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Home My WebLink About07-01-13 _ _ _ _ _ __ _ .��„ _ BURFAU OF INDIVIDUAL TAXES Pennsylvania lnheritance Tax � pennsylvania PO BOX 280601 HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE REV-1543 EX DocE%E[ (OB-12) And Taxpayer Response FILE NO.21 ACN 13130301 DATE 06-25-2013 ' i�'�,'�.+ -;� ;.� ��'"C� �� ii��~i:1 s 'ts !�3� �il:..;_,,fi? j ype of Account ,%�ji3 JGj_ 1 �� I ,F�ate of DOROTHY C LEISTER Savings, , �$.qN Checking Date of Death 05-14-2013 Trust CLAYTON M LEISTER JR ��ttii� !,�`!:� CountyCUMBERLAND Certificati� 17409 N 37TH AVE ��A��A ��. GLENDALE AZ 85308-4334 CU�iBERLAf�� ;�., �,� ORRSTOWN BANK provided the department witM the information below indicating that at the death of the above-named decedent you were a joint own�r or beneficiary of the account identified. Account No.4000038516 Remit Payment and Forms to: Date Established 07-2&2010 REGISTER OF WILLS Account Balance $16,688.86 1 COURTHOUSE S(2UARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $8,344.43 Tax Rate X 0.045 Potential Tax Due $375.50 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 NOTEi) due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1 : Please check the appropri�te boxes below. 1 A �No tax is due. 1 am the spouse pf the deceased or 1 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 a�Potential Tax Due. g �The information is The above information 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 � 12°lo I am�a sibling ofi the deceased. 3 on reverse.) � 15% All o�her 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 a set has been or will be reported and tax paid with the PA Inheritance Tax inheritance tax form Return fifed by the est te 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 Aliowable 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 additional space is required,you may attach 8 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 If ou are makin a correction to the establishment date Line 1 account balance Line 2 ,or Y 9 ( ) ( ) 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 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. 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 ciaimed 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: 1. Date Established 1 2. Account Balance 2 $ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 $ 5. Debts and Deductions 5 - 6. Amount Taxable 6 $ 7. Tax Rate 7 X 8. Tax Due 8 $ 9. With 5°/a 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 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 L c z. '�'��-- 3 D�lv � � Home Go z — y3�-- `�G Z� Taxpayer Signature Telephone Number Date 4/�� 3 IF YOU NEED FURTHER ASSISTAPJCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVlSION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 _ _ _ .�,� BUREAU OF INDIVIDUAL TAXES Pennsylvania lnheritance Tax � pennsylvania PO BOX 280601 HARRISBURG PA 17128-0601 (C1fOCt1l1tIOC1 NOtICe DEPARTMENT OF REVENUE And Taxpayer Response REV-1543 E%DocEkEC �oe-�z, FILE NO.21 ACN 13130299 ;��; r a j.;d.,�; y��;•�-�:�c DATE 06-25-2013 ��!v l�� ';1 � � �,"'s�_0.5 i �:. ♦ Type of Account '�'�'!3 `��l" 1 �� te of DOROTHY C LEISTER Savings .; SSN Checkin� G L E s �: t;� Date of Death 05-14-2013 Trust CLAYTON M LEISTER JR Q(�i'F-{AF��' ��)a,j��'CountyCUMBERLAND Certifica�t� 17409 N 37TH AYE GLENDALE AZ 85308-4334 CUMRERLA��b�� 4;i,, t�,Q ORRSTOWN BANK provided the department with the information betow indicating that at the death of the above-named decedent you were a joint own�r or beneficiary of the account identified. Remit Payment and Forms to: Account No.647829 Date Established 0&14-1990 REGISTER OF WILLS Account Balance $ 18,069.51 1 COURTHOUSE SGtUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $9,034.76 Tax Rate X 0.045 , Potential Tax Due $406.56 NOTE': If tax payments are made within three months of the i, decedenYs date of death,deduct a 5 percent discount on the tax With 5°lo 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 appropri�te 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. I g �The information is The above information is correct, no deductions are being taken,and payment will be sent correct. with my response. Proceed to Sfep 2 on reverse. Do not check any other boxes. C �The tax rate is incorrect. � 4.5% I amiia lineal beneficiary(parent,child,grandchild, etc.)of the deceased. (Select correct tax rate at , right,and complete Part � 12% I amla sibling of the deceased. 3 on reverse.) � 15% All o�her relationships (including none). p �Changes or deductions The information above is incorrect and/or debts and deductions were paid. listed. Complete Part�and part 3 as appropriate on the back of this form. E Asset will be reported on The above-identified a set has been or will be reported and tax paid with the PA Inheritance Tax �nheritance tax form Return filed by the est e representative. REV-1500. Proceed to Step�on reverse. Do not check any other boxes. Please sign and date Ithe 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. (If additional space is required,you may attach 8 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 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 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. 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 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: 1. Date Established 1 2. Account Balance 2 � 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 $ 5. Debts and Deductions 5 - 6. Amount Taxable 6 $ 7. Tax Rate � X 8. Tax Due 8 $ 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 Wills,Agent." Do not send payment directly to the Department of Revenue. Under penatty 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 /�o z- — �8� - �°B� �.�1„ �., Home G o � �- �'I 35 — `��zS�- Taxpayer Signature Telephone Number Date �� y�� J J� IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA 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 - _ _ . i . _ . _ _ �.., BUREAU OF INDIYIDUAL TAXES Penns Ivania lnheritance Tax � pennsylvania PO BOX 28D601 � HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE REV-I543 E%DocE%EC (OB-12) And Taxpayer Response FILE NO.21 ACN 13130300 _;_,n�. �. DATE 06-25-2013 ; _ ;�,... . _ f'l�t,J!C3 S i.:��l �{ ,f�:?��._�..J Type of Account '`i t3 ��j�. �. �{� I ��state of DOROTHY C LEISTER Savings SSN Checking �L��s�' �;- Date of Death 05-14-2013 Trust ° CLAYTON M LEISTER JR County CUMBERLAND Certificdte 17409 N 37TH AVE ��'{��A�J',�,�� GLENDALE AZ 85308-4334 Cu��RLAN�D ��•o �A ORRSTOWN BANK provided the department with the information below indicating that at the death of the above-named decedent you were a joint own r or beneficiary of the account identified. Remit Payment and Forms to: Account No.103210105 Date Established 07-06-1998 ' REGISTER OF WlLLS Account Balance $��,1 g1,�g ' 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $5,595.60 Tax Rate X 0.045 Potential Tax Due $251.gp NOTE': If tax payments are made within three months of the decedent's date of death,deduct a 5 percent discount on the tax With 5°!o Discaunt(7ax 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 appropri�te 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 ypunger 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 informationl 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'la lineal beneficiary(parent, child,grandchild,etc.) of the deceased. (Se{ect 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 s incorrect and/or debts and deductions were paid. listed. Complete Part�and part 3 as appropriate on the back of this form. E �Asset will be reported on The above-identified as et has been or will be reported and tax paid with the PA Inheritance Tax inheritance tax form Return filed by the esta e representative. REV-1500. Proceed to Step on reverse. Do not check any other boxes. Please sign and date�he 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 deductibie items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additionai space is required,you may attach 8 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 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 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. 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. ff indicating a different tax rate,please state your relationship to the decedent: 1. Date Established 1 2. Account Balance 2 $ 3. Percent Taxable 3 X 4. Amount Subject to Ta�c 4 $ 5. Debts and Deductions 5 - 6. Amount Taxable 6 $ 7. Tax Rate 7 X 8. Tax Due 8 $ 9. With 5%Discount(Tax x .95) 9 X Step 2: Sign and date be�ow. 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 perjury, I declare that the facts I have reported above are true,correct and complete to the best of my knowledge and belief. Work � D Z -- �' �' '� - �,�- r'�f� z°.�Ci�,�h �.- � Home � o� -- �l'� �! ' '� Taxpayer Signature Telephone Number Date G f�7� � 3 IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA 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