HomeMy WebLinkAbout05-22-13 B�R�� oF INDIVIDUAL TA:ES pennsylvania lnheritance Tax � pennsylvania
PO BOX 280601
HARRISBURG PA 17128-0601 Information Notice DEPARTMENTOFREVENIIE
And Taxpayer Response p"154"�""Y" "' "'
FILE NO.'2a+PB � I" i �j— �5� I
ftE �OP��i�C� ;?��F"!CC OF AcNisizs3oi
�_,.� ,�, DATE05-14-2013
,�f)[3 ��fl� 22 P� � �� TypeofAccount
_ Estate of DOLORES WIGHTMAN Savings
C L E R!( �)r SSN Checking
��f I�F�Lt{°�S� (l Q(��te of Death 02-17-2013 Trust
ROSEMARIE KEHRLE untyCUMBERLAND Certificate
33 ALTERS RD GUM6ERLA,P!n CO., '��1
CARLISLE PA 17015-8969
oeRSrowH BANK 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.108006781
Date Established 11-Ot-2005 REGISTER OF WILLS
Account Balance $28,793.06 1 COURTHOUSE S�UARE
Percent Taxable X 50 CARLISLE PA 17013
Amount Subject to Tax $14,396.53
Tax Rate X 0.150
Potential Tax Due $2,159.48 NOTE': If tax payments are made within three months of the
decedent's date of dea[h, 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 �The information is The above information is correct, no deductions are being taken,and payment will be sent
correct. with my response.
Proceed fo 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 � �p�o 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.
R V-1500. � Proceed to Step 2 on reverse. Do not check any other boxes.
,�ti �
��aa/,3 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 8 1/2"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 makln a correction to the esWblishment date Line 1 account balance Line 2 ,or
y g ( ) ( ) percent taxable(Line 3),
please obtaln a written correction from the Tinancial instRution and attach it to tM5 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 accoun[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 join[accoun[s 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 tau 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 that the facts I have reported above are true,correct and complete to the best of my knowledge and
belief.
WOfk �//-�
`�a-oe.vv�.a,..�a� /C�Q,e� Home 7/ 7 oZ/$ �S'�// �a a/.3
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 NEED
ONLY: 1-800-447-3020 „r
BUREAU OF INOIVIDUAL TAXES Peons Ivania lnheritance Tax � ennsVLvania
PO BOX 280601 y � ✓
HARRISBUftG PA 17128-obol Information Notice DEPARTMENTOFREVENUE
And Taxpayer Response "° "" `Yr°�°"X" ` "�,
FILE N0.29d0 p/I -,o�" OSZ I
ACN 13125302
- - � DATE OS-14-2013
REGlS�E';�R OF l`,'11_�S
Type of Account
�!li3 (�IflY 22 �� � 2�Estate of DOLORES WIGHTMAN Savings
SSN Checking
C L t F�;� 4��� Date of Death 02-17-2013 Trust
ROSEMARIE KEHRLE � r �.�• CountyCUMBERLAND Certificate
33 ALTERS RD �F�i FIANS� .,�t��ti
CARLISLE PA i�ois-s969GUMBERLA�lf? ;_�,�., P�
ORRSTOWN BANK 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 Na. 146001540
Remit Payment and Forms to:
Date Established 05-042009 REGISTER OF WILLS
Account Balance $ 150,021.58 1 COURTHOUSE SQUARE
Percent Taxable X 50 CARLISLE PA 17013
Amount Subject to Tax $75,010.79
Tax Rate X 0.150
Potential Tax Due $��,P5t.8P 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 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
carrect. 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 � �pa�, 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 o/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.
� s/,��,� 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 8 1/2"x 11"sheets of paper.)
Date Paid Payee Description Amount Paid
Total Enter on Line 5 of Tax Calculation $
PART Tax Calculation
3 If you are making a correction to the establishment date(Line t)account balance(Line 2),or percent taxable(Line 3),
please obWin a written correction from the financial instRution 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 tauable 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 da[e of death,the percentage tauable is 100%a divided
by the total number of owners including the decedent. (For example:2 owners=50%, 3 owners=33.33%, 4 owners
=25°/a, 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 Ihe 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 �/�
y��o.�.�-c� %�eA�...2v Home 7/7- �2 i$ '�`fv i �a a /i 3
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: t-800-447-3020