M SCHWARTZ Savings SSN Checking Date of Death 04-08-2013 Trust IRMA H HERSHEY County CUMBERLAND *r: Certificate 207 CHEROKEE DR o MECHANICSBURG PA 17050-2504 C w TTI rri rn r-- I— m in n z rn c.o ;:u to v C7 :3 f � r• M - -- - - - — - � -� - �.... _� _.�.. _� ...r--. � •- ..- -Z PNC 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. Account No.5005288165 Remit Payment and Fomes to: Date Established 05-01-1971 REGISTER OF WILLS Account Balance $36,995.00 1 COURTHOUSE SQUARE Percent Taxable X50 CARLISLE PA 17013 - Amount Subject to Tax $18,497.50 Tax Rate X 0.045 Potential Tax Due $832.39 NOTE': If tax payments are made within three months of the decedent's date of death,deduct a 5 percent discount on the tax With 5%Discount(Tax x 0.95) $(see NOTET7 ,7 JP 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 taxis 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 shown above as Potential Tax Dm g e information is The above information is correct;no deductions are being taken,and payment wfll be sent `�orrect. with my response. Proceed to Step 2 on reverse. Do not check any other boxes. C 0The tax rate is incorrect. 4.5% I am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased. (Select correct tax rate at right,and complete Part F� 120/9 1 am a sibling of the deceased. 3 on reverse.) 150/e Ah other relationships(mduding none). D ❑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 F�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 Debts and Deductions 2 Allowable debts and deductions must meet both of the following 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 81/2"x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If you are making a correction to the establishment date(Line 1)account balance(Line 2),or percent taxable(Line 3), otease obtain a written correction from the flnanctat 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. 1. Accounts that are held-intrust 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 1©Q%divided by the total number of owners including the decedent. (For example:2 owners-50%,3 owners-33.33'/0,4 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 Pad 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 state Official Use Only ❑AAF your relationship to the decedent: PA Department of Revenue i 1. Date Established 1 2. Account Balance 2 $ PAD --� 3. Percent Taxable 3 X 11 4. Amount Subject to Tax 4 $ 2 3 _ 5. Debts and Deductions 5 - 4 6. Amount Taxable 6 $ 5 7. Tax Rate 7 X 6 B. Tax Due 8 $ 7 8 9. With 5°/a Discount(Tax x.95) 9 X Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to"Register of Wills,Agent." Do not serol 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. '�r>>9 / F Work !'�k - � . Home 717-74,1-9179- Z/ tS�l�"iL3 Taxpayer Signature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA 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 BUREAU OF INDIVIDUAL TAXES NOTICE OF INNERITAHCE TAX pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION APPRAISENENT, ALLOWANCE OR DISALLOWANCE PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (12-12) HARRISBURG PA 17128-0601 JOINT1,Y HELD OR TRUST ASSETS RECO`D��'D O' i E Or DATE 07-01-2013 RE iZ Or .111S ESTATE OF SCHWARTZ COLLEEN M DATE OF DEATH 04-08-2013 '��i3 cul. 1 P�m` 1 sS FILE 21 13-0549 COUNTY CUMBERLAND CUMBERLAND SSM/DC IRMA H HERSHEY CLER1\ OF ACH 13124000 207 CHEROKEE DR k G* COURT APPEAL BY DATE:08-30-2013 ME C HAN I CSBURG (See reverse side under ObjecdoAs) {�i M13 AOO'' �� Amount Rosittad MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS � REV-I54Q EX AFP�f12-12)--------------------------------------------­--- --------------- NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 07-01-2013 ESTATE OF:SCHWARTZ COLLEEN M DATE OF DEATHs04-08-2013 COUNTY:CUMBERLAND FILE NO. : 21 13-0549 S.S/D.C. NO.: 209-46-0087 ACNt 13124000 TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK NA ACCOUNT NO. : 5005288165 TYPE OF ACCOUNT: C )SAVINGS CX) CHECKING C )TRUST C )TIME CERTIFICATE DATE ESTABLISHED 05-01-1971 Account Balance _ 36,995.00 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 18,497.50 UPPER PORTION OF THIS NOTICE Debts and Deductions •00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 18,497.50 REGISTER OF WILLS AT THE Tax Rate y .045 ABOVE ADDRESS. MAKE CHECK Tax Due 832.39 OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT C+) DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID 05-11-2013 CDO17596 41.62 790.77 TOTAL TAX PAYMENT 832.39 BALANCE OF TAX DUE .00 INTEREST AND PEN. .DO TOTAL DUE .00 * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. �e \ IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR]. YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. "If PURPOSE OF NOTIM To fulfill the requirements of Section 2140 of the Inheritance and Estate Taos Act, Act 23 of 2800. (72 P.S. Section 9148). PAYMENTt Detach the top portion of this notice and submit with your oavment to the Resistor of Wills printed on the reverse side. Wako check or money order payable tot Resister of Wills. Agent. Failure to pew the tax, interest and panalty duo may result in the filing of a lion in the appropriate county or the issuance of an Orphan's Court citation. REFUND CCR). A refund of a tax credit, which was not requested on the tex return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" CREV-1315). Applications are available from the Department's Web sato at www.rev�nia.stat a.0 any Reristar, Of Wills or Revinue'Distrlct Office or from the Department's 24-hour answering qsw eek - 581 services for taxpayers with special hearing and/or speaking needs+ 1-800.447-5828 (TT only). OBJECTIONS! Any party in interest net satisfied with the aporaisment, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this notice may ebisct within 60 days of the date of receipt of this notice by: A) Protest to the PA Department of Revenue, Board of Appeals by filing a protest online at www. rdof .us on or before the 69-deb appeal period expires. 2 ePV.r ferPan e o haa•o.lNwteat to be valid, you must receive a confirmation number and processed date from the Board of Appoils Web site. You may also send a written grotest to PA Department of Revenue, Board of Appeals, PO Box 281821, Harrisburg, PA IMS-1021. Petitions,mov not be famed; or B) Elect to hove the matter determined at the audit of the personal representative account; or ADMIN- C) Appeal to the Orphans' Court. ISTRATIVE CORRECTIONSs Factual errors discovered on this assessment should be addressed in writing tot PA Department of Revenue, Bureau of Individual Taxes, ATTN. Post Assessment Review Unit. PO Box 28"01. Harrisburg, PA 17128-0601 or call (717) 707-6505. See Page 4 of 'Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT, If any tax due is paid within three calendar months after the decadent's death, a five percent discount of the tax paid Is allowed. PENALTY. The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessod and not paid before Jan. 18, 1496, the first day after the and of the tank amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has bean assessed as Indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to the data of payment. Taxes which became delinquent before Jan. 1, 1482, bear interest at the rate of six percent per emus calculated at a daily rate of 0.000164. All taxes which became delinquent on or after Jan. 1. 19B2 will bear interest at a rate which varies from year to veer with the rata announced by the PA Department of Revenue. Rates for 1982 through 2486 can be found in the Pennsylvania Resident Instruction Booklet (REY-1501), the Pennsylvania Non-Resident Instruction Booklet (REV-1736) or on the Department of Revenue Web site www-revenue.state.Pa.us. The applicable interest rates for 2007 through 2813 ares Interest 'Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rata Factor 2007 8X .000219 2068 7x .808192 2009 5X .011137 2018 4% .000118 2011-2013 3X .008882 Interest is calculated as follwss INTEREST - BALANCE OF TAX UNPAID X MUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Aro notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the dots of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. w . w w fi - COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.2BOB01 HARRISBURG,PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 017596 HERSHEY IRMA H 207 CHEROKEE DR MECHANICSBURG, PA 17050 ACN ASSESSMENT AMOUNT CONTROL NUMBER loll '------ - ------- 13124000 $790.77 ESTATE INFORMATION: SSN: FILE NUMBER: 2113-0549 DECEDENT NAME: SCHWARTZ COLLEEN M ' DATE OF PAYMENT: 05/13/2013 � POSTMARK DATE: 05/11/2013 i COUNTY; CUMBERLAND DATE OF DEATH: 04/08/2013 TOTAL AMOUNT PAID: $790.77 REMARKS: CHECK#6753 INITIALS: DMB SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS 25th ANNUAL,TWO OLD FARTS TEWT HQ,TEWT Central Command 4 July 2015 Class of 1996 —Gary Dwyer,Paul(Mick) Schwartz,Tim Garner,Frank Deyo You are ordered to report for a six hour tour of duty at the Carlisle Barracks Golf Course to participate in the 25th Annual, Two Old Farts Tactical Exercise Without Troops. You will enjoy yourself regardless of the number of strokes required to complete your 18 hole assignment. You will proceed from your home of record individually or in groups to report for duty no later than 0800 (SHOTGUN START) hours. Upon completion of your assignment you will return to your home of record utilizing the same manner of travel utilized to arrive at the TEWT site. DATE: Friday, 17 July 2015 TIME: 0800 (SHOTGUN) DUTY STATION: Carlisle Barracks Golf Course Carlisle Barracks, PA (717)243-3262 AUTHORITY: You don't have any, neither do we TOF TEWT FORMAT: The four combatant team scramble will play the best shot of the foursome with the other three members playing from the immediate area of the best shot. No more than six drives will be utilized per team member but at least one drive of each team member MUST be used per side. If a tie occurs upon completion of play, the tie will be broken using the scores for the 18th hole, then 17th hole if necessary, etc. Team scoring will be handicapped. ADDITIONAL INSTRUCTIONS: From Route 81,Take the Middlesex Exit(#52) Proceed west on route Carlisle/Harrisburg Pike—Route 11 Turn Left onto Post Rd. At the stop sign,turn Right onto Claremont Turn Left into the Carlisle Barracks Entrance; proceed through stop sign to course The Bruces TOF TEWT Command itrrlrrrrrrrrrrr�rttr�I�E�fi�rtrli3r�rr�flrrlttrrr�I�Ir! _ _ _----- U.S.POSTAGE -207 CHEROKEE DR J _ PAID MECHANICSBURG,PA MECHANICSBURG RA 17450-2504J 17055 �u�9s,15 AMOUNT $2,34 1000 17013 00112591-16 1 t1 i• PIter! .. auk