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Home My WebLink About02-06-13BUREAU OF INOIVIOUAI TAXES PU BOX 280601 HARRISBURG PA 1]128-0601 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response pennsylvania DEPARTMENT OF REVENUE aEV-iun cM no=ExEC toe-tz, FILE NO. 2112-1304 ACN 13104689 DATE 01-30-2013 ROY E LARSEN 21 N 11TH ST ALLENTOWN PA 18101-1019 Estate of ELEANOR Date of Death 10-27-2012 County CUMBERLAND Type of Account Savings Checking Trust Certificate rte:. P w G 0 ..n m m z ~? ~Zrn m CITIZENS BANK OF PENNSYLVANIA provided the dE the death of the above-named decedent you were a Account No. 6200258531 ~rn m n Q7 Q ~~ -~ o mm ~v q ~ ~ 71:,dta~~ p 0 - -tt;'rti , '~.~y~ Y7-- O - ~ ~ "~-. - ~ n n C~ ^ o ~ ' rr, m ~ O ...{ ~ ~ vent with the irl~rmation below indicating that at owner or beneficiary of the account identified. Remk Payment and Farms to: Date Established OB-28-2002 REGISTER OF WILLS ~ Account Balance $ 25 453.82 1 COURTHOUSE SOUARE i Percent Taxable , X r~ CARLISLE PA 17013 Amount Subject to Tax $12 726 91 , . Tax Rate X 0.045 Potential Tax Due 71 $ 572 NOTE': If tax payments are made within three months of the ' , decedent s date of death, deduct a 5 percent discount on the tax With 5°J° Discount (Tax x 0.95) $ (see NOTE') due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1: Please check the appropriate boxes below. 1 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.) D ~ Changes or deductions listed. E~Asset will be reported on inheritance tax form REV-1500. 1 am the spouse of the deceased or 1 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 [he deceased. 12°!° 1 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 o/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 2 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 Descdption Amount Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If ou are makin a correction to the establishment date Line 1) account balance Line 2 , or y g ( ( ) percent taxable (Line 3), please obtain a written cori$etlfiq from the financial institution and attach it to this form. 1. Enter the date the account wiisl'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 [he 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. A. 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. rr mdicanng a different tax rate, please state your relationship to the decedent: 1. Date Established 1 X X X Untler 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. work ~Iy--~3~ -Sb`l3 Home (~iD ~s2/-S~lS~ ~~ TaxpaygF Signature Telephone Number Date 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 .St6p 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. ~. ~dr REG~~~ ~~ OF ,~11.~-5 S~ b ~ ~` 4~'`3 FE r .. ~o ORS ~At-~.`-~ '*n ' ~iu~~ 3 .~ "7,Ss-' ~'~' .~• c:? I,~.P Q1 n e+ N +e O W ~~ "6 d in N a a