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BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
REV-1543 EX AFP (08-08)
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
~r _ AND FILE N0. 21 p~ CAS
~`{ F~<,'i-~~~~'~~' RESPONSE ACN 0913 3g
' ~ 0440
;~ ,!;;°~1. ,`; °~. ~,~~~~.~ ~ DATE 05-26-2009
TYPE OF ACCOUNT
~~~~ ~~~ ~ ~ A~ ~Q~ OF JULIA A SCHLEGEL
SSN ^ SAVINGS
196-64-3184
~iL~ DATE OF DEATH 04-07-2009 ® CHECKING
OUNTY ^ TRUST
['-~~~~~~'~ ~ CUMBERLAND ^ CERTIF.
** EDWIN L SCHLEGEL w~~~~ ~~, ~'IIT PAYMENT AND FORMS T0:
PO BOX 219 REGISTER OF WILLS
ELIZABETHVILLE PA 17023 CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
SUSQUEHANNA BANK provided the Department with the information below, which has been used in calcu
potential tax due. Records indicate that at the death of the above-named decedent, you were a
If you feel the information is incorrect lating the
please obtain written correction from the financial institutions/attachcaacopyftohthiscformt.
and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of
Pennsylvania. rlease caii 1717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account N~. 1200471409 Date
0 3 - 0 6 - 2 0 0 9 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $- payment to the Register of Wills. Make check
Percent Taxable X .00 payable to "Register of Wills, Agent".
Amount Subject to Tax 50.000
'~ . 0 0 NOTE: If tax payments are made within three
Tax Rate X months of the decedent's date of death,
. 0 4 5 deduct a 5 percent discount on the tax due.
Potential Tax Due ~- Any Inheritance Tax due will become delinquent
PART ~ 00 nine months after the date of death.
0 TAXPAYER RESPONSE
.. ~~~ i ak ,...
A• The above information and tax due is correct. ;•..sf. `
Remit payment to the Register of Wills with two copies of this notice to obtain
CHECK a discount or avoid interest, or check box "A" and return this notice to the Re
0 N E Wills and an official assessment will be issued by the PA Department of Revenue9ister of
B L 0 C K B. ^ The above asset has been or will be reported and tax
0 N L Y to be filed by the estate representative. paid with the Pennsylvania Inheritance Tax return
C• ^ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2^t and/or PART 3^ below.
PART If indicating a different tax rate, please state
a relationshi .~~;.r. ~ ~';s:r
p to decedent: ,~,fc~:~~.~.',~"~''•../~!~
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
PART
0
OF TAX ON JOINT/TRUST ACCOUNTS
1
2 $`
s X
4 ~`
5
6 ~
7 X
8 $
DEBTS AND DEDUCTIONS CLAI~M~ED
DESCRIPTION
TOTAL CEnter on Line 5 of Tax Computation)
Under penalties of ~
perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowl dge and belief.
HOME C ~~) .~ a ~._ ~' '' '~~~
T XPA R SIGNATURE WORK ( ) ~„' ,rte
TELEPHONE NUMBER DATE
DATE PAID PAYEE
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 bec{axablelevenewhenlthemdecedenttsrname waseaddedsasaaematteraof.convenience.
3. A ]oint account is
4. Accounts (including those held between husband and wife) the decedent put in ]oint names within one Year prior o
death are fully taxable.
5. Accounts established ]ointly1'between hfsobananotherlor othershareofullyataxable.to death are not taxab e.
6. Accounts held by a decedent in trust
REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE
BLOCK A - If the information and computation in the noticeSirn tworcopiesdanddsubmitsthem withbalcheckafordthelamount of„
1.
in Block A of Part 1 of the "Taxpayer Response section. 9
tax to the register of wills of the county indfromethe registeDreofrwills.of Revenue will issue an official assessmen
(Form REV-1548 EX) upon receipt of the return
2 BLOCK B - If the asset specified on this notice has been or will be reported and tax Paid with the Pennsylvania Inheri ance
an "X" in Block B of Part 1 of the "Taxpayer Response" section. Sign one
Tax Return filed by the estate's representative, Place
copy and return to the register of wills of the county indicated.
K C - If the notice information is incorrect and/or deducti{nthemewithnyouracheck forcthelamountaof taxppayablerto thenregister
3. BLOC
according to the instructions below. Sign two copies and submi
of wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receiP
of the return from the register of wills. - TAX COMPUTATION
TAX RETURN - PART 2
LINE
1. Enter the date the account °. ed9after 12/12/82 a acc unts the de edent hput ain ] ~ {~ ~ feree thregardless rof ftheavalueeof
NOTE: For a decedent who di
fully taxable. However, there is an exclusion not to exceed 53,000 p
the account or the number of accounts held.
If a double asterisk C**) appears befors reportedsbv nthe financialdinstitutionn of this notice, the 53,000 exclusion
was deducted from the account balance a
2. Enter the totelofathecaccountethatoisttaxablelto eachrsurvivoruis determinedeasffollows:
3. The percentag
A. The percentage taxable of ]oint assets established more than one Year pri°MULTIPLIED BY 100,s dePERCENT TAXABLE
1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY SURVIVINGBJOINT OWNERS
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 Percenccou~ntsB owned byC theU decedent but held
B. The percentage taxable for assets created within one near of the decedent's death or a
in trust for another individual(s) (trust beneficiaries): = PERCENT TAXABLE
1 DIVIDED BY OWNERSNORBTRUST BENEFICIARIESNT MULTIPLIED BY 100
le: Joint account registered in the name of the decedent and two other persons and established within one Year of death by
Ex amp
the decedent. _ 50 percent (TAXABLE FOR EACH SURVIVOR)
1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 -
amount subject to tax (Line 4) is determined bylnuPa~{13ing the account balance (Line 2) by the amounttsubjectetoLtax (Line 4).
4. The
5. Enter the total of the debts and deductions lists
6. The amount taxable tei{ax6~ate CLinem7)easbdeterminedlbelowe debts and deductions (Line 5) from
7. Enter the aPPropria Collateral
Spouse Lineal Sibling
Date of Death 15 percent
3 percent 6 percent 15 percent
07/01/94 to 12/31/94
6 percent 15 percent 15 percent
01/01/95 to 06/30/00 0 percent 15 percent
ercent ~ 12 percent
07/01/00 to present 0 percent 4.5 p
*The tax rate imposed on the netu~aluParentraenfadoptive par entaordacstepParentaof theachild isuOgPercent.
death to or for the use of a na
'Heal class of heirs includes grandparents, Pare{es, children and other lineal descendents• "sceldren" includes natural chi ren
d children and step children. "Lineal descendendentsnanddtheirldescendantsf the
The li
whether or not they have been adopted by others, a op
natural parents and their descendents, whether or not then have been adopted by others; adopts e
endants. "Siblings" are defined as individualse~hbeneficiariesst one parent in common with the decedent, whether by blood
and step-desc
or adoption. The Collateral class of heirs includes all o DEBTS AND DEDUCTIONS CLAIMED
CLAIMED DEDUCTIONS - PART 3
Allowable debts and deductions are determined as follows:
e le ally responsible for payment, or the estate subject to administration by a personal representative is insufficient
A. You ar 9
to pay the deductible items.
B. You actually Paid the debts after the death of the decedent and can furnish proof of paymen .
_ _.._~ ~.,. ;+on„~ed fully in Part 3. If additional space is needed, use 8 1/2" x 11" sheet of paper. Proof of