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Home My WebLink About08-12-13 (2) ' , eueEnu oF iNOrvmun� rnxES Penns Ivania lnheritance Tax ' �� e�1�7S lvania n �/ vo eoz zeobot Y p ,7 xARRISBURG PA 17128-0601 IflfOffllatlOfl NOtIC@ ' �EPARTMENTOF REVENUE And Taxpayer Response °`"„""°°""` `°°"�'I �> � 2 FILE NO. 21 /\'� 2� (��p � � ACN 13129787 oL. J DATE 06-19-2013 t Y,LtiJ UFcil,t � , F?�GlS i�ft GF ��IiLLS Type of Account � Jfit3 �� E�of RANDALL E HORNER �Savings S Checking Date of Death 05-20-2013 Trust SANDY K RHOADES C��K �i CountyCUMBERLAND Certificate 532 N BEDFORD ST CARLISLE PA 17013-1913 ��t Hi1�s� c��R; CUfABfRLAND C4., PA 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. Account No. 129287 Remit Payment and Forms to: Date Established 10-19-1992 REGISTER OF WILLS Account Balance $ 1,301.54 1 COURTHOUSE S�UARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $650.77 Tau Rate X 0.120 Potential Ta�c Due $75.09 NOTE`: If tax payments are made within three mortths 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 Taz Due. g �'ihe information is The above information is correct, no deductions are being taken, and paymen[will be sent �T � 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.)oi the deceased. ""''�'�'`4`� (Select correct tax rate at W i�=6 right, and complete Part � �pq, I am a sibling of the deceased. ? 3 on reverse.) � 15% All other relationships(including none). Lm�.Lb,,,�,y i�� 'Z 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 o/this lorm. 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. Please sign and date the back of the form when finished. ��'' " � P"Rr Debts and Deductions z Allowable deb[s 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 oi paper.) Date Paid Payee Description Amount Paid GtJ/N�o O S �Ji�ecT C.2ei71R foN 'a d-S , o0 - 3 PO� ^ � L ��. _ �7' Cv+b1� 'Z�, � 3 co- � � � ��,i - � , PART Tax Calculation 3 It you are making a correction to the establishment date(Line 1)account balance(Line 2),or percent taxable(Line 3), ° please obtain a writt€Pf"correction from tlse flnancial institution and anach it fo 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 inc!uding 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 Ihe decedent. ii. For joint accounts established more than one year prior to the date of death,the percentage taxable is 100%divided by the tolal 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 subjecl to tax is determined by multiplying the account balance by the percent taxable. 5. Enter Ihe[otal of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from ihe amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. If indicaling a different tax rate,please state , Official Use Only p naF your relationship to the decedent: Carn- Law•W r F�� i PA Departmeni of Revenue 1. Date Established 1 2. Account Balance 2 $ PAD i. 3. Percent Taxable 3 x � 2 4. Amount Subject to Tax 4 $ 3 5. Debls and Deductions 5 - �. �.d� �l� 4 � 6. Amount Taxable 6 $ 5 i 7. Tax Rate 7 X 6 - _T 8. Tax Due 8 $ i�=,_..,._..,_.,,,.-- 8 9. With 5%Discount(Tax x .95) 9 X i 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 for any payment you are making. Checks must be made payable to"Regisler of Wills, Agent" Do not send payment directly to the Department of Revenue. Under penalry of perjury, I declare that the facts I have reported above are true,correct and complete to the best of my knowledge and belief. �' �� /� Work 5 S p Z Home -I/7—��{$- 845$ Taxpayer Signature Telephone Number a�3, �4� $ Date g- $- �3 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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