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Home My WebLink About06-30-15 (2) IIEV-1162 EX�l1-9fi1 COMMONW FALTH OF PHJNSTIVANIP oEaaa.MErv.or r+evEN�e IIPEPV OF INOIVIDUALTA%ES oeer.zeoeoi HnAAiseuac.Pn n�ze-aam pENNSVLVANIA RECEIVED FFOM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 020913 FAHNESTOCK DONALD 204 W PINE STREET MT HOLLY SPRINGS, PA 17065 ACN ASSESSMENT AMOUNT CONTROL NUMBER ---- __ 15127200 � 5378.22 ESTATE INFORMATION: ssr�: � FILE NUMBER: 2115-0437 � oeceoeN7 Nanne FAHNESTOCK KIRBY L I DATEOFPAYMENT: OB/30�20'I5 I POSTMARK DATE: O6/30/2015 � couNrv: CUMBERLAND I DATEOFDEATH: 04/12/2015 � TOTAL AMOUNT PAID: 5378.22 REMARKS: CHECK# 135 INITIALS: CJ sEA� RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTEfl OF WILLS euxenu o� ieomvun� rnxes Pennsylvania lnheritance Tax � � �� pennsylvania PO BOX 300601 Information Notice �� DEPAPTMENTOf FEVENOE NFRRISEOR6 PP V12B-0601 ncmn n m.irtc .oein And Taxpayer Response Fi�E Na 2i is-oas� ACN 15127200 DATE OS-20-2015 Type of Account Eslate of KIRBV L FAHNESTOCK �Savings SSN 198-44-9031 % Checking Trust �. DONALD E FAHNESTOCK CounryCUMBERLAND Certificate 204 W PINE ST � '�� '� MT HOLLY SPGS PA 17065-1122 �'" o � �� > > ,�� 0 3 ` i - ' cn . `�' - _ u n s T BANK provided the department with the iniormation below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Remit Payment antl Forms�o: AccouniNo.9864363875 Uate ESWblished 01-16-2075 HEGISTER OF WILLS Accoun�Balance $g,g4Z2g 1 COURTHOUSE SOUARE CARLISLE PA 17013 Percent Taxable X 100 Amount Subject to Tax $8,84Z29 Tax Rate X 0.045 NOTE': If tax payments are made within three monihs af the Potential Tau Due $398.13 decedenPs date of death,deduct a 5 percent discount on the tax With 5% Discoun[(Tax x 0.95) $(see NOTE') due. Any inheritance tax due will become delinquent nine months afler ihe date af death. PART $t2P 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. Pmceed to Step 2 on reverse. Do not check any othei boxes antl disregard the amount shown above as Potential7az Due. g u The information is The above information is correc[, no deduclions are being taken, and payment will be sent correct. with my response. Proceed to Step 2 on reverse. Do not check any other boxes. � �The tax rate is incorrecL � 0.5% I am a Ilneal beneficiary(parent,child,grandchild, etc.)of the deceased. (Select correct�ax rete at rigM, and comple�e Part � �2% I am a sibling o�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 andpart 3 as appropriate on the 6ack ot fhis lorm. E �Asset will be reported on The above-identified asse[has been or will be repotled and tae paid with ihe PA Inheritance Tax inheri�ance tax form ReNm filed by the estate representative. REV4500. ProceedtoStep2onreverse. Donotcheckanyotherboxes ^ � Please sign and date the back of the form when finished. �� PART Z Debts and Deductions Allowable debis and deduclions must meet both of the following criteria� A. The deceden[was legally responsible for payment,and ihe estate is insuNicient to pay the deductible items. B. You paid the debis after the death of the decedent and can furnish proof oi payment i�requested by the depariment. Qf adtlitional space is required,you may attach B 1/2"x 11"shee[s of paper.) Date Paid Payee Description Amoun� Paid To�al Enter on Line 5 o�Tax Calculation) $ PART Tax Calculation 3 N 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 iinancial institution antl attach it to this form. t Enter the da[e[he account was established or titled as it existed at the date of death. 2 En�er the rotal balance of�he account including any interest accmed a�the date of death. 3 En�er ihe percenta9e o�the account�ha�is taxable to you. a. First,de[ermine the percen�age owned by ihe decedent. i. Accounis ihat are held "in tmst for"another or others were 100%owned by�he decedent. ii. Forjoint accounis established more than one year prior to the da[e of tleath,the percenta9e taeable is 700%divided by�he total number of owners including the deceden�. (For example:2 owners=50%, 3 owners=33.33%,4 owners =25%,etc.) b. Next,divide ihe decedenCs percentage owned by ihe number of survivin9 owners or beneficiaries. 4. The amounl subject m tav is de�ermined by multiplyinq�he account balance by the percen�taxable. S Enter�he total of any tlebts and deductions claimed fmm Part 2. 6. The amount ta�cable is determined by subtracting ihe debts and deductions trom the amount subject to tax. 7. Enter the appropriate[ax rate fmm Step 1 based on your relationship to the decedent. If indicatin a tlifferent tax rate, lease state ` �,� i your relalionship b(he decedent: n + � ��a��"'�-��`�A�'�s" � '�' � 1. Date Established 1 �,��k• ' �� '� �;. ti `� tte 2. Account Balance 2 $ � , ,.0 " j :�"��,: 4�"�'�'v,�,�. ^,a�t?e:�.- 3. Percent Taxable 3 X ,2 �,.,a �,�� r,. � „� �,��; 4. Amount Suhject[o Tax 4 S � �. 3 t;�,n x� r ".�. '� s�•'�, a � ,sF" s�w. 5. Debts and Deductions 5 ' 6. AmouniTaxable 6 $ r� '�'�� '�'� �� ' -k�' t:$�ix; 7. Tar Rate 7 X w-�, �.„x�' "-w t�+ ��z��.. � ��.�a iir �3�Ed' S`*`_ '�°u�*' ?i e. Tax Due 8 $ $ , x� , t�, ,:�r a „ 9. With 5%Discoun�(Tax x .95) 9 X J,„,�„� �„,�*,y;,,,: St@P 2: Sign and date below. ReNrn TWO comple[ed and signed copies to ihe Register of Wills listed on[he iront 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�he Department of Revenue. Under penalty of perjury, I declare that ihe facts I have reported above are true,correct and complete to ihe best of my knowledge and belief. , /� / �!v-- Work � Y �,�/'�6ILLd-(LL,�Y Home ?�p jZPiU !S 0 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