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Home My WebLink About06-13-13 COMMONWEALTH OF PENNSYLVANIA REV-1182 EX(11-96) DEPARTMENT OF REVENUE BUREAU Of INDIVI�UALTAXES DEPT.280601 HARRISBURG,PA 1]128Afi01 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 017742 KELLER JEFFREY C 310 SEATON COURT CARLISLE, PA 17015-4546 ACN ASSESSMENT AMOUNT CONTROL NUMBER ________ �oia '_________ ________ 13119138 � 54.31 ESTATE INFORMATION: SSN: � FILE NUMBER: 2113-0663 � DECEDENT NAME: KELLER DOLORES M � DATEOFPAYMENT: 06/13/2013 � POSTMARK DATE: 06/12/2013 I COUNTY: CUMBERLAND I DATE OF DEATH: 03/1 7/201 3 � � TOTAL AMOUNT PAID: 54.31 REMARKS: CHECK# 5045 INITIALS: D61 SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS .,�� oF �NO�vra�� T��$ � pennsylvania PO BO% 280601 Pennsylvania inheritance Tax HARRISBURG Pn 17128-0601 Informatian Notice DBPARTMEN70FREVENUE And T�payer Response R`� "•' `•�„`�" <,• ", / FILE NO.2tT0 Z�'{��r7� ACN 131t9138 DATE 04-12-2013 Type of Accrount Estate of DOLORES M KELIER Savings Ghecki�g Date of Death 03-17-2dt3 Trust JEFFREY C KELLER CountyGUMBERLAND Certificate 310 SEATON CT CARIZS�E PA 17015-4545 f--� "K^ � � �.-� � o.. � � � `�{ � � � � U :y � OCJC3 n �'"° � 5cna L. <"') Ltl � � � t!! e--�S � �:yo-! _ _. q C9 "'� � � czr� �S H�1C OP PENNSY�YANFA provided the de¢artment with the infarmation below indicating that at the death of 4he above-named decedent you were a 'aint owner or beneficiary af the account identified. AocouM No.$1006818T4 Rertut Payrt�eret and Farms to: Date Established 06-06-7966 REGISTER OF WILLS Account Balance $ 17,ig4.07 1 COURTHOUSE SQUARE CARLISI.E PA 17013 Peroent Ta�cabie X 54 Amount Subject ta Tac $8,592.04 Tax Rate X 0.150 NOTE': If tax payments are made within three months of the PotentiaV Tax Due $7,288.8t ��enYs date af daath,deduct a 5 perceni discaunt on the tax With 5%Discount{Tax x b.95} $(see Nt3TE') due. Any inheritance t�due wi1l became detinquent nine months after the date of death. PART St�p 1; Please check the appropriate boxes beiaw. y A �No tax is due. i am the spause of the deceased or i am the parent of a decedent who wes 21 years aId ar younger at date of death. Proceed to Step 2 on reverse. Do not check any otAer boxes and disregard the amount shown above as Potential Tar Due. g �The inFormation is The above information is correct,na deductians are being taken,and payment wiii be sent correck. with my response. Proceed ro Step 2 on raverse. Do nat check any other bpxes. c �he tax rate is incorreci. �4.S�s I am a ilneai beneficiary{pareM,child,grandchiid,eto.}of ihe deceased. (Select correct ta�c rate at right, and complete Part � �g��o I am a sibling of the deceased. 3 on reverse.) � 1590 AII other relationships(inciuding none}, p �hanges nr deductions The information above is incorrect and/or debts and deductions were paid. I�sted. Compteie Part 2 and part 3 as appmprrate orr fhe back nf this form. E �Asset witl be reported on The above-identified asset has been or wlll be reported and ta�t paid with the PA Inheritance Ta�c inharitance ta�c farm Return filed by the sstate repeesentafive. REV-1506. Proceed to Step 2 an reverse. Da not check any ather boxes. Ptease sign and date the back o##he form when flnished. 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 additio�al space is required,you may attach 81/2"x 11"sheets of paper.) Date Paid Payee Description Amount Paid 03- � 3 �� 03�-/3 �,� o 0 63�1-!3 - o..ti � o O -/ -/3 ic .� nc - � Total Enter on Line 5 of Tax Calculation $ ,. PART Tax Calculation 3 If you are making a correetion to the establishmeM date(Line 1)account balance(Llne 2),or percent taxable(Line 3), please obtain a written conectlon hom 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.) b. Ne�ct,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[he appropriate tax rate from Step 1 based on your relationship to the decedent. If indicating a different tax rate,please state rO your relationship to the decedent: J � . 1. Date Established 1 BG�06��G/� 2. Account Balance 2 $ � d"1�• �7 3. PercentTaxable 3 x 4. Amount Subject to Tax 4 $ � � 5. Debts and Deductions 5 - m 6. AmountTaxable 6 $ �� Y9 7. Tax Rate 7 X • �� 8. Tax Due 8 $ f 9. With 5% Discount(Tax x .95) 9 X y 3� St@p 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. Work7�7��/�-3-t�0� � Home7/7- -7 33 ll D !O-' 3 axpayer 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