HomeMy WebLinkAbout02-27-13 (12)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 DocEXE ~~ ~12),, , (r
FILE NO.B~''PO- ~ ~'~ „/J„~(~C
ACN 13105937
DATE 02-06-2013
REGtSTE~t 4F ~yiLLS~
~~~~ f E~ ~ ~ t i ~ ~ ~~ SSN SHOAFF
Date of Death 01-28-2013
MAE K PETERSON ~LE~~ ~~ County YORK
1520 S MOUNTAIN RD ~~N/~N5' CQU~T
DILLSBURG PA 17019-880 ~B~~L~~~ ~~.~ P1~k
Type of Account
Savings
Checking
X Trust
Certificate
u rovided the department with the information below indicating that at the death of the
MEMBERS 1ST FC p
above-named decedent you were a joint owner or beneficiary of the account identifie .
Remit Payment and Forms to:
Account No. 212725 REGISTER OF WILLS
Date Established 06-02-2011 45 NORTH GEORGE STREET
Account Balance $13,793.73 YORK PA 17401-1240
Percent Taxable X 50
Amount Subject to Tax $ 6,896.87
Tax Rate X 0.045 NOTE'`: If tax payments are made within three months of the
Potential Tax Due $ 310.36 decedent's date of death, deduct a 5 percent discount on the tax
Discount (Tax x 0.95) $ (see NOTE'`) due. Any inheritance tax due will become delinquent nine months
With 5 after the date of death.
PART
1
Step 1: Please check the appropriate boxes below.
A ~ No tax is due.
g The information is
b~ 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
nheritance tax form
REV-1500.
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).
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 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 artment.
(If additional space is required, you may attach 8 1 /2" x 11 "sheets of paper.) p
•• ~~M a,~ ~~~a~~~~y a correction to the establishment date (Line 1) account balance (Line 2), or percent taxable (Line 3),
please obtain a written correction #rom 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% divide
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 Inc'liratinn a rliffo rt~n+ +..., ....a. ~ ~ _
- --- - -~ _ ......,, .,, , < <a,. , a~C, N~edse stare
your relationship to the decedent: flffiCial 11Se fJnly (;,~ qAf
1. Date Established 1 PA Department of .Revenue
2. Account Balance 2 $ PAD
3. Percent Taxable 3 X 7
4. Amount Subject to Tax 4 $ ~
5. Debts and Deductions 5 - 3
6. Amount Taxable
6 $ ~
7. Tax Rate 7 X
8. Tax Due 8 $ ~
9. With 5% Discount (Tax x .95) 9 X ~
Step 2: Sign and date below. Return TWO com leted an
along with a check for any payment you are making. Checks musgbedmade payable toe' Reg ste of IWillsed on the front of this form,
payment directly to the Department of Revenue. ,Agent." Do not send
Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best f
belief. o my knowledge and
Work
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Taxpayer Signature Telephone Number
Date
IF YOU NEED FURTHER ASSISTANCE, CONTACT YORK COUNTY REGI
DEPARTMENT OF REVENUE DISTRICT OFFICE, STER OF WILLS, PA
717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEART ERITANCE TAX DIVISION AT
ONLY: 1-800-447-3020 NG AND/OR SPEAKING NEEDS
Date Paid PavPP