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Home My WebLink About06-05-13 (2) OIIREAU OF INOIVIDIIAL TnxES Penns Ivania lnheritance Tax � DennsVLvania � PO BOX 280603 y • + HARRISBURG PA 17128-06 01 If1T01'I11aYlOf1 NOYIC@ ,+ DEPARTMENTOFREVENl1E xsv-uaa ez m�exec <oe-iz� And Taxpayer Response FILE NO.� � ' ��`� ACN 13127872 ,_, _ DATE 05-24-2013 --�,�c .r, REGISTFii OF f�lL?.a Type of Account 1013 JUN 5 �j� i � �State of FLORENCE M SWEET Savings SIV Checking C l,E R K 0 t• Date Y Death 02-13-2013 Trust MAUREEN A SAMWAYS Count CUMBERLAND Certificate 86 WINDSTONE DR ORPHANS� COUFt( PORTSMOUTH RI ozs�i-3�as��MBE�RLAND CO.,.pq MEMBERS 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. Remit Payment and Forms to: AccountNO.297153 Date Established 12-13-2006 REGISTER OF WILLS Account Balance $38,385.46 1 COURTHOUSE SQUARE Percent Taxable X 16.667 CARLISLE PA 17013 Amount Subject to Tax $6,39770 Tax Rate X 0.045 Potential Tax Due g 287_90 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 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 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 bozes. 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 � �Z�/ 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. Comp/ete Part 2 and part 3 as appropriate on the back ol 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 Tax inheritance tax form Return filed by the estate representative. REV-1500. Proceed to Step 2 on reverse. Do not check any other boxes. Flease sign and date the back of the form when finished. �\ / 1 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 81/2"x 11"sheets of paper.) Date Paid Payee Description Amount Paid „J Total Enter on Line 5 of Ta�c 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 torm. 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 Irust 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 beneticiaries. 4. The amount subject to tax is determined by multiplying the account balance by lhe 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 trom the amount subject to tax. 7. Enter the appropriate tax rate from Slep 1 based on your relationship to lhe decedent. If indicating a different tax rate,please state OffiCial Use Only Q AAF � your reia[�onsnip to the decedent: PA Department of Revenue j 1. Date Established 1 � 2. Account Balance 2 $ PAD � 3. PercentTaxable 3 X i� ' 4. Amount Subject to Tax 4 $ �3 � 5. Debts and Deductions 5 - 4 � 6. Amount Taxable 6 $ � � 7. Tax Rate 7 X 6 8. Tax Due 8 $ � � 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 oi this form, along with a check for any payment you are making. Checks must be made payable to"Register of Wills,Agen[." Do not send payment directly to the Department of Revenue. Under penalry of perjury, I declare that the tacts I have reported above are true,correct and complete to the best of my knowledge and belief. wo�k !�l p / /y 1 3lpC7od- Home N D/ !0 3 d D� Ta ayer Signature Telephone Number Date� 3�/ 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 r?� ONLY: 1-800-447-3020 !, � . -_ _ ._. . ._._ -- - ; . - . �� .. - .F , '� { '✓ .\,.1 i Y '`.��_�'� i �r� T� � � �' � � 1 . � � , 5.•..:_f."'_'c . . ._ '� O � — i M : . .� J�. i - ~ 1 � � • t � _ ' 6� t��. _ � � � � _ � � � ° - � � � � � � � 1 1 - a' � �' m � �J m � '� i� 1 � � � .+ ta r-- , . �: � � I � � ' ,� f � �� ,� � , � < . � � , < F d w r y �c � �$ , � 9' O� ., � . .. G^ E ' i m i � I � i,.�