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Home My WebLink About07-10-13 (3) BURFAU OF INDIVIUWL TRXES Penns Ivania lnheritance Tax � Pennsylvania PO BOX 280601 � HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE And Taxpayer Response +EVasae eK eo�exec �ae-ix� ACN N3O135285 pCI' � J� ��/�' DATE 06-26-2013 AECwi1:?'.� . ;;'� '�i�� P,EG��..;;;.:; or ';-,!�.S Type of Account ,I ,3 J�u�_ l� �� €�a�qf RALPH P JONES Savings )i $$N Checking Date of Death 05-15-2013 Trust JENNIFER BAIN ��L„„ ��- CountyCUMBERLAND Certificate 218 STONEHEDGE LN MECHANICSBURG PA 17055-7007 Qf;p;�iA,t�S� �J�F;i CUMBERLAND CO.. PA M�MSeRS 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. RemR Payment and Forms to: AccountNo. 105290 Dffie Establiahed 01-12-2001 REGISTER OF WILLS Account Balance $2,000.12 1 COURTHOUSE SaUARE Percent Taxable X 16.667 CARLISLE PA 17013 Amount Subject to Tax $333.36 Tax Rate X 0.045 Potential Tau Due $15.00 NOTE*: If tau 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 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. i 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 6oxes and disregard the amount shown above as Potential Tar 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 tarz 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 � �p��, 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/orm. E �Asset will be reported on The above-identified asset has been or will be reported and tau paid with the PA Inheri[ance Tarz inherdance tarz 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 s 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 81/2"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 mrking a correctlon W ths e�blithment d�te(Llne 1)acewuM b�IM�ce ILine 2),or psrceM hxable(Line 3), ---- _. . . RNap oblain a w�n corr�ctbn hom the flnmclal InstRutlon and alltich Rho this form. 1. Enter the date the account was estaWished 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 perceniaQe of the ac9ount that is taxable to you. a. First,determine the percentape owned by the decedent. i. Accounts that are held'in trust for"another or others were 100qe owned by the decedent. ii. For joint accounts est�l(ahed 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 owners=33:39"i'o,4 owners =25qo,etc.) b. Next,div�fe the decedeM's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to[ax is detertnined by mukiplying the account balance by[hB percent taxable. 5. Enter the totel 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 hom Step 1 based on your relationship to the dece�lent. If indicating a diHerent tex rate,please state your relationship to the decedent: 1. Date EstaWished t 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 S. Tax Due 8 $ 9. With 5%Discount(Tax x .95) 9 X St@� 2: Sgn and date bebw. Retum TWO completed and signed copies to the Register of�AS Gsted on the front of this form, along with a check for any payment you are making. Checks must be made payable to"Register of V�iils,�t" Do not send payment directly to[he Department of Revenue. Under penaity of peryury, I declare that the facts I have reported above are true,correct and complete to the best of my knowledge and belief. WOrk Home Taxpayer Signature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT PEM1INSYLVA{+1}A DEPARI'MENT OF REVENUE DISTRICT OFFICE, OR THE INWERITANCE TAX DIVISION AT 717-787-8327. SERVIGES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 � d- � � � �s s �� ' a°" � -5"� � � �� W � N• «�' „r,� t�i1 � � h�1 � ��Q t�) � Q ^ . e �� D� N n � � � � ' . � O c"' � � m � _ �-iJ �` C 7 :3 � � ��' C r • �.r7 '.� :4 r z" r F � � � ^� n ., T''GY :� L� � _, � :r, _ .� �^ .. � , . ��, _ \ C^J)„ � _^ C., '� � ;�C r C� � ^ ' r� ;.� .r V C� `� � �'� ,�„ � e '..n F_, � � � , � w � _� f�,.i . . �1 ':�7 � i� '= �j. �.., a � �i�F — iJ . � � .:� = � '; � i � �� n 'vF� � V a� /ol ff� i � f�l't � . . . � . � ��i `t