The URL can be used to link to this page

Home My WebLink About05-24-13 COMMON W EAL1 H OF PpNNSYLVANIA RPl 11fi2 EX111-961 DEPAHIMENT OFRCVENUE �URFAU OF INDIViDUALTA%ES DFPi.28060t nARHISBUFC.Pn i i�28-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT INO. CD 017660 WERTZ VICTOR E 7594 LAKESIDE AVENUE HARRISBURG, PA 17112 ACN ASSESSMENT AMOUNT CONTROL -- �a�� NUMBER - -- -- - - 101 � 5205.59 ESTATE INFORMATION: sSN: I FILE NUMBER: 211 3-0540 I DECEDENT NAME: WERTZ RICHARD H I DATEOFPAYMENT: 05/24/2013 I POSTMARK DATE: 05/21/201 3 I CouNrY: CUMBERLAND I DATEOFDEATH: 04/27/2013 I � TOTAL AMOUNT PAID: 5205.59 REMARKS: CHECK# 2956 INITIALS: CJ sEA� RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WIILS euREnu oF tNOrvioua� �axes Penns Ivania lnheritance Tax -h�� ennSV lvania n PO BOX 280601 Y �/ HARRISBURG PA 1]128-0601 II�IfOr�TlatIOl� NOYICB' .. ` DEPARTMENTOFREVENUE And Taxpayer Respor�se p`� "" "�"""" '�°"_' FILE NO.•&tF$ LI'-I� •�1*��D ACN DATE 05�-09-2013 ,�v �. . ._ . . . _ .. ,,, �i�i.j�'i. .: �J�' � � Type of Accoun[ �:13 (r��' 2�{ !'j � 1i� ` 6state of RICHARD H WERTZ Savings �SN Checking Date of Death 04-27-2013 Trust VICTOR E WERTZ L� � r �, CountyCUMBERLAND Certificate 7594 LAKESIDE AVE ��ii.�� ,. - HARRISBURG PA 17112-421 � L�UPABE�,Lt,P'.:� . , , .-. MERRILL LVNCH 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 idE;ntified. Remit Payment and Forms 1:0: Account No. 672 Date Established REGISTER OF WILLS Account Balance $ 14,425.06 1 COURTHOUSE S�UARE Percent Taxable X 33.333 CARLISLE PA 17013 Amount Subject ro Tax $4,809.37 Tax Rate X 0.045 Potential Tax Due $216.42 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") a . �l due. Any inheritance[ax due vvill become delinquent nine months after the date of death. PART St@p 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 nnt check any other boxes and disregard the amount shown above as Potential Tax Due. g �The information is The above information is correct, no deduc�ions are being taken, and paymen[will be sent correct. with my response. Proceed to Step 2 on reverse. Do not check any other k�oxes. C �The tax rate is incorrect. d4.5°/ I am a lineal beneficiary (��arent,child, grandchild, etc.) of the deceased. (Select correct tax rate at right, and complete Part � �2� I am a sibling of the deceased. 3 on reverse.) � 15% All other rela[ionships (including none). p �Changes or deduc[ions The information above is incorrect and/or debts and deduc[ions were paid. listed. Comp/ete Part 2 and part 3 as appa�priate on the back of this form. E �Asset will be reported on The above-identified asset has been or will be reported and tv:paid with the PA Inheritance Tax inheritance tax form Retum filed by the estate representative. REV-1500. Proceed to Step 2 on reverse. Do net 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 Ihe following criteria: A. The decedent was legally responsible for payment, and the esiate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can fumish proof of payment if requested by Ihe departmen[. Qf additional space is required, you may attach 8 1/2"x 11"sheets of paper.) Date Paid Payee Description Amount Paid - -, -- �-- --- --._—_ --�� - --�I - — — �I _. _._..._ .-- --- — _ _� a Total (Enter on Line 5 of Tax Calculation) $__ _. i 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 awrued 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 Ihe decedent. ii. For joint accounts established more than one year prior to[he date of death, [he percentage taxable is 700%divided by the total number of owners including the decedenL (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 differen[tax rate, please state " �� your relationship to the decedenY. ``� aa� � " � � ,��u+ `� �`,v�,1, h� ��i j4�fk � c:� 1. Date Established 1 ��z �,�,� �i ,.4 }�,, t,�} ��7�}� �? 2 Account Balance 2 $ ,{�� ' �'��j� t, � , < ,r . � c,... i .. f... .. � 3. PercentTaxable 3 X.._ _. _ �� .�F��;��,, — �y�� i .z� r.. �#.ev �,sF..a.�i `' 4. Amount Subject to Tax 4 $ _ ��z �, � F �.� , 5. Debts and Deductions 5 - ��`� �s �� ,��°n,.t.�,e�� ;��. t v ��hr� 6. AmountTaxable 6 � a y� �,.,�� a �� j�y br�;;��'�;�'�.� � nfa ` t�;�*{ d�k��'a� a�r�j�,r 7. Tax Rate 7 X � � �w v� kl�a�. ,+'8;'�'a� �� I'� �'�t'�§�r i � 8. Tax Due 8 $ � '�1; i ;; 9. With 5% Discount(Tax x .95) 9 X u:.._>„>., . �,�.a .� ._�. ..-�„ � . .. . -. . St@p 2: Sign and date below. Return TWO completed and signed copies to the Register of Wiils lis[ed 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 7i7 a4� �Sc� �„u��q( �. Gt�� Home 717 54� ( 63� 5�4��oi3 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 ON LY: 1-800-447-3020 �� ° �� . 2ECfi ' , , 0�� T� ��tr� , � .:; �, .� �-s � � ?ii3 I'i�iY 2y r ;� ; ' $r � � c �;L;;;, � ra Oi;i"riAi;i;'�C ; j N CU�l8E12LA1:'t`, ": �'�., PA L+. 1 i�'f L.e. .}� 1� fzJ ttj (s,t 'j} � '- � tt't 1 p� `; � � � ,; �� . {3 ^�. O � � , _ w � � � ; � M. , _ =. .�t. � ,� � ,�:,. � �a� �; ar� a� ��. "� �`� — __ __ _�__� �