HomeMy WebLinkAbout02-21-13 (12)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 ]128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EXI11-961
NO. CD 017203
PTASZEK THOMAS F
695 JULIE CT
MECHANICSBURG, PA 17055
(uIJ
ESTATE INFORMATION: s
FILE NUMBER: 2112-1297
DECEDENT NAME: PTASZEK BARBARA E
DATE OF PAYMENT: 02/21/2013
POSTMARK DATE: 02J19/2013
couNTY: CUMBERLAND
DATE OF DEATH: 11/29/2012
REMARKS:
CHECK#2231
AMOUNT
ACN
ASSESSMENT
CONTROL
NUMBER
13500323 ~ 5574.15
TOTAL AMOUNT PAID:
5574.15
INITIALS: HEA
seal RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OR WILLS
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
Pennsylvania Inheritance Tax
Information Notice
And Taxpayer Response
d
~ Pennsylvania
OEPAgTMENT OF REVENUE
aev-~sase ex ue~exec coenv
FILE NO. 2112-1297
ACN 13500323
DATE 01-25-2013
REGISTER Or" `a~liLLS
?013 FEB 21 ~~ 1
Dale of Death 11-29-2012
PTASZEK THOMAS F CLERK Oi:` County CUMBERLAND
695 JULLE CT ~~~'~iANS' COURT
MECHANICSBURG PA I7o5CUMBERLAN,R CO., PA.
Type of Account
Savings
X Checking
Trust
Certificate
CENTRIC BANK 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. 3055720
Date Established
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Remit Payment and Forms to:
REGISTER OF WILLS
$ 26,861.03 1 COURTHOUSE SQUARE
X 50 CARLISLE PA 17013
$13,430.52
X 0.045
Potential Tax Due $ 604.37
With 5% Discount (Tax x 0.95) $ (see NOTE') $'j~(, 1
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 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.
I 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 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 o/this Corm.
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 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 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 "intrust 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 2 $
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, I declare that [he facts I have reported above are true, correct and complete to the best of my knowledge and
belief.
Work
Taxpayer Signature
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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