HomeMy WebLinkAbout03-07-13 (8)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENVE
BUREAU OF INDIVIDUAL TAXES
^EPT. 280601
HARRISBURG, PA 1]128-Ofi01
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
N0. CD 017290
KOONSE RICHARD D JR
710 MOORE RD
WASHINGTON, PA 15301
role
ACN
ASSESSMENT
CONTROL
NUMBER
~I
REV-1162 EXI11-961
AMOUNT
13100624 ~ S 129.72
DECEDENT NAME: KOONSE DOROTHY J
DATE OF PAYMENT: 03/07/2013
POSTMARK DATE; 03/06/2013
CouNTY: CUMBERLAND
DATE OF DEATH: 12/ 1 6/2012
REMARKS:
CHECK#1944
TOTAL AMOUNT PAID:
S 129.72
INITIALS: HEA
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
PU BOX 280601
HARRISBURG PA 17128-0601
Pennsylvania Inheritance Tax
Information Notice
And Taxpayer Response
pennsylvania
DEPARTMENT OF REVENUE
nEV-isaa ez oa~cxcc gee-~z~
FILE NO. 2170
ACN 13100624
DATE 01-04-2013
LISA KOONSE
710 MOORE RD
WASHINGTON PA 15301-8042
CITIZENS BANK OF PENNSYLVANIA provided the df
the death of the above-named decedent you were a
Account No. 6143884234
Date Established 0425-1995
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
With 5% Discount (Tax x 0.95)
Estate of DOROTH
Date of Death 12-16-2012
County CUMBERLAND
Type of Account
Savings
Checking
X Trust
Certificate
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Irtment with the informa~r`~eltiw i 1~ica~gl~lat at
nt owner or beneficiary of tkr~ accow~t id ~)7ti~ed.
Remit Payment and Forms tb: ~ ~ 'x1
REGISTER OF WILLS
$ 3,641.44 1 COURTHOUSE SOUARE
CARLISLE PA 17013
X 25
$ 910.36
X 0.150
$136.55 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') ~ a 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.)
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).
p ~ Changes or deductions
listed.
E ~ Asset will be reported on
inheritance tax form
REV-1500.
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 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
Payee
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 t 1" sheets of paper)
Date Paid
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 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 [he 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 relationsnip [o the ceceoenr:
1. Dale 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
.St@p 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, 1 declare that the facts I have reported above are true, correct and complete to the best of my knowledge and
work ~~ 3ok- (a3~
Signature
Debts and Deductions
Telephone Number
Date 3 ~ y_
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