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Home My WebLink About06-13-13 (2) _ _ COMMONWEALTH OF PENNSVLVANIA REV-1182 EX�71-98) DEPARTMENT OFREVENUE BUREAU OF INDIVIDUAI TAXES DEPT.280601 HARFISBURG,PA 1]128-0801 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 017741 KELLER JEFFREY C 310 SEATON COURT CARLISLE, PA 17015-4546 ACN ASSESSMENT AMOUNT CONTROL NUMBER ------- ,o�a ---------- -------- 13118038 � $2,011 .88 ESTATE INFORMATION: SSN: I FILE NUMBER: 2113-0663 � DECEDEN7 NAME: KEL�ER DOLORES M � DATEOFPAYMENT: 06/13/2013 I POSTMARK DATE: 06/12/2013 I CouNTY: CUMBERLAND � DATE OF DEATH: 03/17/2013 I � TOTAL AMOUNT PAID: 52,011 .88 REMARKS: CHECK# 5048 INITIALS: DB1 SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF IN�IVIOURL T�ES Pennsylvania lnheritance Tax �i�j pennsylvania PO BO7( 280601 ■ DEPARTMENTOFHEVENUE IWRRISBURG PA 17128-0601 Information Notice ■�1� xevasas ex no�eeec roe-�n And Taxpayer Response FILE NO.2�79 �.1-13� �a�O�j ACN 13118038 DATE 04-04-2013 Type of Account Estate of DOLORES M KELLER �Savings SSN Checking Date of Death 03-17-2013 Trust JEFFREY C KELLER County CUMBERLAND Certificate 31D SEA�N CT �ARLIS��j PA 170�-4546 W .J..! ,I � � . v � �.�- o � t° E oc� Q O O � �' fJ� '�( Q � C'") ti.l Q J tal � � V S � r � N � � � . . V. � � Q � ---- lt1 p� r � � � FULTON BANK NA provided the department with the information below indicating that at the death of the above-named decedent ou were a joint owner or beneficia of the account identified. Remit Payment and Forms to: AccountNO.9903 Date Eatabllshed Ot-23•1997 REGISTER OF WILLS Account Balance $94,123.09 1 COURTHOUSE S�UARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tau $47,061.55 Tax Rate X 0.150 NOTE': If tax payments are made within three months of the Potential Tax Due $7,05923 decedent's date of death,deduct a 5 percent discount on the tau 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 informatio[iis - The al�ove information is correct, no deductions are being taken,and payment will be sen[ correc[. with my response. Proceed to Step 2 on reverse. Do not check any other boxes. � he tax rate is incorrect. �5% I am a lineal beneficiary(parent,child, grandchild, etc.) of the deceased. (Select correct tax rate at right,and complete Part � 12% 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 Tau inheritance tax form Return filed by the estate representative. REV-1500. Proceed to Sfep 2 on reverse. Do not check any other bozes. 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 decsdent was legally responsible for payment,and the estate is insuflicient 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 additianai space is r�uired,you may attach 81(2"x 11"sheets of paper.) Date Paid Payee description Amount Paid Tokal Errter on Line 5 of Tax Caicu�ation $ PART Tax Caiculation 3 N you are meking a correctian to the estabiishment date(Line 1j accouM baiance(Line 2),or percent taacable(Line 3), please obtain a written correctlon tmm the financial insUtudpn and attach!t to thia form. i. Enter ihe date the account was eskabEished or titled as it existed at the date o(death. 2 Enter the total balance of ihe account including any irterest accrued at the date of death. 3. Enter the percentage of the account that is[axable to you. a. First,determi�e the percentage awned by ihe decedent. i. Accounts that are held "in trust for"another or others were 100%owned by the deceden[. ii. For joint atxounts estabiished more than ane year prior[o the date of deatfi,#he percentage tanable is 100%divided by the total number of owners including the decedent. {For example:2 owners=50%,3 owners=33.33°10,4 owners =25%,etc.} b. Next,divide the deoedenYs percentage owned by the number of surviving owners or beneficiaries. 4. The amaurrt subject to ta�c is determined by muitiptying the account baiance by the percent tauable. 5. Enter the to[a!of any debts and deductians claimed from Part 2. 6. The amount taxabie is determined by subtracting the debts and deductions from the amount subJect to tau. 7. Enter the appropriate tau raie from Step t based on yaur relationship Yo the decedent. If indicating a different tax rate,please state t^ your relationstrip to the decedent: 1 � 1. DateEstablished 7 0 -�3- 997 2. Account Balance 2 $ ,�/.Z�. v�' 3. Percent T�able 3 X .rl� 4. Amount Subject to Tax 4 $ 'y ,7,O G�. '�� 5. Debts and Deductions 5 - 8. AmountTauable 6 $ tS�a "�� 7. T�Rate 7 X .�r�.._ — ! 8. 7axDue B $ � /�7. 7�7 9. Wi[h 5°1a Discount(Tax x.95} g X � � �+� .�iif8K3 �: Sign and date below. Aeturn TWO compieted and signed copies to the Register of Wiils listed on the front pf this form, along wi[h a check for any payment ypu are malting. Checks musi be made payable to"Register of Will&,Agent" Do nat serxi payment directly to the Department of Revenue. Under penaity of pery'ury, I declare that the facis I have reported above are true,correct and compiete to the best of my knowiedge and belief. Wark��-G,�D^r�'.�C11 �. Home�j7 --7 .� �a G'� — !:>^1 T payer Signature Telephone Number Date IF YC7U NEED FURTHER AS5ISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT C?F REVENUE QISTRIGT OFFICE, OR THE INHERITANCE TAX QIVISION AT 717-787-832�. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 4-840-447-3020 _ . _ � o `°� � �i,� \� �� nb 2+ ` -� �6 � 1 . ,r-i a � � ; W J � d O \ � � �y � � OC.? p r ' t.� �+- � �C - 2 - O 0 � Z j } w � `"� � _ � � � N = � � Il) G7 W � � � • 4h a r�-' V � � ' n � 0 � 4 �' � � t b �b i :; G , R � = � � : � Q � � � � : � _ � �`'' � �, �� = w C� � � �. � 3 - � i � � �, ' yC �" m � � � = (n � �°' F �, F