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Home My WebLink About03-12-13COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: HOLTZMAN JOHN A 644 N 2ND ST WORMLEYSBURG, PA 17043 fold ESTATE INFORMATION: ssN: 168-26-4798 FILE NUMBER: 2113-0261 DECEDENT NAME: HOLTZMAN DOROTHY J DATE OF PAYMENT: 03/ 12/2013 POSTMARK DATE: 03/ 1 1 /2013 COUNTY: CUMBERLAND DATE OF DEATH: 01 /02/2013 REV-1162 EX(11-96) NO. CD 017309 ACN ASSESSMENT AMOUNT CONTROL NUMBER 13110566 ~ 5227.93 TOTAL AMOUNT PAID: REMARKS: CHECK# 2244 SEAL PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT INITIALS: HMW 5227.93 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 JOHN A TZMAN 278 TIUS AVE SU RY PA 17801-1058 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response REG~ $ ~R ~~ ~r LS ~kf ~ Pennsylvania DEPARTMENT OF REVENUE REV-1543 EX DocEXEC (08-12) FILE NO.~t~O"'- ~ ~ ~ ~' ~ ~~ / ACN 13110566 DATE 03-06-2013 ~~+ i~ ~~ ~ ~ ~!~ ~' ~ Nt168-D26-479gHY J HOLTZMAN Date of Death 01-02-2013 ~ ~-~ ~ ~ ~' County CUMBERLAND QRRFi~~S' C~#JRT cu~e~~i~~~ ~~,. ~~ ~~ L ` b~l~l ,u. ~0 5i ._,_.., ,Dt i~ ~N~ ,,.~~~,rs~~- ~ T" Cl~ ~ zz.~l~ 1~~~3 ~ZZ~ .~~ Type of Account Savings Checking X Trust Certificate SUSQUEHANNA 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. Remit Payment and Forms to: Account No. 0 Date Established 07-23-2008 REGISTER OF WILLS Account Balance $ 10,663.35 1 COURTHOUSE SQUARE CARLISLE PA 17013 Percent Taxable X 50 Amount Subject to Tax $ 5,331.68 Tax Rate ~_ X 0.15 ~ J~o/t~.e'f Potential Tax Due $ 799.75 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 5% Discount (Tax x 0.95) $ (see NOTE*) due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1: Please check the appropriate boxes below. A ~ No tax is due. g ~ The information is correct. C The tax rate is incorrect. (Select correct tax rate at fight, 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 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, randchild, etc.) of the deceased. ~o1J 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 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 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 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 "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 indicating a different tax rate, please statq Official USe Only ^ AAF your relationship to the decedent: 9/~ PA Department t~f F~evenU~ 1. Date Established 1 ~ 2. Account Balance 2 ~ ~ ~p(o ~ ~ PAD 3. Percent Taxable 3 X ~~ ~ rr 2 4. Amount Subject to Tax 4 $ ~?j3 ~ • b~ 3 5. Debts and Deductions 5 - /'~~' 4 6. Amount Taxable 6 $ ~~ ~ , Co ~ 5 7. Tax Rate 7 X .~ 6 8. Tax Due 8 $ ~~~~~ ~ 8 9. With 5% Discount (Tax x .95) 9 X ~ Z~ . ~ 3 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 Clare that the facts I have reported above are true, c - rrect and complete to the best of my knowledge and belief Work ~~ ~ ~~ _ ~~ `{ ,- Tax yer Signature Telephone Number Date IF O NEED FURTh~R ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DE RTMENT 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 ,~ I `~J ~. ~~ ~. '~ a :i { ,i' f . m ~, .~} s: ~8 S :ou u W +r V~ a a O ~~ w ~~ ~/{`1 c~ J r _- ~~ ~ ~ ~ r~` ~ ~ _r 3 ~, Y J'~ a-'~ " a ~~ V , ~ \-~ R ~ ~ ~. c~ 7` r j 1~ ~ Q ~~j ~ ~ ~ _ ~~.- ~'j ~ ~ ~ ~~ a ~~ ~~»~~~n~ ~~~ ~~~~ ~0 ZT ~~ ~Z ~b~! ~~~z, "f ~~ ~Y'i '~ }~~j .~