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Home My WebLink About06-24-13 COMMONWEALTHOFPENNSVLVANIA � � REV-1782EX�11-96) �EPARTMENT OFREVENUE � BVREAU OF INDIVIDUAL TAXES DEPT.280801 HARRISBUPG,PA 1]t 28-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 017784 CAWLEY MARY 1020 KENT DRIVE MECHANICSBURG, PA 17050 ACN ASSESSMENT AMOUNT CONTROL NUMBER _'_'"___ roia '__"___' '""___' 13115893 � S 127.71 ESTATE 1NFORMATION: SSN: I FILE NUMBER: 2113-0702 � DeCEOENr rvAnnE: SCHAFFNER MARY D � DATEOFPAYMENT: O6/24/2013 I POSTMARK DATE: 06/21/2013 ' COUNTY: CUMBERLAND � DATE OFDEATH: 12/03/2012 I � TOTAL AMOUNT PAID: $127.71 REMARKS: CHECK# 1175 INITIALS: CJ SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS . BUREAU OF IN�IVIOUAL T�ES Penns Ivania lnheritance Tax '�i� enns lvania Po soX zao6o� v P Y HARRSSBURG PA 17128-0601 Information Notice �� DEPARTMENTOFREVENUE And Taxpayer Response aE� �s�°Ex°°<E.E<<o,-,�, FILE N0.2�6 21-13- D7l�Z ACN 13115893 RECORD D OfF10E OF DATE03-25-2013 RE61ST t� . 2013 JUN 2'i F�l 12 36 r''Pe0'A°°°°"` Estate of MARY D SCHAFFNER Savings SSN Checkin MARY CAWLEY CLERK Oi� Dateof Death 12-03-2012 Trust 9 1020 KENT DR ORPHANS' COURT CountyCUMBERLAND Certificate MECHANICSBURG PA i�osappwbBERLAND C�., PA METRO BANK 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.536054109 Remk Payment and Forms to: Date Established 10-07-2002 REGISTER OF WILLS Account Balance $5,676.01 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Taz $2,838.01 Tax Rate X 0.150 Potential Tax Due $425.70 NOTE': If tax payments are made within three months of the decedenYs date of death,deduct a 5 percent discount on the tax With Sq,Discount(Tax x 0.95) $(see NOTE') due. Any inheritance tax due will become delinquent nine months aRer the date of dea[h. 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 not check any other boxes and disregard the amount shown above as Potential Tax Due. g �The information is The above intormation is correct, no deductions are being taken,and payment will be sent correct. with my response. Proceed to Step 2 on reverse. Do not check any other boxes. C �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 � 7 p=�, I am a sibling of the deceased. 3 on reverse.) � 15% All other relationships(including none). p �Changes or deductions The informaGon above is incorrect andJor debts and deductions were paid. listed. Complete PaR 2 and part 3 as appropnate on the back of this lorm. E �Asset will be reported on The above-identified asset has been or will be reported and taz 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 follaving 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 peyment if requested by the department. (If additional space is required,you may attach 81/2"x t t"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If you are making a correctbn W ttie establishmeM dete(Llne 1)aCCOUOt balence(line 2),or percent tazable(Line 3), please obtalne wrltten correctbn trom the tinandal lnstilutbn and etpich R tO thls 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 interes[accrued at the date ot deaih. 3. Enter the percentage of the account that is taxable to you. a. First,determine the percentage ow�d 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 percentape taxabie is 100%divided by the total number of owners including the decedent. (For example:2 owners=50%,3 awners=33.33%,4 owners =25°/,,etc.) b. Next,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 accouot ba�ance 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 deducEions from the amount subject to tax. 7. Enter the appropriate tax rate from Stsp 1 based on your relationship to the decedent. If indicating a different ia�c rata,pleasg state your relationship to the decederrt: �V�+ ' 'N . 1. Date Established 1 /°"°T^�°`� 2. Account Balance 2 $ S�7G'`" � 3. Percent Taxable 3 X So a. Amount Subject to Tax 4 $� F��• d � S. Debts and Deductions 5 - ° 6. AmountTaxable 6 � g��•°� � 7. Tax Rate 7 X Q,a'4LS 8. Ta:�Due 8 $�Z 7• 7! 9. With 5%Discount(Tax x .95) 9 x St@p Z: 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,AgeM." Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are[rue,correct and complete to the best of my knowledge and belief. Work " Home 7�'1 7-2��ls'�� Ta3�paye ignature TelephoneNumber Date�^/`l�3 IF YOU NEED FURTHER SISTANCE, CONTACT CUMBERLAND COUNTY REGFSTER OF WILL° �*� DEPARTMENT OF REVENUE DISTRlCT OFFICE, OR THE 1NHERITANCE TAX DIVi�' r;,;- 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAK" �" ! 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