HomeMy WebLinkAbout11-14-12BUREAU OF INDIVIDUAL TAXES
PD BOX 280601
HARRISBURG Pq 17128-0601
Pennsylvania Inheritance Tax
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xpayer Response
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LANDIS D KAUTZ
8448 S FLORENCE AVE
TULSA OK 74137-1435
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Cl1MBRR,Jv'VD CO.. PA
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DEPARTMENT OF REVENUE
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FILE NO. 2112-0293
ACN 12158564
DATE 10-25-2012
Estate of FRANCES I KAUTZ
SSN 196-14-3523
Date of Death 03-03-2012
County CUMBERLAND
Type of Account
Savings
Checking
Trust
Certificate
WELLS FAR60 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. 5284438446
Date Established 02-03-2012
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Remit Payment and Forms to:
REGISTER OF WILLS
$ 6,178.00 1 COURTHOUSE SOUARE
X 50 CARLISLE PA 17013
$ 3,089.00
X 0.150
Potential Tax Due $ 463.35
With 5% Discount (Tax x 0.95) $ (see NOTE')
NOTE': If tax payments are made within three months of the
decedent's date of death, deduct a 5 percent discount on the tax
due. Any inheritance tax due will become delinquent nine months
after the date of death.
PART Ste 1: Please check the a
1 P ppropriate boxes below.
A ~ No tax is due.
g The information is
correct.
C ~ The tax rate is incorrect.
(Select correct tax rate at
right, and complete Part
3 on reverse.)
p ~ Changes or deductions
listed.
E Asset will be reported on
inheritance tax form
REV-1500.
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.
Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount
shown above as Potential Tax Due.
The above information is correct, no deductions are being taken, and payment will be sent
with my response.
Proceed to Step 2 on reverse. Do not check any other boxes.
4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased.
12% I am a sibling of the deceased.
15% All other relationships (including none).
The information above is incorrect and/or debts and deductions were paid.
Complete Part 2 and part 3 as appropriate on the back of this loan.
The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax
Return filed by the estate representative.
Proceed to Step 2 on reverse. Do not check any other boxes.
Please sign and date the back of the form when finished.
PART
z
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.)
2. Account Balance z
3. Percent Taxable 3 X
4. Amount Subject to Tax 4 $
5. Debts and Deductions 5 =
6. Amount Taxable 6 $
7. Tax Rate 7 X
8. Tax Due 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, 1 declare that the facts I have reported above are true, correct and complete to the best of my knowledge and
belief.
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Tnvnnvnr Rinr,atura Telephone Number Date !i~/z/i~--
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IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA
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
Date Paid Payee Description Amount Paid
Total Enter on Line 5 of Tax Calculation $
BUREAU OF INDIVIDUAL TAXES
'PD Box znocol
HARRISBURG PA 17128-0601
Pena, v la Inheritance Tax
~(}~~, ~ I ation Notice
An~;'?T~cpayer Response
FiF';I.
CUM~t P~~-W`~D ~C . PA
TREVA L BRYSON
20 BAYBERRY DR
MECHANICSBURG PA 17050-3172
~ Pennsylvania
DEPARTMENT OF REVENUE
REV-3563 E% OocE%EC (OB-33)
FILE NO. 2112-0293
ACN 12158563
DATE 10-25-2012
Estate of FRANCES I KAUTZ
SSN 196-14-3523
Date of Death 03-03-2012
County CUMBERLAND
Type of Account
Savings
Checking
Trust
Certificate
weLLS FARGO 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. 5284438446
Date Established 02-03-2012
Account Balance $ 6,178.00
Percent Taxable X 50
Amount Subject to Tax $ 3,089.00
Tax Rate X 0.150
Potential Tax Due $ 463.35
With 5% Discount (Tax x 0.95) $ (see NOTE')
Remit Payment and Forms to:
REGISTER OF WILLS
1000RTHOUSESOUARE
CARLISLE PA 17013
NOTE': If tax payments are made within three months of the
decedent's date of death, deduct a 5 percent discount on the tax
due. Any inheritance tax due will become delinquent nine months
after the date of death.
PART Ste 1: Please check the a
1 P ppropriate boxes below.
A ~ No tax is due.
B ~ The information is
correct.
C ~ The tax rate is incorrect.
(Select correct tax rate at
right, and complete Part
3 on reverse.)
p ~ Changes or deductions
listed.
E 'Asset will be reported on
inheritance tax form
REV-1500.
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.
Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount
shown above as Potential Tax Due.
The above information is correct, ne deductions are being taken, and payment will be sent
with my response.
Proceed to Step 2 on reverse. Do not check any other boxes.
4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased.
12% I am a sibling of the deceased.
15% All other relationships (including none).
The information above is incorrect and/or debts and deductions were paid.
Complete Part 2 and part 3 as appropriate on the back ofthis /orm.
The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax
Return filed by the estate representative.
Proceed to Step 2 on reverse. Do not check any other boxes.
Please sign and date the back of the form when finished.
PART
z
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 81/2" x 11"sheets of paper.)
Debts and Deductions
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 wntten 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: 2owners = 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
your relationship to the decedent:
1. Date Established 1
2. Account Balance r
3. Percent Taxable 3 X
4. Amount Subject to Tax 4 $
5. Debts and Deductions 5 =
6. Amount Taxable 6 $
7. Tax Rate ~ X
S. Tax Due fi $
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
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Taxnaver Signature
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Home
Telephone Number
Date /l~lx/~y-
IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA
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
Date Paid Payee Description Amount Paid
Total Enter on Line 5 of Tax Calculation $
BUREAU OF INDIVIDUAL TAXES
PD BOX 280601
HARRISBURG PA 17128-0601
Pennsylvania Inheritance Tax ~ Pennsylvania
~{F`(~UI ~ , Fi,G ormation Notice ~..1~ DEPARTMENT OF REVENUE
,i t l~f h ~ axpayer Response wE. "°' E= o,~E.E~ ,o,-,,,
''-i FILE NO. 2112-0293
F?F~a~ -~ ~'`~~ ACN 12157102
DATE 10-16-2012
„
CUMB~RI.AIvU CO., PA
Estate of FRANCES I KAUTZ
SSN 196-14-3523
Date of Death 03-03-2012
County CUMBERLAND
Type of Account
Savings
Checking
Trust
Certificate
TREVA L BRYSON
20 BAYBERRY DR
MECHANICSBURG PA 17050-3172
WELLS FARGO 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. 1000665647366 Remit Payment and Forms to:
Date Established 10-31-1973 REGISTER OF WILLS
Account Balance $ 12,128.00 1 COURTHOUSE SQUARE
Percent Taxable X 16.667 CARLISLE PA 17013
Amount Subject to Tax $ 2,021.37
Tax Rate X 0.150
Potential Tax Due $ 303.21 NOTE*: If tax payments are made within three months of the
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With 5% Discount Tax x 0.95
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$ (see NOTE') ece
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death, deduct a 5 percent discount on the tax
due. Any inheritance tax due will become delin
t
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h
quen
n
ne mont
s
after the date of death.
PART Ste 1: Please check the a
1 P ppropriate boxes below.
A ~ No tax is due.
g ~ The information is
correct.
C ~ The tax rate is incorrect.
(Select correct tax rate at
right, and complete Part
3 on reverse.)
p ~ Changes or deductions
listed.
E Asset will be reported on
inheritance tax form
REV-1500.
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.
Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount
shown above as Potential Tax Due.
The above information is correct, no deductions are being taken, and payment will be sent
with my response.
Proceed to Step 2 on reverse. Do not check any other boxes.
4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased.
12% I am a sibling of the deceased.
15% All other relationships (including none).
The information above is incorrect and/or debts and deductions were paid.
Complete Part 2 and part 3 as appropriate on the back of this /orm.
The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax
Return filed by the estate representative.
Proceed to Step 2 on reverse. Do not check any other boxes.
Please sign and date the back of the form when finished.
PART
z
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 r~mourn rain
Total Enter on Line 5 of Tax Calculation $
4. Amount Subject to Tax 4
5. Debts and Deductions 5 =
6. Amount Taxable 6 $
7. Tax Rate 7 X
8. Tax Due 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.
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Taxnaver Siariature
Telephone Number
Date //~~2//t
IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA
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
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