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Home My WebLink About07-16-13 BUREAU OF INOIVIOWL TAXES Penns Ivania lnheritance Tax � ,•�'IZ enns lvania PO BOX 2B0601 v P Y NARNISB112G PA 17128-0601 Information Notice ��v� OEPARTMENTOFREVENUE vev.uu cx o..e�a u�.�n And Taxpayer Response FILE NO.21 -�'�j'0�1�� ACN 13134432 DATE 06-25-2013 RDFC OF�'��t 0� REG�S7ER �� LS TypeofAccount 1 �; .� Estate ot ELINOR DOUVILLE Savings �fi,3 JU(_ lb P�j Zs Checking D�f Death 04-11-2013 Trust THOMAS DOUVILLE CLERK pF CountyCUMBERLAND Certificate STE 301 5225 WILSON LN ORPHQNS� CQU�'r MECHANICSBURG PA i�o5s-cc�M$ERLqHp C�., PQ � Psecu 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: Account No.8106182721 Date Established 02-08-1983 REGISTER OF WILLS Account Balance $ 16,981.22 1 COURTHOUSE SDUARE PercentTaxable X 16.667 CARLISLE PA 17013 Amount Subject to Tax $2,83026 Tax Rate X 0.045 NOTE': If tax payments are made within three months of the Potential Tax Due $ 127.36 decedenYs date of death,deduct a 5 percent discount on the tax With 5°/a Discount(Tax x 0.95) $(see NOTE') due. Any inheritance tax due will become delinquent nine months after the date of death. 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 informalion 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. � �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 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 Retum filed by Ihe esta[e 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 following criteria: A. The decedent was legally responsible for payment, and Ihe estate is insufticient to pay the deductible items. B. You paid the debts after the dea[h of the decedent and can furnish proof of payment if requested by the department. (Ii additional space is required,you may attach 8 1/2"x 11"sheets of paper.) Date Paid Payee Description Amount Paid - - s r � a ' , 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. Enterthe percentage ofthe accountthatistaxableto 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. a. The amount subject to tax is determined by multiplying the account balance by the percent tauable. 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[he decedent. It indicating a different tax rate,please state OffiCial Use Only 0 AAF � your relationsnip to tne decedent: PA Department of Revenue I 1. Date Established 1 1 2. Account Balance 2 $ 1�„ A'�'l. � ,� PA� 3. Percent Taxable 3 X � Zo• ��O'� � 1 4. Amount Subject to Tax 4 $ �gc�'�.n�p 3 5. Debts and Deductions 5 -��'� �� 4 �' 6. Amount Taxable 6 $ — �(�� 3 7�', n�� 5 . _ 7. Tax Raie 7 X . �4�i 6 � 8. Tax Due 8 $ —� — � � 8 J 9. With 5%Discount(Tax x .95) 9 X _ St@P 2: Sign and date below. Return TWO completed and signed copies to the Register o(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, AgenL" Do not send payment directly to the Department of Revenue. Under penalty ot perjury, I declare that the facts I have reported above are true,correct and complete to the best of my knowledge and beliet. Work � Home '� ! h / D�3J � '1/ �-l{l ��11--13 Ta cpayer 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. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 . - . RECORDED QFFICE OF ? REGISTER OF k7lLLS �: ` .. 10i3 JUL a6 F(� 2 23 � r r ��` � � . : . � • CLERK OF ��'� ORPNA�dS' COURT �'�'— CUMBERLAMD CCz. PA =x" �°"v J Q I 9� � y _ � � . � c v� ` ' i v� y� C} �' M� il) �, �a � � d) � � � � ' . r � � � ;�� _ � .i ;; — �� ., r y� ''i � = � � �� ; � _ ,� � - ' , � _ , �., r _ o - � .:; � ; -- (j, 9, � ' i :; ' � _ ' I i;;� . r _ r� '�� i _ ��, ��:. ` � _ . � � 1 � , C� � tni I (l � < � ` � 9 ,�, � ' a 'r� � � .'; 't . �:it..�..._,, � � � � - �� ,1�`: � � th� �+1'r�l