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Home My WebLink About02-25-13COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: ROHM WILLIAM A 2977 ENOLA ROAD CARLISLE, PA 17015 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) NO. CD 017222 ACN ASSESSMENT AMOUNT CONTROL NUMBER fold ESTATE INFORMATION: sSN: FILE NUMBER: 2113-0190 DECEDENT NAME: ROHM ANNA M DATE OF PAYMENT: 02/ 25/ 2013 POSTMARK DATE: 02/25/2013 COUNTY: CUMBERLAND DATE OF DEATH: 02/06/2013 13108164 ~ $49.26 TOTAL AMOUNT PAID: REMARKS: SEAL CHECK# 1344 INITIALS: HMW RECEIVED BY: 549.26 i.. ~.~~w rwr~wlr'n [+TI']AC'~AI Ir_LI REGISTER OF WILLS REGISTER OF WILLS ritance Tax ~ Pennsylvania BUREAU OF INDIVIDUAL TAXES Pennsylvania Inhe DEPARTMENT OF REVENUE ~1 PO BDX 280601 Information Notice REV-1543 EX DocEXEL (OB-12) ' `0 HARRISBURG PA 17128-0601 7 And Taxpayer Response FILE NO.-~-~I "' 13 ` ACN 13108164 DATE 02-19-2013 RE~ISTE ~F ~~~1L~.S Type of Account ~~~~ F~~ Z 5 ~~ ~EStof ANNA M ROHM Savings SSN Checking Date of Death 02-06-2013 Trust C~.E~~ ~~ my CUMBERLAND Certificate WILLIAM A ROHM QRPKANS' C~~~`~' 2977 ENOLA RD ~~lBERLAND C~., Pry CARLISLE PA 17015-9542 is rovided the department with the information below indicating that a ified death of the M >~ T BAN p above-named decedent you were a joint owner or beneficiary of the account i ent Remit Payment and Forms to: Account No. 1072102 REGISTER OF WILLS Date Established 07-21-1990 1 COURTHOUSE SQUARE Account Balance $ 2,304.27 CARLISLE PA 17013 Percent Taxable X 50 Amount Subject to Tax $1,152.14 Tax Rate X 0.045 NOTE'`: If tax payments are made within three months of the Potential Tax Due $ 51 85 Gam. ~ ~ decedent's datetance tax due will become delalquent n ne months With 5% Discount (Tax x 0.95) $ (see NOTE*) due. Any Inhe after the date of death. PART Step 1: Please check the appropriate boxes below. 1 ue. I am the spouse of the deceased or I am the parent of a decedent who was A ~ No tax is d 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 information is The above information_ is correct, no deductions are being taken, and payment will be sent B ~ with my response. correct. Proceed to Step 2 on reverse. Do not check any other oxes. 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 inheritance tax form REV-1500. i Please sign and date the back of the form when finished. 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. 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 •• ,~N 41~ ~~~a~~~~y d 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% divi by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33%, 4 ownedr = 25%, etc.) 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: 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 f PAD 1 '2 3 4 5 s 7 Official Use Only ^ AAF PA Department of Revenue Step 2: Sign and date below. Return TWO completed and signed co ies to th along with a check for any payment you are making. Checks must be made payable toe' Reg ster ofllWillseA oe th'e front of this form, payment directly to the Department of Revenue. 9 Do not send Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the b belief. est of my knowledge and Work Taxpayer Signature`~L~~' s ~ ~, ~' Home ~t?- ~~ ~-~z ~ 5~ Telephone Number IF YOU NEED FUF~THER ASSISTANCE Date ~~ Z~,___. ~ 3 CONTACT CUMBERLAND 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 PavPP