HomeMy WebLinkAbout03-07-13COMMONWEALTH 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 EX~11-96)
NO. CD 017289
KOONSE RICHARD D JR
710 MOORE RD
WASHINGTON, PA 15301
ewe
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
ESTATE INFORMATION:
FILE NUMBER; 2113-0273
DECEDENT NAME: KOONSE DOROTHY J
DATE OF PAYMENT: 03/07/2013
POSTMARK DATE: 03/06/201 3
CouNTY: CUMBERLAND
DATE OF DEATH: 1 2/ 1 6/2012
13100628 ~ S 136.38
TOTAL AMOUNT PAID:
REMARKS:
S 136.38
CHECK#1943
INITIALS: HEA
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
PO BOX 280681
HARRISBURG Pq 1]128-0681
Pennsylvania Inheritance Tax
Information Notice
And Taxpayer Response
pennsylvania
DEPARTMENT OF REVENUE
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FILE NO. 2170
ACN 13100628
DATE 01-04-2013
LISA KOONSE
710 MOORE RD
WASHINGTON PA 15301-8042
CITIZENS BANK OF PENNSYLVANIA provided the dt
the death of the above-named decedent you were a
Account No. 6144655670
Date Established 09-09.1991
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
With 5% Discount (Tax x 0.95)
Type of Account
Estate of DOROTHY J KOONSE ~ Savings
SSN 191-28-8959 Checking
Date of Death 12-16-2012 X Trust
County CUMBERLAND Certificate
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Irtment with the informatic~'r1 below in~l ating that at
nt owner or beneficiary of the account identified.
Remit Payment and Forms to:
REGISTER OF WILLS
$ 3,828.28 1 COURTHOUSE SQUARE
„ „_ CARLISLE PA 17013
$ 957.07 I
X 0.150
$143.56 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') ~ due. Any inheritance tax due will become delinquent nine months
after the date of death.
PART St@ 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
B I ,The information is
` orrect.
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-15D0.
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 ofthis /orm.
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 [he 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 correctfon 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 k to this form.
1. Enter the date the account was established or titled as it existed a[ 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 indicaGnga different tax rate, pleas
your relationship to the decedent: _
1. Date Established 1
2. Account Balance <
3. Percent Taxable
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
cJtt3p 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 Wilts, Agent " Do not send
payment directly to the Department of Revenue.
Under penalty of perjury, I declare that the facts 1 have reported above are true, correct and complete to the best of my knowledge and
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Telephone Number Date 3-
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 ANDJOR SPEAKING NEEDS
ONLY: 1-800-447-3020