HomeMy WebLinkAbout09-11-06
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CO 007182
HOUDESHELL EMILY DAISY
12 SHARON RD
ENOLA, PA 17025
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
------~- fold ---------- --------
101 I $330.60
ESTATE INFORMATION: SSN: 164-36-2795 I
FILE NUMBER: 2106-0446 I
DECEDENT NAME: LENKER DAISY ALMA I
DATE OF PAYMENT: 09/08/2006 I
POSTMARK DATE: 09/07/2006 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 04/16/2006 I
I
TOTAL AMOUNT PAID: $330.60
REMARKS:
CHECK#107
SEAL
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*'
INFORMATION NOTICE
AND
EC 'T~owe~ 8j1:SPONSE
FILE NO. 21 06-0446
ACN 06135052
DATE 07-18-2006
.EV-IS~S EX AFP lO9-DOl
TYPE OF
ACCOUNT
D SAVINGS
IX] CHECKING
D TRUST
o CERTIF.
EMILY D HOUDSESHELL
12 SHARON RD
ENOLA PA 17025
2006 s,::p -~S..~ Jqr ~ISY A LENKER
S.S. NO. 164-36-2795
CLE~OF DEATH 04-16-2006
O!ip' 'AN'; ~ CUMBERLAND
r" ~ L, v t'll
CUi t\ln ('0 PA REltIT PAYI1ENT AND FORltS TO:
I'. .. I, ,.I .., RESISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
SOVEREIGN BANK has provided the DepartBant with the inforeation listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you f881 this inforaation is incorrect, please obtain written correction fr~ the financial institution, attach a copy
to this forB and return it to the above address. This account is taxable in accordance with the Inheritence Tax Laws of the C~Bonwealth
of PennsYlvania. Questions Bay be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0921710917 Date 02-18-2005
Established
Account Balance
Percent Taxeble
Amount Subject to
Tax Rete
Potential Tax Due
x
22.935.29
50.000
11.467.65
.15
1. 720.15
TAXPAYER RESPONSE
To insure proper credit to your account, two
(2) copies of this notice Bust accoBpany your
paYBent to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
x
NOTE: If tax paYBents are Bade within three
(3) ~nths of the decedent's date of death,
you aay deduct a 5~ discount of the tax due.
Any inheritance tax due will bec~e delinquent
nine (9) BonthS after the date of death.
Tax
PART
[!]
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
[J The above inforBation and tax due is correct.
1. You Bay choose to reBit payBent to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you Bay check box "A" and return this notice to the Register of
Wills and an official asseSS8ent will be issued by the PA Departaant of Revenue.
[J The above asset has been or will be r&ported and tax paid with the Pennsylvania Inheritance Tax return
~e filed by the decedent's representative.
The above inforaation is incorrect and/or debts and deductions were paid by you.
You Bust cOBplete PART ~ and/or PART ~ below.
If you indicate a different tax rate. please state your
relationship to decedent:
PART
[!]
TAX RETURN - COMPUTATION OF
LINE 1. Date Establlsned 1
2. Account Balence 2
3. Percent Taxable 3 X
4. A.ount Subject to Tex 4
S. Debts end Deductions .5
6. Anount Taxable 6
7. Tax Rate 7 X
8. Tax Due 8
TAX ON JOINT/TRUST ACCOUNTS
2.-.rI€.~~
"2. 'a tf ~5". ~ CJ
, '5'c-
II Y 1.1" u,5""
41'21.00
...,a'lc.,~S"
.O~ 5'
0'30 ,~C)
DEBTS AND DEDUCTIONS CLAIMED
PART
[!J
DATE PAID
1./-15.o~
PAYEE
DESCRIPTION
I -... - F....,"-l
TOTAL (Enter on Line .5 of Tax Cu.putation)
AMOUNT PAID
~/21. Db
IRS
I
$
declare that the facts I
and belief.
have reported above are true. correct
HOME (7 h >7 ~2 - OIS-/
WORK ( >
end
Dl.rt ..oy
~
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSI1ENT with applicable interest based on inforBation
subBitted by the financial institution.
2. InheritancB tax bBcoBes delinquent nine Bonths after the decedent's data of deeth.
3. A joint account is taxable even though the decedent's naBe was added as a Batter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint naBes within one year prior to
death are fully taxable as transfers.
5. Accounts established jointly between husband and wife Bore 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 InforBation and cOBPutation In the notice are correct and deductions are not being clai..d, place an "X"
in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and subBlt theB with your check for the aBount of
tax to the Register of Wills of the county Indicated. The PA Department of Revenue will Issue an official assesSBent
(ForB REV-1548 EX) upon receipt of the return frOB 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 Pannsylvania Inheritance
Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one
COpy and return to the PA Departsent of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the
envelope provided.
3. BLOCK C - If thB notice inforBation is incorrect and/or deductions are being claised, check block "C" and coaplete Parts 2 and 3
according to the instructions below. Sign two copies and subBit thes with your check for the asount of tax payable to the Register
of Wills of the county indicated. The PA Departsent of Revenue will issue an official assesSBent (Fors REV-1548 EX) upon receipt
of the return frOB the Register of Wills.
TAX RETURN - PART
2
- TAX COMPUTATION
LINE
1. Enter
NOTE:
the date the account originally was established or titled in the sanner existing at data of death.
For a decedant dying aftar 12/12182: Accounts which the decedent put in joint nBBes 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 nueber of accounts held.
If a double asterisk (MM) appears before your first nBBe In the address portion of this notice, the $3,000 exclusion
already has been deducted frOB the account balance es 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 deterBlned as follows:
A. The percent taxable for joint assets established sore 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
exBBple: A joint asset registered in the naBe of the decedent end two other persons.
1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100
l6.7~ (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 indlvidual(s) (trust beneficiaries):
1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT
OWNERS DR TRUST BENEFICIARIES
X 100
PERCENT TAXABLE
Exasple: Joint account registered in the nase of the decedent and two other persons and established within one year of death by
the decedent.
1 DIVIDED BY 2 (SURVIVORS) = .50 X 100 50~ (TAXABLE FOR EACH SURVIVOR)
4. The ..ount subject to tax (line 4) is detersined by Bultiplying 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 asount taxable (line 6) is detersined by subtracting the debts and deductions (line 5) frOB the asount subject to tax (line 4).
7. Enter the appropriate tax rate (line 7) as deterBined below.
Dat. of D.ath Spouse Lineal Sibling Collateral
07/01/94 to 12/31/94 370 670 1570 1.570
01/01/9.5 to 06/30/00 070 670 1.570 1.570
07101/00 to present 070 4..570- 1270 1.570
MThe tax rate Isposed on the net value of transfers fros a deceased Chlld twenty-one years of age or Y
ounger at
death to or for the USe of a natural parent, an adoptive parent, or a stepparent of the child is O~.
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 COBBon with the decedent, whether by blood
or adoption. The "Collateral" class of heirs includes all other beneficiaries.
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are detersined as follows:
A. You legally are responsible for paysent, or the estate subject to adsinistration by a personal representative is insufficient
to pay the deductible itess.
B. You actually paid the debts after death of the decedent and can furnish proof of pay.ent.
C. Debts being clai.ed sust be Ite.ized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x 11". Proof of
paYBent say be requested by the PA DepartBent of Revenue.
0IIpnnn of the T~ - InlIIm8I RlMnue ServIce
Form 1 040 u.s. Individual Income Tax Return
For Ibe .Ian 1 . Dee 31, 2005, 01' other tal
YOlI' IIrst name
Use the
IRS label.
Otherwise, Home 8dr.Irea (number and slnlet). If you '- . P.O. box. see InslruclIons. no. You must enter your
please print social security
or type. 730 Tower Road A number(s) above. A
CIty, lawn or posl oIIc8. If you ~ a foreign adchss. see Instructians. SlallII ZIP axle
--.....--. CJIeddng 8 box beIo.lIiIl not
~ Enola PA 17025 ...JOII'taxor......
c.~. .. Chect hn if JGU. or JOII' spouse if filing joinUy. RII: $310 1J)1o tIis flI1d1 (see inslrudions) ................ .. 0 You 0 Spouse
Filing Status 1 Single 4 Head of household (with qualifying person). ~
2 Married filing joinIIy (MIl if only one had irmne) =i;'~;> ~~~~ir:r: chi d
3 Married firmg separalllIy. EnIier spouse's SSM aboIIe & full name here. ..
IlIIIIe hn ." 5 0 Qualifying ~er) wiIh dependent dlld (see instndions)
Y~..I~.~.~~.~~~~.~.~.~.~:.~.~~~~~.::::::::::::]- =-!!'.
(2) Deoendent's (3) Oependent's (4) If GIlle: wIta:
social secUritY re~fionship CIIIBI/fvlno. hid
number to vou mIIrI fni r.IilJd wIIh you .....
J lax aIlCIlt . did IIlII
C_ irllllni) ......--YOU
dueto~
:..~..
D.;:......
on IIlII
........ -- .
Label
(See 1rstrucIions.)
Check only
one box.
Exemptions
If more than
four.~,
see instructions.
Income
Attach Form(s)
W-2 ... AIIo
atIach F...
W-ZGand l_R
if tax .. wiIhhIId.
If JOlI did not
gilt 8 W-2,
see iIlstructions.
ROLLOVER
Enduse, but do
not alIad1, any
...,... NsO,
r::l=-V.
~ustec:l
GrQss
Income
MI
Last name .
Dais
If. joint nllum, spouWs first name
A
Ml
Lenker
Last_
164-36-2795
&pa.e.. 8odaI-.tIy.......
1
First name
last name
dToIal number of ex claimed....................................................... ~~ ..I 11
7 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 4, 120.
8a Taxable interest. Attach Schedule B If required.............. i......... '" ..... ......... 8a 7,978.
b Tax......opl interest. Do not incfude on line Sa .............1 8bl 2, 325.
9. Ordinary dividends. Attach Schedule B If required ..........: i . . . . . . . . . . . . . . . . . . . . . . . . . . 9a
b~................................................. 9bl 1,538.
10 TarabIe ref1nIs, crediIs, or offseIs of stale and local inaJme taxes (see instruclions) ...................... 10
11 Alimony received. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 11
12 Business income or (loss). Attach Schedule C or C.EZ ................................. 12
13 Capital QIIin or (loss). All Sch D if reqd. If not .. dl here ........................... 0 13
14 ou.er gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . _ .. 14
15a IRA distributions. . . . . . . . . . . ~I I b Taxable amount (see instrs) .. 15b
16. Pensions ar'ld annuities....[]i!l 105,991. b Taxable amount (see instrs) .. 16b
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E .. 17
18 Farm income or (loss). Attach Schedule F ............................................. 18
19 Lh1e~~ccrnPEKlSatkM1 ........................................................ 19
21. Social securi\Y I8Iefils ...... .... U!!I 13,808./ b Taxable amount (see instrs) ..21b
21 ou. income 21
22 Add the amOuntS in i.8 i8r__~ OOiUmn fW i;;s -7 -n;oUdi '21:- ThiS ~ -yoo..-. inCOiM.. 22
23 EOOcator expenses (see instructions) ...................... 23
24 Certain business expenses of reseMsls, ~ lIItisls, and _basis
lP/8OIIIIllIIt officialS. AIIadI Form ZlQi or ZlQi.EZ . . . . ... . . . . . . . . . . . . " 24
25 Health savings account deduction. Attach Form 8889 ........ 25
2& Moving expenses. Attach Form 3903 . . . . . . . . . . . . . . . . . . . . . .. 2&
Z1 One-half of self-emp/oyment tax. Attach Schedule SE ....... Z1
28 Self-emp~ SEP, SIMPLE, and qualified plans ........... 28
29 SeIf~ he8IIh insurance deduction (see Instn.ictions) ............. 29
38 Penalty on early withdrawal of savings ..................... 30
31 a AIinDly paid b Recipient's SSM . .. . .. .. 31 a
32 IRA deduction (see instructions) .: r .. .. .. . :. : .. ~.. . .. .. .... 32
33 Student loan interest deduction (see Instructions) ........... 33
34 Tuition and fees deduction (see Instructions) . . . . . . . . . . . . . . .. 34
35 Domestic IIodudion acIMties dedldon. AIIach fonn 8903 .J........... is
36 Add lines 23 .318 and 32 - 35 ............................................................. 36
r1 Subtract line 36 from line 22. This'is -..._ aross income .. .. . .. .. . .. .. . .. .. .... r1
2,122.
1,334.
1, 671.
20,340.
11,737.
49,302.
,
BAA For DIscIoaan. Privacy Act, and Paperwork Reduction Act NoIIce, see insIrudions.
49,302.
FDlA/)II2 11107105
Form 1040 (2005)
Form 1048 l2OO5l
Tax and
Credits
StaIdard
DeducIIon
for-
· People who
check8d any box
on line 398 or
39b or who can
be claimed as 8
dependent. see
instructions.
· All others:
Single or Married
fiI~ separately.
$5.000
Married filing
l;"~
~erJ,
$10,000
Head of
household,
$7,300
Other
Taxes
Payments
If you have a
=~~
Schedule EIC.
Refund
Dlrec:t deposit?
See instriJctions
and fill in 73b,
13c. and 73d.
Amount
You Owe
Third Party
DesIanee
~
Joint retum?
See instructions.
Keep a copy
for your records.
Paid
Preparw's
Use Only
Daisv A Lenker 164-36-2795 ~2
as Amount from line 37 (adjusted woss income) ....... ~ .r.....:.................... ...... as 49,302.
39a ~ {B You were bom befpre January 2'tl941. B Blind. 10181 boxes .-
if: Spouse was bom before Janua~2, 1941, Blind. checked ~ 39-L
b:l~r:-~~~:~'.~.~.~~.~.~I._~....... ~ 39b 0
_IIIJ IIemiad ~ (from Sc:heduIe A) or your standard deduction (see left 1Jl8Iljn) .................... 40
41 Subtract line 4O,from line 38 ......................................................... 41
42 If Hne 38 is CMIl' $109,475, !! ~ pnMded housina to a plISOII displaced by Hurric:ane Kabina. see
instructions. 0lhnisIt, IIIIItipIy $3.200 by the tIUT ...... of ~1S aai,,*, on line 6d . . . . . . . . . . . . . . .. 42
43 Taxable Income. SubIract Hne 42 from line 41.
If line 42 is IlIllr8thl1n line 41, enIllr.o- .. . . . . . . . . .. .. . . . . . . . . .. . . . . .. .. .. . .. .. .. . .. . . . .. . . . ... 43
44 Tax (see instrs). CIB:k if 8lIJ tax is from: _ 0 Fonn(s) 1814 b 0 Fonn 4972 .. .. . . . . .. . . .. . .. . . .. ... 44
45 Alternative minimum tax (see instructions). Attach Form 6251 .......................... 45
41 Add lines 44 and 45 .... . . .. .. . .. .. .. .. . .. . .. . -. ..,.. . . . .. . . .. .. .. . . .. . . .. .. . .. .. . . . . ~ 46
III Foreign tax aedit. Attach Form 1116 if required. . . '. . . . . . . . .. III
48 CnllIit for diId and dependent care expenses. Attach Form 2441 .......... 48
49 Credit for the elderly or the disabled. Attach Schedule R ..... ..
50 Education credits. Attach Form 8863 . . . . . . . . . . . . . . . . . . . . . .. 50
51 Retirement savings contributions credit. Attach Form 8880 ... 51
52 Clild tax credit (see instructions). AtIach Fonn 8901 if required .......... 52
53 Adoption aedit. Attach Form 8839 ......................... 53
54 CnIdils from: _ 0 Form 8396 b 0 Fonn 8859 ................ 54
55 Other credits. Check applicable box{es): _ 0 Fonn 3llOO "'-
b 0 ~ c DForm 55,
5& Add lines 47 through 55. These are your total CNdits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 56
51 Subtract line 56 from line 46. If line 56 is more than line 46. enter -0- ................. ~ 51
58 SeIf~tax.AttachScheduleSE....................... ............................... 58
59 SGciaI security and MedicanI tax on tip income not nlpOrtlld to llII1PIoJer. AI:tacIt Fonn 4137 ................. 59
60 AdditionaItIx on 1RAs. otIu qualific:d n:tircmcnt plans. cb:. AtIach Form 5329 if n:quin:d ........ .. .. .. .. ... 60
61 Advance earned income aedit payments from Form{s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 61
62 Household employment taxes. Attach Schedule H ...................................... 62
63 Add rmes 57.Q. 'This is vour tDtai tax ..................................................... ~ 63
64 Federal income tax withheld from Forms W.2 and 1099 ...... 64 306.
&5 2lXJ5 estimaIIldtax paymenIs and amount applied from 2004 return ..... . .. &5 1 , 000 .
r 66:==:on~..'~~i66bj"""""""""'" 66.
ff1 &l:ess social SlI:lIJ'i\Y and tier 1 RRTA tax will1heId (see instruGtiOns) ...... ff1
68 Additional child tax credit. Attach Form 8812................ 68
69 Amount peid IIitb I8qII8St for 8Idension to file {see instrudionSb' . . .. .... 69
70 payments from: a 0 Form 2439 b 0 Form 4136 c Form 8885 70
71 ~~~~.and67~.~...................................................... ~ 71
72 If line 71 is IlIllr8 than line 63. subIract line 63 from line 71. 11is is the amount JOlI lMlI)I8id ............... 72
13aAmount of line 72 you want ntfunded1o~ .................... ....... ... ... .... ... ~ 13_
· b Routing number. . .. . .. ., -L · c Type: n Qlecking 0 Savings
· d Account number ....... _ ~
74 Amount of Hne 72 WIt watt aDDlIed to lIIIlIr -1IIimIted tax ....... ~ 74 I
75 Amount you owe. Sublract line 71 from line 63. For delails on how to pay, see}instruclions, .. .. . .. .. .. .. .. ~ 75
76 Estimated tax oenaHv (see instructions) ...... . . . . . . . . . . . . .. 76
Do JOlI watt to allow another person to disaJss tIis retum witIt the IRS (see instruGtiOns)? .......... Dyes. Complete the following. P{I No
DesIgrme's Phone _ PersonaIIclenlIfIcatIan _
rwne · no. ~ runber (PIN) ~
lQIer per1BItles of perjury. I decI8re tI1lIt I '- -meet IhIs relI.m and _..-ojIng sc:hellIIes and staIIlmenIs. and kllhe best of my knowledge and
belief, !hey - true. comtCt, and c:ornp/eIe. Dechntion of IRl*lII' (allw' thin taxpey8f) is '-d an all infc>........... of which IRl*lII' lias eny knOwledge.
Your sQ1altn Dille YO1M' llCCI4lIIlIon 0IlyUme phone IUnber
."
$pouR's~. If a joint relI.m. baIh nut s91-
."
9.884.
39,418.
3.200.
36,218.
5.427.
5.427.
5.427.
5.427.
1.306.
4,121.
0aI8
clerk
$pouR's GCalpIIlIon
Pnltwer's ."
Flnn'srwne Self-Pre ared
~If ,."
adchu~
ZIP oode
0aI8
Phlpnr's SSN or PTlN
EIN
Phone 110.
FDIA0112 llJ07Ill5
Form 1140 (2005)