HomeMy WebLinkAbout02-27-13 (14)ritance Tax , pennsyLVanla
BUREAU OF INDIVIDUAL TAXES PennSylVanla Inhe DEPARTMENT OF REVENUE
PO BOX 280601 Information Notice REV-1543 EX DocEXEG (08-12) ~
HARRISBURG PA 17128-0601
And Taxpayer Response FILE N0-6?70' ~~' f ~ _ d r
- ACN 13105945
DATE 02-06-2013
RE~l5T~ ~F ~ILL.S
~~13 FEB ~? P1 ~ ~ ~tN SHOAFF
Date of Death 01-28-2013
CLE~~ Q~ County YORK
MAE K PETERSON
1520 S MOUNTAIN RD Q~~~"~~~~~ ~~~~T
DILLSBURG PA 17019-8804~~~BE~L~~D ~(~., 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
ove-named decedent you were a joint owner or beneficiary of the account identifie .
ab
Remit Payment and Forms to:
Account No. 212725 REGISTER OF WILLS
Date Established 04-06-2011 45 NORTH GEORGE STREET
Account Balance $ 8,981.43 YORK PA 17401-1240
Percent Taxable X 50
Amount Subject to Tax $ 4,490.72
Tax Rate X 0.045 NOTE*: If tax payments are made within three months of the
Potential Tax Due $ 202.08 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 /o ( after the date of death.
PART Step 1 ;Please check the appropriate boxes below.
1
. I am the spouse of the deceased or I am the parent of a decedent who was
A ~ No tax is due
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.
information is The above information is correct, no deductions are being taken, and payment will be sent
g The
correct. with my response.
Proceed to Step 2 on reverse. Do not check any other boxes.
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
hesitance tax form
REV-1500.
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 as /a r ao rate on the back of th s form.
Complete Part 2 and part 3 pP P
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. ~,~j1
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 deductibl
B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the de artm
(If additional space is required, you may attach 8 1/2" x 11"sheets of paper.) p ent.
please obtain a written orrect on f om thelfinanc al~institut on~a d ttachbt t nce (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 this 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% i
by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33% 4 oW ed
= 25%, etc.) e s
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 state
your relationship to the decedent: OffjCial USe Only [~ AqF
1. Date Established 1 PA Department of Revenue
2. Account Balance 2 $ PAD
3. Percent Taxable 3 X 1
4. Amount Subject to Tax 4 $ 2
5. Debts and Deductions 5 - 3
6. Amount Taxable 4
6 $ ~
7. Tax Rate ~ X S
8. Tax Due 8 $ ~'
9. With 5% Discount (Tax x .95) 9 X ~
Step 2: Sign and date below. Return TWO com leted
along with a check for an p and signed copies to the Register of Wills listed on the front of this form
y 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 declare that the facts I have reported above are true, correct and complete to the
belief. best of my knowledge and
Work
HnmA
taxpayer Signature
Telephone Number D ea ea
CIF 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 PaVAP _