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Home My WebLink About02-01-13COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 017124 L1CIlC000 CTCOUCnI n C 7~1R ~E'd2r~~ `~UZC~.11~ M . 2 ~ ~es~.u ~ ctc. ~ ~ . iv~c~1 F ~ l~~l fold ESTATE INFORMATION: sSrv: FILE NUMBER: 21 12-1 100 DECEDENT NAME: DEDERER SUSAN K DATE OF PAYMENT: 02/01 /201 3 POSTMARK DATE: 01 /31 /201 3 COUNTY: CUMBERLAND DATE OF DEATH: 10/02/2012 REMARKS: AMOUNT REV-1162 EX(11-96) ACN ASSESSMENT CONTROL NUMBER 1 1 31 03677 ~ 5328.08 TOTAL AMOUNT PAID: 5328.08 CHECK# 2733 INITIALS: DMB SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES Pennsylvania Inheritance Tax PO SOX 280601 HARRISBURG PA 17128-0601 Information Notice And Taxpayer Response RECOR~FD 4F~"!CE OF Pennsylvania DEPARTMENT OF REVENUE REY-1543 EX DocEXEL (33-12) FILE NO. 2112-1100 ACN 13103677 DATE 01-23-2013 ?~i3 FEB 1 ~Cl I1 S~ state of SUSAN K DEDERER CLERK Q ~ SSN Date of Death 10-02-2012 SUZANNE M DEDERER ORPHANS' CQURT County CUMBERLAND 20 KESWICK DR MECHANICSBURG PA I7o5o-@BERLANA CO., PA Type of Account Savings Checking Trust Certificate AMERICHOICE Fcu 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. 28790 Remit Payment and Forms to: Date Established 01-06-1997 REGISTER OF WILLS Account Balance $ 14,581.16 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $ 7,290.58 Tax Rate X 0.045 Potential Tax Due $ 828.08 NOTE`: If tax payments are made within three months of the d d ' With 5% Discount (Tax x 0.95) $ (see NOTE* ) ece ent s date of death, deduct a 5 percent discount on the tax due. Any inheritance tax due will b d li ecome e nquent nine months after the date of death. PART Ste 1: Please check the a 1 P ppropriate boxes below. A [~ No tax is due. 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. 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. 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.) 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 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 "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 , i ,:` your relationship to the decedent:~',~~~ ~ ~~` ~ 1. Date Established 1 "'3~ "~ ~ ~3~~ 2. Account Balance '~"' ~'~ ,. 3. Percent Taxable 3 X r ~,~~.:_-~- -~-- 4. Amount Subject to Tax 4 $ :. _ ~ 5. Debts and Deductions 5 - ~,~,=', ~ ~, . ~ _ ""f' 6. Amount Taxable 6 $ ~. ~ ~ r.~ ~ ~ ,i { ' 7. Tax Rate X ,~~ . ~ ~- r4r mss: -~~,~~ 8 $ ~~, r u = ,s, ~ as ~s ~ ,. 8. Tax Due ~ '~ `~ ' ~ "' 9. With 5% Discount (Tax x .95) 9 x ;.' r ,.`,, , "~"--" - ~ °~ 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 pe ty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. Work I ~ ~ ~ ~~~ ~ X' ~ ~~ ~~ ~ n /~ ~~ ~ ~~ ~ ~ ~ % ;',Q~.~ Home T ay r Signature Telephone Number Date IF U 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 .. _._ ~_~~ o,,,oo Description Amount Paid ~~~ ~, ~) ~-- ~.;; ~ g ~~ ~- '`` jam; ;~_ ~C ~~' (i~ .J ~- ~~ `_~ Vh 1 ~ ~~/ C ~ ~ 'jam v_, l_.~ I \' L, c~ -~' i ~ =b ._ '~ ~; t%~ ~~ 5 {..,. ,.. {; ~A~ i ~~ tti~ t if.~ ~~~ ~~ `~ ;~ ~. ~ ~~. ~ ~ ~, ~. ~. ,---. ~ ~ ~~ (~, ~~~ ~-` ~\. r~ _ `1 ~~ V J -~ - ; ,~ v ~~~. r, `~,_. ~~ ~~ .SNnHdklO 5111.' ~'.0 `~~~t932~ ~0 ~~~.~~~ v~GN0~3k! t ~x r T~ ~:x.<. - £~ ~~, ~,-: ;~ s ,~ -_ ~~ ~_ ~: :.~ ,} , ~ ~z } ~~ ~~~v ~, E '/ = . ~k ~~ - -., o m ~4'. < , M t p c r zLOZ' ~ f`,' x ~. r