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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
*...
... <tNFORMATION NOTICE
. AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 [b-- OQ39
05001608
06-10-2005
REY-15~3 EX AFP 109-001
TYPEiOF
ACCOUNT
D SAVINGS
[i] CHECKING
D TRUST
D CERTIF.
EST. OF LEO J REICHWEIN
S.S. NO. 180-22-0673
DATE OF DEATH 02-09-2005
COUNTY CUMBERLAND
I
REHIT PAYHENT AND FOfS TO'
REGISTER OF WILLS
CUMBERLAND CO COURT H USE .
CARLISLE, PA 17013
CLAIRE R ZEGLEY
906 LAURENS LANE
WARMINSTER PA 18974
COMMERCE BANK has provided the DepartllBnt with the inforllation listed below which has been used in
calculating tha potantial tax dua. Thair racords indicata that at tha daath of tha abova dacadant, you wara a joint ownar/banaficiary of
this account. If you faal this information is incorract, plaasa obtain writtan corraction from tha financial institution, attach a COpy
to this form and rgturr. it to the above address. This ~CCDunt i~ taxable in accordance with the Inharitanca T~x L~~~ of tha Ccm..onwEalth
of Pannsylvania. Quastions may ba answarad by calling (717) 787-83Z7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR
Account No. 512105081 Date 08-29-1997
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
51,250.41
50.000
25,625.21
.15
3,843.78
TAXPAYER RESPONSE
FILING AND PAYMENT INSTRUCTIpNS
I
To insura propar credit to your acc~unt, two
[Z) copies of this notice must aCCD pany your
payment to tha Registar of Wills. ake check
payable to: "Registar of Wills, Aga~t".
x
NOTE: If tax payments are made wit~in thrae
(3) months of tha dacadant.s data 0 daath,
you may deduct a 5% discount of the tax due.
Any inharitanca tax dua will become dalinquant
nina (9) months after the date of d ath.
Tax
PART
[!]
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
o Tha abova information and tax dua is correct. I
1. You may choosa to remit paymant to the Register of Wills with two copies of this notice ~o obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Reg~ster of
Wills and an official assassment will be issued by the PA Department of Revenue. I
o The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance ~ax return
to ba filed by the decedent.s representative. i
~ The above information is incorrect and/or debts and deductions were paid by you. i
You must complete PART ~ and/or PART ~ below.
PART
~
DATE
DEBTS AND DEDUCTIONS
I
I
I
I
AMqUNT
PAID
PART If you indicate a different tax rate'J.Plaas.state your
~ relationship to decedent: ~j ~ ,-~~
1
2
3
4
S
6
7
8
TAX ON JOINT/TRUST ACCOUNTS
fj-21-/'197
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TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
S. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
...,.
wr
_1 -,,2,2, -,.IS
~ I?
PAYEE
t<' .2€ G/...~
DESCRIPTION
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,'11'/ 8teof-H€tf:.s If€. G.u eSI- r::'o/C. DUd.
..soN 1-0 AI-f€/>/IJ rH[ 7.!id!_o1
N -/- tT~S
TOTAL (Enter on Line S of Tax Computation)
CJ6- &<l
PAID
Under penalties of perjury, I declare that the
complete to the best of my knowledge and belief.
tJ C.....p
7~ &~
SIGNATURE
facts I
$ I
i
have reported above are true, correc~
HOME (2/5) 4Lf3-8"/2.1 .
WORK (2/5:") &3 ~- 4.bOcJ
TELEPHONE NUMBER
and
1'0 ' 19- .2c'tJs-'
DATE
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information
submitted by the financial institution.
2. Inheritance tax becomes delinquent nine months after the decedent's date of death.
3. A joint account is taxable even though the decedent's name was added as a matter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint names within ona year prior to
death are fully taxable as transfers.
5. Accounts established jointly between husband and wife more than one year prior to death are not taxable.
6. Accounts held by a decedent "in trust for" another or others are taxable fully.
REPORTING INSTRUCTIONS - PART
1
- TAXPAYER RESPONSE
1. BLOCK A - If the information and computation in the notica are correct and deductions are not being claimed, place an "X"
in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of
tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment
(Form REV-1548 EX) upon receipt of the return from the Register of Wills.
2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decadent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one
COpy and return to the PA Department of Revenue, Bureau of Individual Taxas, Dept 280601, Harrisburg, PA 17128-0601 in the
envelope provided.
3. BLOCK C - If the notice information is incorrect andlor deductions are being claimed, check block "c" and complete Parts 2 and 3
according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register
of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt
of the return from the Register of Wills.
TAX RETURN - PART
2
- TAX COMPUTATION
lINE
1. Enter
NOTE:
the date the account originally was establishad or titled in the manner axisting at date of death.
For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1) year of death are
taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of
the account or the number of accounts held.
If a double asterisk (MM) appears before your first name in the address portion of this notice, the $3,000 exclusion
already has been deducted from the account balance as reported by the financial institution.
2. Enter the total balance of the account inclUding interest accrued to the date of death.
3. The percent of the account that is taxable for each survivor is determined as follows:
A. The percent taxable for joint assets established more than one year prior to the decedent's death:
1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE
JOINT OWNERS SURVIVING JOINT OWNERS
Example: A joint asset registered in the name of the decedent and two other persons.
1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100
16.7% (TAXABLE FOR EACH SURVIVOR)
B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
X 100
PERCENT TAXABLE
Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by
the 'decedent.
1 OIVIDED BY 2 (SURVIVORS) = .50 X 100 50% (TAXABLE FOR EACH SURVIVOR)
4. The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3).
5. Enter the total of the debts and deductions listed in Part 3.
6. The amount taxable Cline 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4).
7. Enter the appropriate tax rate (line 7) as determined below.
MThe tax rate Imposed on the net value of transfers from a deceased ChIld twenty one years of age or younger at
death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0%.
The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children
whether or not they have been adopted by others, adopted children and step children. "lineal descendents" includes all children of the
natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants
and step-descendants. "Siblings" are defined as individuals who have at least one parent in common with the decedent, whether by blood
or adoption. The "Collateral" class of heirs includes all other beneficiaries.
Date of Death Spouse Lineal Sibling Collateral
07/01/94 to 12131/94 3" 6" 15" 15"
01/01/95 to 06/30/00 0" 6" 15" 15"
07/01/00 to present 0" 4,5". 12" 15"
-
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are determined as follows:
A. You legally are responsible for payment, or the estate SUbject to administration by a personal representative is insufficient
to pay the deductible items.
B. You actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x II". Proof of
payment may be requested by the PA Department of Revenue.
PART 3
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 005$29
ZEGLEY CLAIRE R
906 LAURENS LANE
WARMINSTER, PA 18974
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUN
TOTAL AMOUNT P
--------
101 I $2,917.~ 0
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AID: $2,917 50
_____n_ fold
ESTATE INFORMATION: SSN: 180-22-0673
FILE NUMBER: 2105-0939
DECEDENT NAME: REICHWEIN LEO J
DATE OF PAYMENT: 10/24/2005
POSTMARK DATE: 10/21/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 02/09/2005
REMARKS:
CHECK# 1070
SEAL
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBA GH
REGISTER OF WILLS
REGISTER OF WILLS