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Home My WebLink About05-22-13 COMMONWEALTH OF PENNSVLVANIA REV-1162 EX�11-96) DEPARTMENT OF REVENUE BUFEAU OF IN�IVIDUAL TAXES DEPL 280601 HARRISBURG,PA iJ128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 017645 KISER JUDY L 208 HEARTH RD CAMP HILL, PA 17011 ACN ASSESSMENT AMOUNT CONTROL NUMBER ---- �o�d 13116755 � 5152.44 ESTATE INFORMATION: SSN: 13116757 � 5403.66 FILE NUMBER: 2113-02J4 I DECEDENT NannE: MEHARGUE JANE A � DATE OFPAYMENT: 05/22/2013 I POSTMARK DATE: 05/22/2013 � COUNTY: CUMBERLAND � DATE OF DEATH: 02/28/2013 I � TOTAL AMOUNT PAID: 5556.10 REMARKS: CHECK# 1446 INITIALS: BAJ SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INOIVIDUAL raues Pennsylvania lnheritance Tax � pennsylvania PO BOX 28D601 DEPARTMENT OF REVENUE HARRISBURG PA 17128-0601 Information Notice And Tax RE.-�s.a Ex o,<E,E� �oa-�z, payer Response FILE NO.2113-0294 RECORL,"� ;y,��;� pF ACN13116755 ,-t+ DATE 03-29-2013 ��3 ��Y �2 F�� ;; �� Type of Account C�E 1'{t ' Estate of JANE A MEHARGUE �Savings � '�� SSN X Checking 0 R�=H A Pd S' C�.�u�t T Date of Death 02-28-2013 rrusc 208YHEARTHERO CUMBERLi,��l,� r:';, r� � CountyCUMBERLAND Certificate . r ;t CAMP HILL PA 17011-8454 aNC BANK NA 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. RemR Payment and Forms to: AccountNo.5004893857 Date EsWblished 0330-2006 REGISTER OF WILLS Account Balance $21,394.00 1 COURTHOUSE SaUARE Percent Taxable X 16.667 CARLISLE PA 17013 Amount Subject to Tax $3,565.74 Tax Rate X 0.045 NOTE': If tax payments are made within three months of the Potential Tax Due $160.46 decedenYs date of death, deduct a 5 percent discount on the tax With 5%Discount(Tax x 0.95) $(see NOTE') �,s�.yy 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 a6ove as Potential Tar Due. g �'fhe information is The above information is correc[,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% 1 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 lorm. 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 esta[e 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 ot the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach 8 7/2"x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation) $ PART Tax Calculation 3 If ou are makin a cortection to the establishment date Line 1 account balance Line 2 ,or Y 9 ( ) ( ) 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 J b. Next, divide the decedenYs 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 deb[s 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 6 $ 7. Tax Rate 7 X 8. Tax Due 8 $ 9. With 5% Discount(Tax x .95) 9 X Step 2: Sign and date below. Return TWO completed and signed copies to[he 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 tacts I have reported above are true,correct and complete to the best of my knowledge and belief. WOrk Home � Tvc yer gnature 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 BURFAU oF INOIVIOUAL r.XES � pennsylvania Po aoX zeo6o� Pennsylvania lnheritance Tax HARRISBURG Pn 17128-0601 Information Notice DEPARTMENT OF REVENUE And Taxpayer Response p" """��""` <�'", FILE N0. 2113-0294 ACN 13116755 �E c Q��'�_� �j( :; �� DATE 03-29-2013 G�SiE�t Or '�:'�.!_; Type of Account ;'fii3 l�iHY 22 ��I �� EslateofJANEAMEHARGUE Savings SSN X Checking C��f't� t.'i' Date of Death 02-28-2013 Trust JUDY L KISER ORPHANS� ��i}f( I CourriyCUMBERLAND Certificate 208 HEARTH RD CAMP HILL PA i�L�IlM�LAi'��D Gt., FI; PNC BANK NA 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.5004893857 Rer�t Payment and Forms to: Date Established 03-30•2006 REGISTER OF WILLS Account Balance $21,394.00 1 COURTHOUSE S�UARE Percent Taxable X 16.667 CARLISLE PA 17013 Amount Subject to Tau $3,565J4 Tax Rate X 0.045 Potential Tax Due $160.46 NOTE`: If tax payments are made within three months of the deceder�t's date of death,deduct a 5 percent discount on the ta�c With 5%Discount(Tax x 0.95) $(see NOTE') �s2, aw 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 Tar Due. g �fhe information is The above information is correct,no deductions are being taken, and payment will be sent carrect. with my response. Proceed to Step 2 on reve�se. IJo 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 � �p�, I am a sibling of the deceased. 3 on reverse.) � 15% All other relationsfiips(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 wi[h the PA Inheritance Tax inheritance tau 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 ihe 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 department. (If additional space is required, you may attach 8 1/2"x 7 7"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If ou are makin a corcection to the establishment date Line 1 account balance Line 2 or Y 9 ( ) ( ), percent taxable(Line 3), please obtain a wrltten correction from the financial institution and attach it to this form. t. 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[axable 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 tauable 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 decedenYs 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 6 $ 7. Tax Rate 7 X 8. Tax Due 8 $ 9. With 5% 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 pery'ury, I declare tha[the facts I have reported above are true,correct and complete to the best of my knowledge and belief. Work � Home T yer ignature Telephone Number Date I 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