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Home My WebLink About01-08-13COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: ZUBRITSKY CYNTHIA A 11 16 STONEYBROOK DR HARRISBURG, PA 17111 fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: SSN: FILE NUMBER: 2113-0008 DECEDENT NAME: WALLACE VERNE A DATE OF PAYMENT: 01 /08/201 3 POSTMARK DATE: 01 /07/201 3 COUNTY: CUMBERLAND DATE OF DEATH: 10/23/2012 REV-1162 EX(11-96) NO. CD 017021 ACN ASSESSMENT AMOUNT CONTROL NUMBER 12161205 ~ S 1, 220.35 TOTAL AMOUNT PAID: REMARKS: S 1, 220.35 CHECK# 6563 INITIALS: DMB SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES Pennsylvania Inheritance Tax PO BOX 280601 HARRISBURG PA 17128-0601 Information Notice ~ E C C, ~ ~ ~ ~ ~ ~ n~r~l~Taxpayer Response PiEVISED NOTICE ;~Z i~'t n -U~3 ~~(11 8 r-;~i ~°~ CLEPK ~~t ORPHANS' C~~~" CINTHIA ZUBRITSKYUMBERLAN~ ~,~,, °'',' 1116 STDNEYBROOK DR HARRISBURG PA 17111-4754 ~, ~ ~ Pennsylvania DEPARTMENT OF REVENUE REV-1543 EX DocEXEC (08-127 FILE NO.-2tt6 ~2 ~ " ~ 3 _ LOO ACN 12161205 DATE 12-05-2012 Estate of VERNE A WALLACE SSN Date of Death 10-23-2012 County CUMBERLAND Type of Account Savings Checking X Trust Certificate BANK OF LANDISBUR6 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. 700019423 Date Established 05-12-2008 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due With 5% Discount (Tax x 0.95) $ 57,092.39 X 50 $ 28,546.20 X 0.045 $ 1,284.58 NOTE": If tax payments are made within three months of the decedent's date of death, deduct a 5 percent discount on the tax $ (see NOTE*) ~a-a 0 ~ 3,$~ due. Any inheritance tax due will become delinquent nine months after the date of death. Remit Payment and Forms to: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 PART Step 1: Please check the appropriate boxes below. 1 A ~ No tax is due. g he information is correct. C ~ The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ 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 form. 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 Debts and Deductions 2 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 Amount Paid Payee Description 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 otltain 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 "intrust for" another or othrers 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: ~ ~ ~~ ~'~~ ~ ~'` I~~ 4 ~ ~,~ f 1. Date Established 1 - ~ ~*-~,~ ~. ~,~~ a~ ;- - , PAD . ~ r~ ~ ~ ~..,. 2. Account Balance 2 $ ~ y ,~r .,x'9 bd d'~hSa} ~'~r y~ "ter '4 ~ i~~~~. 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 ~,,~~,,, ~.- ,~, r ~ ~ ~ - .~,. ~~ 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 erjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. /~ _ % l/ // /~ ~~ ,~~ Work 7 ~ `7 ' 7~,5 - ~~3 / ~ \ Home / 7 --~Sl/~-a3 Z~ x a er Si na ure Tele hone Number 7 ~ 7 3 SS` Date -- ~~~' P Y 9 P ~5 R'~/ ~ I` IF YOU NEEA 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 ON LY: 1-800=447-3020