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Home My WebLink About07-19-13 BUREAU OF INDIVIDIWL TAXES penns �vania lnheritance Tax ]['�' pennsylvania PO BOX 280601 y Yi�' XARRISBURG PA 17128•0601 Information Notice DEPARTMENTOFREVENUE v[r-ts�f[x oa�cx[c�ae-�z� And Taxpayer Response FILE NO.2113-0629 ACN 13134912 DATE 06-25-2013 1i O �} � TYPe-ef Acco�u� Estate oi JOAN L HASTING� � c Savings SSN � m -° � _. '- Checking Date ot Death 04•18-2013 � � r F� rr rr Trust ROBER7A R LEWIS CounryCUMBERLAND � z rn � " ��Certificate 1631 BRIDGE ST z v? � p �� NEW CUMBERLAND PA 17070-1174 � n o -t -s't T; c� a -n � — ,� c _' � � N ' rn : � � ' �� O l�--� 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. Remit Payment and Forms to: Accounf No.535294705 Date Established 10.142003 REGISTER OF WILLS Account Balance $4,242.44 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $p,127,p2 Tax Rate X 0.150 NOTE': If tax payments are made within three months of the Potential Tax Due $378.18 decedenYs date oi death,deduct a 5 percent discount on the tax With 5°/,Discount(Tax x 0.95) $(see NOTE') due. Any inheriiance tax due will become deiinquent nine months after the date of death. PAR7 Step 1 : Please check the appropriate boxes below. i A �No tax is due. I am the spouse of the deceased or 1 am the parent of a decede�t 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 i�tormation is correct,no deductions are being taken,and payment will be sent correct. with my response. Proceed to S(ep 2 on reverse. Do not check any other boxes. � �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 � �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 appropnate on the back ol this form. E �Asset wili be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax inheritance ta�c form Return filed by Ihe estate representative. REV-1500. I Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PaRr Debts and Deductions x Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment,and the eslate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment i(requested by the department. (If additional space is required, you may attach 8 7/2"x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PAHT Tax Calculation 3 If you are making a corcection to the establishment date(Line 1)account balance(Line 2),or percent taxable(Line 3), please obtain a wririen correction from the financial institution and attach it to this form. 7. Enter the date the account was established or titled as it existed at the date of death. Z. 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 taxa6te is 1005'o 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 diMerent tax rate,please state OfflCial US8 Only �AqF i your relationsnip to the decedent: PA Department of Revenue 1. Date Established 1 1 2. Account Balance 2 $ PAD ?I 3. Percent Taxable 3 x �I 4. Amount Subject to Tax 4 $ 2 1 3 5. Debts and Deductions 5 - 4 � 6. Amount Taxable 6 $ � 7. Tau Rate 7 X 6 8. Tax Due S $ � � S 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 tor 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 besi of my knowledge and belief. WOrk ��l,J-�/L,r.. \`�� {�y��,.,,�� Home Taxpayer Signature � Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. 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