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Home My WebLink About03-07-13 (2)COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF flEVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1]1280601 RECEIVED FROM; KOONSE RICHARD D JR 710 MOORE RD WASHINGTON, PA 15301 rae 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: 12/16/2012 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT FEV-1762 EX(7 7-961 N0. CD 017288 AMOUNT ACN ASSESSMENT CONTROL NUMBER 13100629 ~ S 136.38 S 136.38 TOTAL AMOUNT PAID: REMARKS: CHECK#1942 SEAL INITIALS: HEA RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES PD BOX 288601 HARRISBURG PA 1]128-0601 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response ~ Pennsylvania DEPARTMENT OF REVENUE PEV-15t3 E% UocE%FC (Ot~lt) FILE NO. 2170 ACN 13100629 DATE 01-04-2013 DANIEL KOONSE 710 MOORE RD WASHINGTON PA 15301-8042 Estate of DOROTHY J KOONSE SSN 191-28-8959 Date of Death 12-16-2012 County CUMBERLAND Type of Account Savings Checking X Trust Certificate ~ '-=' m ci CO ~ ~ ~ ~?O ~ rn s n ~.1 rY-t 7r.D Z m -a 1 ~; r:a ~'to-o o`-' , CJ c'B c°+ ~3 - CITIZENS BANK OF PENNSYLVANIA provided the department with the information be~ow in~tin`gltlf~t at the death of the above-named decedent you were a joint owner or beneficiary of ~e account~lentified: Remit Payment and Forms to: Account No. 6144655670 Date Established 09-09.1991 REGISTER OF WILLS Account Balance $ 3,g2g.2g 1 COURTHOUSE SQUARE Percent Taxable X 25 CARLISLE PA 17013 Amount Subject to Tax $ 957.07 Tax Rate X 0.150 Potential Tax Due $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 With 59'° Discount (Tax x 0.95) $~see NOTE") T 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 I ~IThe information is `~-H1'~c~ a'rorrect. C The tax rate is incorrect. (Select correct [ax 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. 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 informatiori is correct, no deductions are being taken, and payment wilt 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. 159'° All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete Part 2 and par[ 3 as appropriate on the back of this fom]. 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 z 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 Description Amount Paid PART Tax Calculation 3 If you are making a correction to the establishment date (Line f) aecouM 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. your relationship to the decedent: _ t . Date Established 1 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 4 5. Debts and Deductions E 6. Amount Taxable E 7. Tax Ra[e i 8. Tax Due E 9. With 5% Discount (Tax x .95) f 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. of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and Work ~~ - ~- f 035 4-Inmu ~7 Sl~ ~ina-. uLF-fN Taxpayer Signature Telephone Number Date 3-5~,~ YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA PARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 7-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND{OR SPEAKING NEEDS JLY:1-800-447-3020