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Home My WebLink About02-27-13 (25)ritance Tax ~ pennsylvania BUREAU OF INDIVIDUAL TAXES PennsylVanla Inhe DEPARTMENT OF REVENUE PO BOX 280601 Information Notice REV-1543 EX DocEXEC (08-12) ~~ HARRISBURG PA 17128-0601 And Taxpayer Response FILE NO.1~®- ~.; ~ ~ ~ ~' ACN 13105950 DATE 02-06-2013 ~~~~~~~~ ~~ ~~~.5 Type of Account l3 F~~ 2? ~~ ~ ~-state of LAURA R SHOAFF Savings SSN Checking Date of Death 01-28-2013 X Trust ~ ~-~ ~ K ~ fi County YORK Certificate EVERETT E SHOAFF ORPHANS' COU~iT 132 SPRING RD DILLSBURG PA 17019-935 +-~~~E~~~~(~ (i{}., PA 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 identifie . abo Remit Payment and Forms to: Account No. 212725 REGISTER OF WILLS Date Established 12-13-2010 45 NORTH GEORGE STREET Account Balance $ 6,895.07 YORK PA 17401-1240 Percent Taxable X 50 Amount Subject to Tax $ 3,447.54 Tax Rate X 0.045 NOTE*: If tax payments are made within three months of the Potential Tax Due $155.14 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 Is due. g The information is correct. I am the spouse of the deceased or 1 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. is incorrect. 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. C ~ The tax rate ^ (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 ans /a r deob~ ate on the back of th s form. D ~ listedg Complete Part 2 and part 3 a pp p 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 Retur Proceed to Step 2 onpeverseat'Do not check any other boxes. REV-1500. 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 •• ~~~ ~~~ ~~~a~~~~y 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% divid by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33%, 4 ownedrs = 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 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 C}fficial Use Only ~] AAF PA Department of Revenr~e PAD 1 2 3 4 5 ~iep 1: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on th along with a check for any payment you are making. Checks must be made payable to "Register of Wills A ent,,e front of this form, payment directly to the Department of Revenue. ~ g Do not send Under penalty of perjury, I declare that the facts I have reported above are true- cnrrPrt any .~.,,w,..i„~.. ~_ .~ _ ,_ belief. /~ _.._ n _... ,~ _ ~ Work T Home axpayer Signature i~ !~ ~30~ ~l~~Q~ Telephone Number Date~_r~,~ ~ IF YOU NEED FURTHER ASSISTANCE, CONTACT Y °~ 3 DEPARTMENT OF REVENUE DISTRICT OFFICE, OR T HE OINHTY REGISTER OF WILLS, PA 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARINGI AND E TAX DIVISION AT ONLY: 1-800-447-3020 OR SPEAKING NEEDS Date Paid Pavee