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Home My WebLink About08-17-15 BUREAU OF INDIVIDUAL TAXES PO BOX 2866oi Pennsylvania Inheritance Tax pennsytvania HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE And Taxpayer Response 11 REV-1543 EX D..EXEC (08-12) RECORDED OFFICE OF ACN 15139660 ;O� AU� 1 � p�q 1 � �� o/u ',vv � / ^ / / �� uw Type cdAccount Estate ofTHERESA JD|COSTAN2D Savings CLU,'K OF unenmnQ 0R ' C 0|.j�7- Date nfDeath O8'19'2O15 Trust DANA ��O / Coun�y�UK�B�RLAN0 ��Oe�ificote 33 ED��W��:�k A.l� MECHAmIC3BVgG PA 17055'2710 PSECU 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.8572681354 Remit Payment and Forms to: Date Established 12-19-2013 REGISTER OF WILLS Account Balance $1,550.58 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $775.29 - '=^'=e ^OZ45 NOTE*: �^If are made wdh�three mon�ocdthe Potend�ToxDue p�, '""= docedon�adate nfdeath,deduct o5percent discount onthe tax With 5%Discount(Tax xO.S5) due. Any inheritance tax due will become delinquent nine months after the date ofdeath. PARTI Step 1: Please check the appropriate boxes below. A \��\No tax is due' I am the spouse of the deceased or I am the parent of a decedent who was shown above as Potential Tax Due. 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 B ~ \ \Tho\�onnaUon � The above inhmnned � oncorey� nodeduobonoaeb�ngtaken.andpaymertv�||beeen �— oonacL. with my ae. Proceed/oStep 2nnreverse. Donot check any other boxes. C �—1The�xra�iaincorrect. F—| 4.S�� | omalineal beneficiary(paent.child,grandchild,�ojnf the deceased. ��(Select correct tax rate at — — hght.andonmp|etapart �—1 12% iumasibling nfthe deceased. 3on ,evwnoo.> �—/ F—� 15% All other relationships(including none). D Changes or deductions The information above ioincorrect and/or debts and deductions were paid. listed. Complete Part 2and part 3aeappropriate onthe back o/this form. E | |Aaoa will be on Thoabove'k1end� U edoss��h�obnnnorv� bempo�odend�xpaidv�dhdhePA|nhehtonoeTax �—�inhohtancotuxhurm Return filed bythe estate representative. REV'1500. Proceed/oStep 2nnreverse. Dnnot check any other boxes. Please sign and date the back nfthe form when finished. aPART ' Debts and Deductions 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 8 1/2"x 11"sheets of paper.) Date Paid Payee Description Amount Paid ZZ 2Q/ MO- `Oner k eS. .09 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 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. i. Accounts that are held"in trust 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 =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 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 Use Only ,[]AAF your relationship to the decedent: �%� PA Department of Revenue 1. Date Established 1 o 2. Account Balance 2 $ SZ7, PAD 3. Percent Taxable 3 Xp 2 .4. Amount Subject to Tax 4 $ 2- 3 5. Debts and Deductions 5 - 4 6. Amount Taxable 6 $ 5 7. Tax Rate 7 X $ 8. Tax Due 8 $ 7 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 perjury, I declare that the facts I have reported above are true,correct and complete to the best of my knowledge and belief. Work Home Taxpayer Signature Telephone Number Date 9/113 '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: 1-800-447-3020 MalpezZi Funeral Home 8 Market Plaza Way (717) 697-4696 Mechanicsburg,PA 17055 www.MalpezziFunera]Home.com Michael J.Malpezzi,Owner,FD Jeremy J.Shartzer,FD Kyle C.Knipe,FD Ian J.McCreary,FD July 6, 2015 Andrew J.DiCostanzo_Sr._ ----33-Edgewood-Drive -- Mechanicsburg, PA-17055 - — This is the final statement for the funeral services of Theresa DiCostanzo We sincerely appreciate the confidence,you have placed in us and will continue to assist you in every way. PROFESSIONAL SERVICES: Viewing(Visitation/Wake) $310.00 Funeral Ceremony $635.00 Graveside Service $510.00 Refrigeration $325.00 Vehicle to transfer remains to Funeral Home $365.00 Hearse(Casket Coach) $465.00 Lead car/Clergy $195.00 Services of Funeral Director/Staff $2,385.00 Other Preparation of Body $210.00 FUNERAL HOME SERVICE CHARGES $5,400.00 SELECTED MERCHANDISE: Casket $1,475.00 THE COST OF OUR SERVICES,EQUIPMENT,AND MERCHANDISE THAT YOU HAVE SELECTED $6,875.00 CASH ADVANCES: At the time funeral arrangements were made, we advanced certain payments to others as an accomodation. The following is an accounting of those charges. Certified Death Certificates $60.00 Newspaper Notices-Patriot $310.94 Newspaper Notices-Beaver County Times $1.70.80 Clergy/Mass Offering $125.00 Flowers $174.90 TOTAL CASH ADVANCES AND SPECIAL CHARGES $841.64 CONTRACT PRICE $7,716.64 TOTAL AMOUNT DUE BY July 22,2015 $7,716.64 C - DANA M. DICOSTANZO 5132 PH.717-571-0017 80-8111/2313 7)697-4696. 15 ROCKLEDGE DR. MECHANICSBURG,PA 17050 DATE PAY TO THE ORDER OF Ct7 O/YL !�� `COLLARS �e- e,•,", PSECO HARRISBURG,PA-1,711 0-2990 .- __r__ _ . __ -� --- - _ FOR . 3 D Theresa DiCostanzo 33 F.dgewood Dr m Mechanicsburg,PA 17055 _'h'.._1.tr ...�.1�:�r: :::}.'t_'f• Lr,.'}`.%''v.'i'fin;- � RECORDED OFFICE OF _ _ FOREVER �; RECIST %l: n 2015JG7 PM z 2 r 5 L-CIUMT�� , . � 3."�M��..:�:�� iM•`�-�w �.ltl��r.lr�!'�1'1�'!�'��'l)3ti��iDr'1€f��:�l�i�rr�li�r.#�I'1��`