HomeMy WebLinkAbout05-17-13 CORA�I�NWEAITH OF PENNSYIVANiA REY-1 t82 EX(7 7-H6}
DEPARTM£NT OF RpVENUE
� BUR@Al10FINDIVIpUALTAXES
OEPL 280601
HAflNiSBUFG,PA 1]128-C60 i
PENNSYLVANIA
RECEIVEp FROM: INHERITANCE AND ESTATE TAX
OFFICIAI RECEIPT
NU. CD Q17620
dt3NOHdE TERESA M
55 QLD PIQNEER RD
CRMP HILL, PR 17011
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
---- t�ta --------- ------
13124117 � 531 .$Q
ESTATE INFORMATI4N: ssN: 131241 18 � $51 .1 7
FILE NUMBER; 211 2-1 1 39 I
DECEDENT NAME: PETERS FATRICIA B j
DATE pFPAYMENT: 05/1 �/2�13 �
POSTMARK DATE: 05/16/2013 �
CouNTY: CUMBERLAND �
DATE OF DEATH: 1 O/09/2012 I
�
TdTA� AMCil3NT PAid: 582.97
REMARKS:
GHECK# 1804
INITIALS: HEA
SEA� RECEiVED BY: GLEIVDA FARNER STRASBAUGH
REGISTER OF WILL5
REGISTER OF WILLS
, BUREAV aF INOIVIDUAL .aXES Pennsylvania lnheritance Tax � pennsylvania
PO BOX 28u6o1 DEPARTMENT OF REVENUE
HARRISBURG PA 17128-0601 Information Notice
p c^ � � �A� � xEV-u�s Ex oo�cxcc �oe-iz�
'���� +�/�iitiff� @- u es onse
FILE NO. 2112-1139
i�EC�fS-r`,'� Of� '�;;1ir.I..S ACN13124118
DATE OS-OS-2013
,.�. i�
�L��;� �+,, Type af Account
�Ri'HAhIS' COU13lSSNt201- ABPETERS X Checking
CUA48ERLAh� �'r?., R�teofDeathl0-09-2012 rr�st
TERESA M DONOHOE CountyCUMBERLAND Certificate
55 OLD PIONEER RD
CAMP HILL PA 17011-2050
PsECU provided the department with the information below indicating that at the death of the
above-named decedent you were a joint owner or beneficiary of the account identified.
Account No.201186473 Remit Payment and Forms ta:
Date Established 09-16-1985 REGISTER OF WILLS
Account Balance $68223 1 COURTHOUSE SQUARE
Percent Taxable X 50 CARLISLE PA 17013
Amount Subject to Tax $341.12
Tax Rate X 0.150 NOTE*: If tax payments are made within three months of the
Potential Tax Due $51.17 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[he date of death.
PART SteP 1 : Please check the appropriate boxes below.
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.
Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount
shown above as Potential Tax Due.
g The information is The above information is correct, no deductions are being taken, and payment will be sent
correct. with my response.
Proceed to Step 2 on reverse. Do not check any other boxes.
� �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°/a All other relationships (including none).
p �Changes or deductions The information above is incorrect and/or debts and deductions were paid.
listed. Complete Part 2 and part 3 as appropriate on the back ol this/orm.
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 filed 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.
PART Debts and Deductions
2
Ailowable debts and deductians must meet both of the following criteria:
A. The decedent was legally responsible for payment,and the estata is insufficient to pay the deductib�e items.
B. You paid the debts after the death of the decedent and can furnish proof ot payment iP requested by the department.
pf additiona!space is required,you may attach 8 T12"x 11"sheets of paper.)
Date Paid Payee Description Amaunt Paid
TofaE Enter on Li�e 5 of Tax CalcutaTion $
PART Tax Calculation
3 if ou are makin e cotrectia�ta tt�es#abi�sh�nt date{llne 1 account�lance(Line 2 or
y g ) ), percent tax�le(�ine 3},
pimase abtain a w�ltten correctian from the financiai institution and ariach it to thls torm.
7. Enter the date the account was established or titled as it existed at the date of death.
2. Enter the total balance ot 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 pthers were 100%awned by the decedent.
ii. For joinf accounts estabiished more ihan one year prior To the dafa of deaTh,the percentage taxable is t 00°la divided
by the total number of pwners inGuding the decedent. (For example:2 owners=50°/n,3 ownets=33.33°!0,d owners
=25%, etc.)
b. Next, divide the decedenYs percentage owned by the number of surviving owners or beneficiaries.
4. The amount subject ta iax is dstermined by multipiying ihe account batance by the peroer�t taxabie.
5. Enter the total oF any debts and deductions daimed fram Part 2.
6. The amount taxable is determined by subtraeting the debts and deductions from the amount subject to tax.
7. Enter the appropriate k�rate from 5tep t based on your relationshlp io the decedent.
If indicating a different ta7c rate,please state
yaur 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 _.
B. Amount Taxable 6 $
7. Ta�c Rate 7 X
$. Tax Due 8 �
9. With 5% Discount(Tax x .95) 9 x
�tE(} �: Sign and date belaw. Retum TWO completed and signed copies ta the Register of Wills listed on the front af this farm,
aiong wiih a check fpr any payment you are making. Ghecks must be made payabie to"Register of Wiils,Agent" Do not send
payment dirsctly to the pepartment of Revenue.
Under penaity of perjury, i dsciare thaT the hects i have reparted above are true,correct and compiete to the besf of my knowfedge and
belief.
Work
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Taxpayer Signature Telephane Number Date
IF YQU NEED FURTHER ASSISTANGE, CONTAGT GUMBERLAND GQUNTY REGISTER C}F WI��S, PA
DEPARTMENT OF REVENUE DISTRiCT OFFICE, OR THE INHERITANCE TAX DIVISIC7N AT
717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS
ONLY: 1-800-447-3020
, BUREAO oF INOIVIDUAL Ta:ES Pennsylvania lnheritance Tax � pennsylvania
PO BOX 28a6a1 DEPARTMENT OFREVENUE
NARRISBURG PA 1112H-0601 Information Notice
xEV-�saa Ex oo�cxEC �oe-ix�
And Taxpayer Response FILE NO.2112-1139
ACN 13124117
�E C(}� >: r-,- ,r�.. DATE 05-08-2013
�C�l�i��=_�� UI` i��;�i !»S
Type of Account
�'13 ��flY 17 FI� I� OSEstateofPATRICIABPETERS Savings
Checking
C L r R K i,i Date of Death 10-09-2012 Trust
TERESA M DONOHOE ����A�s, �,��U;�.�. CountyCUMBERLAND Certificate
55 OLD PIONEER RD
CAMP HILL PA i�oii-zo�UM6ERLA?JG G��., ;�,!�
Psecu provided the department with the information below indicating that at the death of the
above-named decedent you were a joint owner or beneficiary of the account identified.
Remit Payment and Forms to:
AccountNo.201186473
Date Established 09-16-1985 REGISTER OF WILLS
Account Balance $424.04 1 COURTHOUSE S�UARE
CARLISLE PA 17013
PercentTaxable X 50
Amount Subject to Tax $212.02
Tax Rate X 0.150 NOTE': If tax payments are made within three months of the
Potential Tax Due $31.80 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 below.
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.
Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount
shown above as Potential Tax Due.
g �he informatiun is The aoove informaiion is correct, no deductions are being taken,and payment will be sent
correct. with my response.
Proceed to Step 2 on reverse. Do not check any other boxes.
� �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. Complete 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 filed 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.
PART Debts and Deductions
2
Ailowabie debts and deductions must meet both of the fo8owing criteria:
A. The decedent was legaily responsibie for payment, and the estate is insufficieM to pay the deductibie items.
B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department.
{!f additional spaoe is required,yau may aKach 81l2"x 11"sheeis of paper.}
Date Paid Payee Description Amount Paid
Total En#er on�ine 5 af Tax Galculation $
PART Tax Calculation
� if ou are makin a carrection ta fhe estabEish�nt date Line 1 account balance Line 2,or
y g { } { } percenf ta�cable(�.ine 3},
please abtain a written wrrection from the financiai instltuHon snd attech 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 acerued ai the date ot death.
3. Enter tfie peroentage af tha accaunt that is taxable to you.
a. First, determine the percentage owned by the decedent.
i. Accounts that are held "in trust for"another or pthers were 100°/a owned by the decedent.
ii. For joint accounts estabiished more than one year prior to the date af death,the percentage Taxable is 100°f�divided
by Ihe total number ot owners indudi�g the decedent {For example:2 owners=50°!0,3 owners=33.33%,4 owners
=25%,etc.)
b. Next,divide the decedenYs percentage owned by the number of surviving owners or beneficiaries.
4. The amaunt subject to tau is determined by muitipiyfng the account balance by the perce�t taxable.
5. Enter the totai of any debts and deductions ciaimed ftom Part 2.
6. The amount taxable is determined by subtraoting the debts and deductions from the amount subject to tax.
7. Enter the apprapriate tax rate from Step S based on your relationship to tbe decedent.
!F Indicating a difterent ta�c rate,piease sfate
your relatipnship ro the decedent:
i. Date Established 7
2. Account Balance 2 $
3. Percent Taxable 3 X
4. Amount Subject to Tax 4 $
5. Debts and Deductions 5 -
6. Amount Taxable 6 $
7. Tax Rate 7 X
$. Tax Due 8 $
9. With 5°/a Discount(Tax x .95) 9 X
�`i��E} 2: Sign and date below. Return TWO completed and signed copies to the Register af Wilis Iisted an the iront of this form,
aiong with a check fpr any payment you are making. Checks must be made payabie to"Register of Wiiis,Agent° Do noi send
payment directly to the Department of Revenue.
Under penaity of perjury, I decfare that ihe facts 1 have re�rted above are frue,correct and complete to the best of my krtowledge and
belief.
Work
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Taxpayer Signature Telephane Number Date
IF YC3U NEED FtJRTFiER ASSISTANGE, C4NTAGT Gt1MBERLANd G4UNTY REGISTER OF WI��S, PA
DEPARTMENT OF REVENUE DISTRiCT OFFICE, OR THE INHERITANCE TAX DIVISlON AT
717-787-$327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS
�� ONLY: 1-$�0-447-3020
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