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Home My WebLink About05-16-13 COMMONWEALTH OF PENNSYLVANIA REV 1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.260601 HARRISBURG,PA 1712$0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 017614 BEAUDUY THOMAS W 306 BAILEY STREET NEW CUMBERLAND, PA 17070 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- Wd ---------- -------- 13111260 $480.79 ESTATE INFORMATION: SSN: FILE NUMBER: 2113-0152 DECEDENT NAME: BEAUDUY RUTH E DATE OF PAYMENT: 05/16/2013 POSTMARK DATE: 05/15/2013 COUNTY: CUMBERLAND DATE OF DEATH: 01/17/2013 TOTAL AMOUNT PAID: $480.79 REMARKS: CHECK# 111 INITIALS: BJ SEAL RECEIVED BY: GLENDA FARMER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES Penns lvania Inheritance Tax E pennsylvania _ PO RIS URG 280601 PA Pennsylvania OF REVENUE HARRISBURG PA 17128-0601 Information Notice ,�,.,�„E.acexEC M-121 And Taxpayer Response FILE NO.2113-0152 ACN 13111260 DATE 03-08.2013 Type of Account Estate of RUTH E BEAUDUY Savings SSN Checking Date of Death 01-17-2013 Trust CECILIA C BEAUDUY County CUMBERLAND Certificate 1704 BRIDGE ST NEW CUMBERLND PA 17070-1141 0 c rn o m n CO cn rn 3> I—' n rrt a M C7I ;IVo z . , (L. ra n O T h O C 1 r rn WELLS FARGO provided the department with the information below indicating tfiat at the dQh Afl°e2 above-named decedent you were a joint owner or be ficiary of the account identified. Account No.3548508385 Remit Payment and Forms to: Date Established 06-17-2011 REGISTER OF WILLS Account Balance $21,36831 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $10,684.16 Tax Rate X 0150 Potential Tax Due $ 1,602.62 NOTE if{ax payments are made within three months the decedent's 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 taxis 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. f3 MThe 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. C The tax rate is incorrect. 4. 5%% 1 am a lineal beneficiary(parent,child,grandchild,etc.) of the deceased. (Select correct tax rate at right,and complete Part 12% 1 am a sibling of the deceased. 3 on reverse.) 15% All other relationships(including none). D 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 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 81 t2"x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART 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. If indicating a different tax rate,please stat Official Use Only 0 AAF your relationship to the decedent: Spi PA Department of Revenue 1. Date Established 1 t 9 8S 2. Account Balance 2 $ PAD 3. Percent Taxable 3 X -5-6 1 2 4. Amount Subject to Tax 4 $ (O t/„$y. 14e 3 5. Debts and Deductions 5 - 4 6. Amount Taxable 6 $ 10 6,1?q, ( to 5 7. .Tax Rate 7 X .;3'4< 6 8. Tax Due 8 $ 4X5'0.79 8 9. With 50%Discount(Tax x .95) 9 X 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 e t Home axpayer 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 z 3�m aw�o p tAU o. J � 1 � qx' � Y J �C pt) � 6ti V10.F�Pt .