HomeMy WebLinkAbout05-30-13 (4) COMMONWEALTH OF PENNSVLVANIA REV-1162 EXI11-96)
OEPARTMENT OFFEVENUE
BUH[AU OFINDNIDUALTA%ES
[JEFT 280601
HARRISBURG.PA�]128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
N0. CD 017690
CARBONE DANIELLE
4713-CHARLES ROAD
MECHANICSBURG, PA 17050
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
--- �a�d -- — --
13126720 � 540.22
ESTATE INFORMATION: sSN: �
FILE NUMBER: 2113-0612 �
DECEDENT NAME: HEICHER EDWIN C �
DATEOFPAYMENT: 05/30/2013 (
POSTMARK DATE: 05/3O/2013 I
CouNTV: CUMBERLAND �
DATE OF DEATH: 05/O8/2013 �
�
TOTAL AMOUNT PAID: 540.22
REMARKS:
CHECK# 723
INITIALS: CJ
sea� RECElVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS �
. _ .. .. _ _ . . .. _ . _ .. . . .
BuR�� oF INOIVIDIIAL TAXES Penns Ivania lnheritance Tax � [�enns�/Lvania
PO BOX 280601 Y 1- J
HARNISBURG Pp n128-D6a1 Information Notice DEPNRTMENTOFREVENUE
And Taxpayer Response "`° °""°°""` `°° "'
:�tGJ!ia"- " t;� �F FILEN0.2170
'�.:: �' ACN 13126720
` � `�':!r DATE 05-21-2013
;��`3 ���Y 30 F� ; �g TypeofAccount
� - ,, �, ,, Estate of EDWIN C HEICHER Savings
���H i, ,; SSN Checking
0 R�H A;Y�' C�U RT Date of Death 05-08-2013 TrUSc
DANIELLE cnae��MBERLA��[� C!.?„ (�A CountyCUMBERLAND Certificate
APT A
4713 CHARLES RD
MECHANICSBURG PA 17050-7710
MEMBERS isr Fcu 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. 12080 Remit Payment and Forms to:
Date Established 04-15-1971 REGISTER OF WILLS
Account Balance $1,693.45 1 COURTHOUSE SQUARE
Percent Taxable X 16.667 CARLISLE PA 17013
Amount Subject to Tax $282.25
Tax Rate X 0.150
Potential Tax Due g qp.34 NOTE': If tax payments are made within three months of the
With 5% Discount Tax x 0.95 decedenYs date of death, deduct a 5 percent discount on the tax
( ) ${see NOTE') Q• - due. Any inheritance tax due will become delinquent nine months
after the date of death.
PART $te 1 : Please check the a
� P ppropriate boxes below.
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 paymen[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 � �2% I am a sibling of the deceased.
3 on reverse.)
� 75% All other relationships (including none).
p �Changes or deductions The information above is incorrect and/or debts and deductions were paid.
listed. Comp/ete 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.
Qf additional space is required, you may attach S 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 It you are making a carrection 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 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: Aic�M�-'
1. Date Established , v-�r �y��
2. Account Balance 2 $ l�93 yS
3. PercentTaxable 3 X �6 LF �
4. Amount Subject to Tax 4 $ �-g a �
5. Debts and Deductions 5 -
6. Amount Taxable 6 $ t1�. 3 �/
7. Tax Rate 7 X �''� iSa
8. Tax Due 8 $ `l���'�—
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 Wilis,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 r 7��) ��aa- 6�5�
A/�'�rrio�,z Home ( Z/�)�95•— �!� ���/"Z
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: 1-800-447-3020
.. .�..�. .. .j .
• �
� ••
!�.� A
�iiVF7n-� n , 1� � n ��
iAi�:�e i1i�`Ji1:1: .r✓'i SW�.
,�..r.,�c. .,;'n . i � D_
t='�s�� � i:ut U�' �' �� .._;j tD
t�i'._
Qy N
(i ,� ��It�Y J� � � . � � � � �
1 . � � y J
��N
a�
CL'cl�;>� U °'
�n
o�r�H���s� c��u�,�r °
cuMa�a��:r�a c��.. �a °
f.,. � � �
..,� � c �
r;
w•
G1 r' � �
� � � �
41 r� 't
h� �� � �
� C Q
n �
v `� �
e � �'
, � c �
W �
n FI � r
} r 44h
p �
� �
� � �
�.:
�. �
�
- � �
� .
o ��
<
�
U p.