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Home My WebLink About03-07-13 (9)COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENVE BUREAU OF INDIVIDUAL TA%ES DEPT. 280601 HARR158URG, PA 1 ]128-0601 RECEIVED FROM: KOONSE RICHARD D JR 710 MOORE RD WASHINGTON, PA 15301 ,~d ESTATE INFORMATION: FILE NUMBER: 2113-0273 DECEDENT NAME: KOONSE DOROTHY J DATE OF PAYMENT: 03/07/2013 POSTMARK DATE: 03/06/2013 couNTY: CUMBERLAND DATE OF DEATH: 12/16/2012 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ~i REV-1162 EX111-96{ ' NO. CD 017286 AMOUNT ACN ASSESSMENT CONTROL NUMBER 13100627 ~ 5136.38 TOTAL AMOUNT PAID: 5136.38 REMARKS: CHECK#1940 INITIALS: HEA SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INOIVIUUAL TAXES PO BOX 280601 HARRISBURG PA 1]128-0601 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response DEBORAH KOONSE 246 ONDREJKO RD SMITHFIELD PA 15478-1414 CITIZENS BANK OF PENNSYLVANIA provided the dE 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) $ 3,828.28 X 25 $ 957.07 X 0.150 $143.56 $ (see NOTE') ~ ~ Pennsylvania DEPARTMENT OF REVENUE REV-15G3 E% Oa[EXEC 100-121 FILE NO. 2170 ACN 13100627 DATE 01-04-2013 Estate of DOROTHY J KOONSE Date of Death 12-16-2012 County CUMBERLAND Type of Account Savings Checking X Trust Certificate d n w ~ ~rn ~ -~ ~ m ~ ca c ~ ~ ~ rrt = n ~ ~ _.,I I~ ~ p, r" rrt twl irtment with the informatfgp~fef~ty irttlicat$fgJ~iat at Se aecoun; i nt owner or beneficiary o~tt d~i tied v~5 ~ _ Remit Payment and Forms t6P `~ "`' "-= c-a REGISTER OF WILLS -t ~~ J 1 COURTHOUSE SQUARE *1 CARLISLE PA 17013 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 I am the parent of a decedent who was 21 years old or younger at date of death. Proceed [o Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potentra! Tar Due. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed [o 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 Debts and Deductions 2 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 Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 N 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 [he 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 tor" 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 t based on your relationship to the decedent. your relationship [o the decedent: _ 1. Date Established 1 2. Account Balance 2 p 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°I° 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 Wilts, Agent " Do no[ 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 [o the best of my knowledge and belief. /} n /~ r /~ work far{- 5~7 a3 Home Signature Telephone Number Date 3-,cF 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 NEARING ANDlOR SPEAKING NEEDS ONLY: 1-800-447-3020