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Home My WebLink About05-08-13 COMMONWEALTH OF PENNSYLVANIA. REV-1162 EX�11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAX.ES DEPT.280601 HARRISBURG,PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD �17610 WERTZ THOMAS P 127 MOUNTAIN VIEW DR ENOLA, PA 17025 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold _________' __'__'_' 101 � 5205.59 ESTATE INFORMATION: S�SN: I FILE NUMBER: 2113-0540 I DECEDENT NAME: WERTZ RICHARD H � DATE OF PAYMENT: 05/15/2013 I POSTMARK DATE: 05/14/2013 I CoUNTY: CUMBERLAND � DATE OF DEATH: 04/27/2013 I TOTAL AMOUNT PAID: 5205.59 REMARKS: CHECK# 2017 INITIALS: HMW SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU oF INDIYIDUAL TAXES Pennsylvania lnheritance Tax ��7�� p�'nnS�/LVal11a PO BOX 280601 DEPARTMENT OFF:EVENUE HARRISBURG PA 17128-0601 Information Notice r REY-1543 EX DocEXEC t08-12) And Taxpayer Response FILE N0.2'176� Z �I�'`��U ACN DATE 05-09-2013 Type of Account Estate of RICHARD H WERTZ Savings Checking Date of Death 04-27-2013 Trust THOMAS P WERTZ County CUMBERLAND Certificate 127 MOUNTAIN VIEW DR ENOLA PA 17025-1535 G'� `�, C c.,._� :S.J e-y.`�: � � � �.e..e C`> �j _'� ---' �.'� ►�'1 —`' �:' _ �; - �.7 �, r-_ �.. f" ,. F-�; �� , (,;'7 ..... �:7 ` ,.: �� - <."7 +::". ��i �� .....: ,�� - r._, �, . — �" � ..� tf5 C;`.3 MERRILL LYNCH provided the department with the information below indicating that at the death o�the above-named decedent you were a joint owner or beneficiary of the account identified. Remit Payment and Forms to: Account No.872 Date Established REGISTER OF WILLS Account Balance $14,428.q6 1 COURTHOUSE SQUARE Percent Taxable X 33.333 CARLISLE PA 17013 Amount Subject to Tax $4,809.31 Tax Rate X 0.045 Potential Tax Due $216.42 - 5Z 2DSS 9 NOTE': If tax payments are made within three months of the decedenYs date of death, deduct a 5 percent discount on the tax With 5% Discount(Tax x 0.95) $ see NOTE') due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1 : Please check the appropriate boxes belaw. 1 A �No tax is due. 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. P�oceed to Step 2 on reverse. Do not check any other boxes and disreg��rd the amount shown above as Potential Tax Due. g i ne iniurmation is i ne abuve i�,iormaiian i�correct, na deouciiuns are oeir�g idnen, and payir7e�ii vviii oe 5en[ rrect. with my response. Prr�ceed to Step 2 on reverse. Do not check any other boxes. C �The tax rate is incorrect. �4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. (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). p �Changes or deductions The information above is incorrect and/or debts and deductions were paid. listed. Comp/ete Part 2 and part 3 as appropriate on the back of this form. E �Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax inheritance tax form Return tiled by the estate representative. REV-1500. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. ART Debts and Deductions 2 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 department. (If additional space is required,you may attach 8 1/2"x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total (Enter on Line 5 of Tax Calculation) $ �ART Tax Calculation 3 If you are making 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%divided by the total number of owners including the decedent. (For example:2 owners= 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 \ ��\�� s� s� � ��c �\"�\\\�� If indicating a different tax rate, lease state �� p �\��`\��\�� your relationship to the decedent: �� ° <, ��, � � � �. �� \� �� o � �`\v��, 1. DateEstablished 1 �� .� �\� �� :� � ��,�� \�:.�� 2 $ \` ' .. ` ,` '\ y s \�� `\ 2. Account Balance � ;��.�� 3. Percent Taxable 3 X �;�°�� A��`�� \" �\�?��V`��- ",��\�\�\��`\�� `��o� ��\�.��\\ ,�� , 4. Amount Subject to Tax 4 � `�"`�` � � �`��`�� ` �� \\��\�� \ ��\�� \\\\� �� \�� A � �\\�� :A�� . � OA��AA��V�\��'a��A�� 5. Debts and Deductions 5 - �, A�� ,, � ��,�� A�\��A;��V�� $ � 6. AmOUfIt T3x1b12 6 c � � •� �AV`��\�� `�V�� `� �A��\��\\�� \�� '� 7. Tax Rate � \ � � \�� \\\ ��\\\ 7 X � � ��\ \ � �� A�� \ O��V�� p a� VA� - �A �� $ W �\� .. � �� \� ��\\��' 8. Tax Due � �A�V � � �"��` � 9. With 5% Discount(Tax x .95) 9 X ;�.��.,��e��.��.��.��.�� ..�� _>��.��.��.��.�� .�.. Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any 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 best of my knowledge and belief. Work 717-�ZS"-�'f�y� ''� . ��r/ Home - � / Taxpayer Signature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 CrJ � H O v � m � w � o m � 9 rt � ��ECG lF '��' R � �' � � ;�� tECl� � ,:�; ��- >.; _;; � n o C rt r� r• cv �'��:3 (`Ii�Y 1� �=;-; " r:, �, d } 1 - �C W � � �. CL�R�i C:`� � QRPH�!�iS' C�,��;f;-�� CUMBERLnrd� c:_,., �,� � �:� ;�: �i� ic? 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