HomeMy WebLinkAbout05-23-13 � 10:43:27 a.m. OS-14-2013 2l5
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�w��►� oF INDIVIWAI TAXES penns Ivania lnheritance Tax � pennsylvania
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HARRISe11R6 PA 17126-0601 Information Notice �EPANTMENT OF(iEV£NUE
�[Y-IS�7 F1 p�cE1FC(M•111
And Taxpayer Response FILE NO.2��3-0389
�r�'"" ACN 13120853
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` ;;�. DATE 04-22-2013
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�����i� �'i r1� ;'�j �= ; Type of Account
' ' - Estate of JEAN L MILlER Savings
SSN Checking
��t.:i t';�, ;' Date of Death 10-OS-2012 Trust
SHARON L ENSOR �F i�'��f�;��. ` County CUMBERLAND Certificate
488 LANCASTER AVE _
ENOLA PA 17025-2634 C�������( �",.r.�. ,�
PNC BANK N�► provided the department with the information below indicating that at the death of the
aboye-named decedent ou wera a joint owner or beneficia of the account identified.
AccaiM Mo.5140043435 Remit Payment and Forms to:
Date Established 07-07-2010 REGI.S7ER OF WILLS
Account Balance $3,676.00 1 CDURTHOUSE SQUARE
Percent Taxable X�g,�� CARLISLE PA 17013
Amount Subject to Tax $602.68
Tax Rate X Q.045
Poten6al Tax Due �27.12 NOTE': If tax payments are made within three months of the
decedertt's date of death,deduct a 5 perceni discount on the tax
W+th 5%Discount(Tax x 0.95) $(see IVOTE') due. Any inheritance tax due will became delinquent nine months
atter the date of death.
pA� Step 1: Please check tNe appropriate boxes beiow.
t
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.
Proc�ed to Step 2 on r+eve►se. Do not check any other boxes and disregard the amount
shown above as Potentia!Tax Due.
g �The informafion is The above infermation is correct,�o deductiorts are being taken,and paymeni wil{be sent
correct• with my response.
Prt�ceed to Step 2 on reverse. Da not check any other boxes.
� �The tax rate is incorrect. � 4.5�o I am a lineal beneficiary(parer�t,child,grandchild,ete.j of the deceased.
{Select correct tax rate at
right,and complete Part � �p�, I am a sibling of the deceased.
3 on reverse.)
� 159'o 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 par7 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
int�entance tax brm Retum tiled by the estate representative.
REV-1500. Proceed to Step 2 on reverse. 1}o not chetk any other boxes.
Please sign and date the back of the form when finished.
1
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— 10:43:39a.m. OS-14-2013 3r5_i
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I� PART
Z Qebts and Deductions
Allowable debts and deductions must meet both of the fo!(owing criteria:
A. The decedent was legafly responsible for payment,and the estate is insufficient to pay the deciuctible items.
B. You paid the debis after the death of the decedeni and can fumish proof o(payment if requested by the department.
{tf addidanat space is required,you may attact�B 1/2"x i 1"shests o(paper.)
Date Paid Payee Description Amount Paid
Total Enter on Li�e 5 of Tax CalculaGon $
Pi4� Tax Calculation
3 lf you are making a cotrection to the estaWishmer�t date(Line 1)account balance{Line 2),or percent taxabie(Line 3),_
pleasa obtaln a wNtte�correction from tha fManclal insti[utloo and attach It to thls form.
1. Enter the date the account was established or tit{ed as it existed at ihe 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. Frst,determine the percentage owned by the decedent.
i. Accounts that are held"in trust for"another or others w�e 100%owned by the decedent.
ii. For joint accounts estabtished more than a�e year prior to the date of death,the percentage taxable is 100%divided
by the totaf number of owners including the decedeM. (For example:2 owners=50qo,3 owners=33.33%,4 owners
=259'e,etc.)
b. Neut,divide ihe decedenYs percentage owned by the number of surviving owners w beneficiaries.
4. The amount subject to tax is determined by multiplying the accourrt balance by the percent ia�cable.
5. Enter the total of any debts and deductions claimed from Part 2.
6. The amount taxable is determined by sublracting the debts and deductions from the amount subject to tax.
7. Enter the apprapriate tax rate frvm Step 1 based on your relationship to ttie decederrt.
It indicatfnq a different tax rate,p{ease state
your relationship to the decedent:
1. Date Established 1
2. Account 8alance 2 $
3. Peroent Taxable 3 X
4. Amount Subject to Tax 4 $
5. Debts and Deduciians 5 -
6. Amouni Taxable 8 �
7. 7ax Rate 7 X
S. Tax Due 8 $
9. WRh 5%Discount(Tax x.95) 9 X
Step 2: S+gn and date below. Return TWO completed and sgned copies to the Register of wlls listed on the front of this form,
aiong with a check for any payment yau are making. Checks must be made payable to"Register of Wills,Agent." Do not send
payment directfy to the DepartmeM of Revenue_
Under penaNy o(pery'ury,I declare thal the facts I have reported above are true,correct and complete to the best of my knowledge and
belief.
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�.,1.�1�'�._ Home o� ' "C! �4,
Taxpayer Signature Telephone Numbe� Date �/o?� �'3
IF YOU NEED FURTHER ASSISTANCE, CONTACi" CUMBERLAND COUNTY REGISTER �F WfLLS> PA
DEPAR7MEN7 OF REVENUE DISTRICT OFFfCE, OR THE 1NHERfTANCE TAX DIVISION AT
717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARtNG AND/OR SPEAKING NEEDS
ONLY: 1-800-447-3020
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