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Home My WebLink About02-21-13 (10)COMMONWEALTH OF PENNSYLVANIA REV-1162 EX111-961 DEPARTMENT OF REVENUE BUREAU OF INDI VIDUAL TAXE$ DEPT. 280601 HARRISBURG, PA 1 ]128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 017205 PTASZEK THOMAS F 695 JULIE CT MECHANICSBURG. PA 17055 ___-_ mw ESTATE INFORMATION: FILE NUMBER: 2112-1297 DECEDENT NAME: PTASZEK BARBARA E DATE OF PAYMENT: 02/21/2013 POSTMARK DATE: 02/19/2013 CouNTY: CUMBERLAND DATE OF DEATH: 11/29/2012 REMARKS: CHECK# 2223 SEAL AMOUNT ACN ASSESSMENT CONTROL NUMBER 12167272 ~ 5767.72 TOTAL AMOUNT PAID: 5767.72 INITIALS: HEA 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 And Taxpayer Response RECD DED DFFIGE OF ~ Pennsylvania OEPAflTMENT OF REVENUE xevasm [x ooozxsc ,am~z~ FILE NO. 2170 ACN 12167272 DATE 12-13-2012 r0i3 FEB 21 P(~ 1 1' Estate of BARBARA E PTASZEK C LER iC 0 F SSN 208-24-4523 ORPNgjyS' COURT CountyCUMBERLANDI2 THDMAS F PTASZEK ~UMBERLAMD CD., pq 695 JULIE CT MECHANICSBURG PA 171155-6032 Type of Account Savings Checking X Trust Certificate MEMBERS 1sT 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. Remit Payment and Forms to: Account No. 403 Date Established 06-15-2011 REGISTER OF WILLS Account Balance $17,958.51 1 COURTHOUSE SQUARE CARLISLE PA 17013 Percent Taxable X 100 Amount Subject to Tax $ 17,958.51 Tax Rate X 0.045 Potential Tax Due $ 808.13 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°!° 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 ' orrect. 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 farm. 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 [he department. (If additional space is required, you may attach 81/2" x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 ff you are making a correction !o the establishment date (Line t) 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 [he 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. your relationship to the decedent: 1. Date Established 1 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due 9. With 5% Discount (Tax 3 X 4 $ 6 $ 7 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. nvuie ~ - / Taxpayer Signature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WELLS, 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