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Home My WebLink About07-30-13 BUREAU OF INDIVIDUAL TAXES Penns Ivania lnheritance Tax � ennsV Lvania PO BOX 280601 y P J HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE And Taxpayer Response REV-1543A EX DocEXEC �oa-�z> FILE NO.21 --� ' 3 —�� ACN 13501788 DATE 06-19-2013 Type of Account Estate of MARTHA M COULSON Security SSN X SEC Acct Date of Death 04-30-2013 Stock MARLENE K LANZA County CUMBERLAND Bonds APT 1 3002 MARKET ST -,.. CAMP HILL PA 17011-4541 �� :-: ��► —C �,..� � � f�l ;'� C� —_� L_ :i:a � {"a7 _. C=' .,.,_ � -- �,�': ..� � ^ -' � � �" C.,.J �.,+ "".:"d �t F � ..� � � �� d..M� l�� . �.:F ' e,..v. �. . f ,,k �-+rt r.T ...r �-. '_� _..y.E �° � ��J - `,_� - r;� . !._., .. ��'�✓ _,_ , x..t'� �... i - j `,F L,j� ,..�-1 '�..li ��N � ! f-1 Y �..�,f AMER I PR I SE F I NANC IAL 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. Account No.10624143 Remit Payment and Forms to: Date Established REGISTER OF WILLS Account Balance $87,986.72 1 COURTHOUSE SQUARE Percent Taxable X 100 CARLISLE PA 17013 Amount Subject to Tax $87,986.72 Tax Rate X 0.120 Potential Tax Due $10,558.41 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%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 infiormation 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% 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 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 l�--'ltiheritance tax 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 Deductians 2 ANowable debts and deductions must meet both af the following criteria: A. The decedent was legally responsible for payment,and the estate is insufficient to pay the deductible items. B. Ypu 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 8 112"x 11"sheets of paper.} Clate Paid Payee Descriptian Amaunt Paid Total (Enter on �ine 5 of Tax Calculation) $ PART Tax Calculation � If you are making a correc#ion ta the establishment date(Line 1}accaunt baiance(Line 2),ar percent taxable(Line 3}, please obtain a written carrection from#he 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. Er�ter the total balance of the accaunt including any in#erest accrued at the date of death. 3. Enter the percentage of the account that is taxable ta you. a. First,determine the percentage owned by the decedent. i. Accounts that are held"in trust for"another or others were 100%awned by the decedent. ii. Far joint accaunts estabiished more than ane year prior to the date of death,the percentage taxable is 100°lo divided by the total number of owners including the decedent. (For example:2 owners=5Q%,3 owners=33.33%,4 awners =25°l0, etc.} b. Next,divide the decedent's percentage owned by the number of surviving awners 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 deductians claimed#ram 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 an 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. Amaunt Taxable 6 $ � 7. Tax Rate 7 X � � 8. Tax Due 8 $ � � � � , 9. With 5% Discount(Tax x .95) 9 X , , : ' '. stC-':p iZ: 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 af Wills,Agent." Do not send payment directly to the Department of Revenue. Under penalty of perjury, I decEare that the facts I have reported abave are true,correct and camplete to the best of my knowledge and belief. „, Work , t � � �,,, r ,, y .. G�?. ,.� Home Taxp yer Signature Telephone Number Date `�_��_�I� iF YOU NEED FURTHER ASSiSTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE D1�TRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-$327. SERVICES F{�R TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEED� ONLY: 1-8Q0-447-3020