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Home My WebLink About02-27-13 (8)BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response Pennsylvania DEPARTMENT OF REVENUE REV-1543 EX DocEXEL <~~~, `~/j FILE NO.~O ~~ ~'~ ~,// ACN 13105943 DATE 02-06-2013 ~~tv Q~FI~~ ~F ~E~iSTi~R 4~' ~~~.LS ~j~ ~~~ ~7 PsSte1 o~f~L,~ 3588 SHOAFF Date of Death 01-28-2013 CLLR j( ~~ounty YORK MAE K PETERSON 1520 S MOUNTAIN RD Q~f ~A~S' C~l~~~ DILLSBURG PA 17019-8804 ~$~~~A~~ ~~`' PQ Type of Account Savings Checking X Trust Certificate rovided the department with the information below indicating that at the death of the MEMBERS 1ST FCU p ve-named decedent you were a joint owner or beneficiary of the account ident~f~e . abo Remit Payment and Forms to: Account No. 212725 REGISTER OF WILLS Date Established 08-04-2011 45 NORTH GEORGE STREET Account Balance $ 5,993.95 YORK PA 17401-1240 Percent Taxable X 50 Amount Subject to Tax $ 2,996.98 Tax Rate X 0.045 NOTE'`: If tax payments are made within three months of the Potential Tax Due $134.86 decedent's date of death, deduct a 5 percent discount on the tax ° i count Tax x 0.95) $ see NOTE'` due. Any inheritance tax due will become delinquent nine months With 5 /. ~ s ( after the date of dezth. PART 1 Step 1: Please check the appropriate boxes below. A ^ No tax ~s due. g The information is correct. 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. C ^ The tax rate is incorrect. ^ (Select correct tax rate at right, and complete Part ^ 12% I am a sibling of the deceased. 3 on reverse.) ^ 15% All other relationships (including none). Chan es or deductions The information above is incorrect as /a r ao rate on the back of th's form. g Complete Part 2 and part 3 PP P D 'listed. ed on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax E Asset will be report inheritance tax form Return filed by the estate representative. REV-1500. Proceed to Step 2 on reverse. Do not check any other boxes. he form when finished. ~~ Please sign and date the back of t PART 2 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 the debts after the death of the decedent and can furnish proof of payment if requested by the de artmen (If additional space is required, you may attach 8 1/2" x 11"sheets of paper.) p t please obtain a w tten~orrection f om t elfsnanc aldinstitut on~and attachbt to th (Line 2), or percent taxable (Line 3), 1. Enter the date the account was established or titled as it existed at the date of death. is form. 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% divid 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 indicatinn a rlifforo.,++., ., ...a_ _i__ - ----~ - ....,,,,,.,,. ~a., ~a~C, N~edse state your relationship to the decedent: 1. Date 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 g $ 7. Tax Rate ~ X 8. Tax Due 8 $ 9. With 5% Discount (Tax x .95) 9 X Official Use Orily ^ qAF PA ~epartmen~ of revenue I PAD 1 2 3 4 fi 7 8 Step 2: Sign and date below. Return TWO com leted along with a check for any payment you are making. Checks musgbe made payable toe"Ree ste of IW,~I~ ted on the front of this form, payment directly to the Department of Revenue. g s, Agent." Do not send Under penalty of perjury, I declare that the facts I have reported above are true. rnrrPCt any ,.,,.~,.,~..~.. ~.. ~~_ ,_ belief. .. Work Taxpayer Signature Home Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT YORK COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEA HERITANCE TAX DIVISION AT ONLY: 1-800-447-3020 RING AND/OR SPEAKING NEEDS Date Paid PavPa