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Home My WebLink About08-15-13 BUREAU OF INDIYIDUAi� TAXES Pennsylvania lnheritance Tax • pennsylvan�a PO BoX 280b01 � _ DEPARTMENT OF REVENUE HARRISBURG PA 17128-D601 �� w , ; 7J�fd�tnation Notice 'y "' +,�-,_A�/�T�fL��\fII�' R�G'��f1nG�C1 REV-1545 EX DocE%EC <OB-127 t, . ' . . _, , a ctr� �c � � � v��,�v FIIE N{�.21-1�%J�� ACN 13134431 �� , i: - .� t c; � .'�� " ;` �� DATE 06-25-2013 ` -�`_ ° Type t�f Account ��`' ""'. `� � � Estate af ELINOR DOUVILLE Savings �, _ "°;� ��r��.?,',� � ,`'. SSN 191-20-5456 X Ghecking Date of Death 04-11-2013 Trust DAVID J DOUVILLE County CUMBERLAND Gertificate s��t»: �6 7 �-'�rdJ'rv�1 .G�r ��w l,S,�j�rr� �.. 1�3�� PSECU provided the department with #he informatian beiow indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Account No.8106182721 R�mit Payment and Forms to: Date Estabtished 02-0&i9$3 REGISTER flF WIL�S Account Balance $ 16,981.22 1 COURTHOU�E S�UARE Percent Taxable X 3 6.667 CARLI$�E PA 170f 3 Amount Subject to Tax $2,830.26 Tax Ftate X O.Q45 �p�E*: If#ax payments are made within three manths of the Potential Tax Due $127•36 decedent's date of death,deduct a 5 percent discount on the tax With 5°Io Discount{Tax x Q.95} $(see NC?TE`) due. Any inheritance tax due will become delinquent nine months after the date of death. PART StGp 1 : Please check the appropriate boxes belaw. 1 A�No tax is due. 1 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 riot ci�eck any other boxes and disregard the amount shown above as Potential Tax Due. g �The information is The above informatian is carrect, na deductions are being taken,and payment will be sent correct. with my response. Proeeed ta Step 2 on reverse. Do not cheek any ofher boxes. G �The tax rate is incorrect. � 4.5% I am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased. {Select correct ta�c rate at right,and complete Part � 12��d I am a sibling of the deceased. 3 on reverse.) � 15°ta AI(other relationships(including none). p �Changes or deductians The infarmatian above is incorrect and/or debts and deductions were paid. listed. Comp/ete Part 2 and part 3 as appropriate on the back af this form. E �Asset will be reported on 7he above-identified asset has been or wil!be reported and tax paid with the PA fnheritance Tax inheritance t�form Return filed by tha estate representative. REV-1500. Proceed to Step 2 on reverse. Da not check any other boxes. Please sign and date the back of the form when finished. PaRr Debts and Deductions 2 Allowable debts and deductions must meet bath of the following criteria: A. The decedent was legally responsibls for payment,and the estate is insufficient to pay the deductible items. B. You paid the debts after the death o#the decedent and can furnish proaf of payment if requested by the department. (If additional space is required, you may attach 8 1/2"x 11"sheets of paper.) Date Paid Payee Description Amount Paid a3 1.� ��tA! �c.n/cr�o � r.s-�/�rR �' �c� / ` vb�ry7 �F- ,o r-G�. D�7' t ` ,0 7'- �?. r-� pt�3. /•� �y r n/ O �. Totai Entsr an L' e 5 of Tax Caiculation} $ i� �j. � PART Tax Calculation 3 If you are making a correction to the establishment date(Line 1)account balance(Line 2y,or percent taxable(Line 3), ; piease obtain a written correction fram the finanaia!institutipn and attach it to this form. 1. Enter the date the account was established or titled as it existed at the date af death. 2. Enter the tatal balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is ta�cable to you. a. First,determine the percentage owned by the decedent. i. Accaunts that are held"in trusi 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 tatal number of owners including the deceden#. (For example:2 owners=50%,3 owners=33.33%,4 ow�ers =25°l0,etc.) b. Next,divide the decedenYs percentage awned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by muitipiying the accaunt balance by the perceni ta7cabie. 5. Enter the totaf of any debts and deductions claimed from Part 2. 6. The amaunt taxable is determined by subtracting the debts and deductians from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relatianship to the decedent. �� e� �� :, � � :::; � �� If indicating a different t�raie,please staie �� `� � � �� ,�� your relatianship to the decedent: . � �� . z � �� ` � 1. Date Established 1 � \ �_ S"�3 ;�� `. ��... \. \ \�:.`' �� 2. Accaunt Balance 2 $ 16�{'"$l. a7� .\�� , .� ��,� o� ��. �� 3. Percent Taxable 3 X /"�, �� ? �� .; �� ; 4. Amount Subject to Tax 4 $ c�8 3� -°� � '' �' � � \ �� \�� Z �� -�� y a �\ \' ��,� \\ �. � \ � �� \ � 5. Debts and Deductions 5 - /�'� ��•�:S� ��' � .' �� s�„�' ��• �, �•�� 6. Amount Taxable 6 $ � �" � �� `� �� .�� < � �.. ,� , � , 7. Tax Rate 7 � � ,, „ . . � °�� c,��ar:�. �� ; 8. Tax Due 8 $ --�"�` �� . , � .�� , . 9. With 5%Discount{Tax x.95) 9 X ��a��u�a'�o s� ��'\�� \'��o�A��"�� \a�� ,.�'�� StEp 2: Sign and date below. Rekurn TWO completed and signed capies ta the Register of Wills listed on the front af this farm, along with a check far any payment you are making. Checks must be made payable to"Register af Wil(s„Agent." Do nat send payment directly to the Department of Fievenue. tJnder penalty of perjury, I declare that the facts l have reparked above are true,correct and cornplete to the best of my knowledge and belief. � -aAEe�k Home ?� 7- 3$— Taxpayer Sig ture Telephone Number Date � -j�..�� IF YOU NEED FURTHER ASSISTANCE, C{�NTACT PENNSYLVANIA DEPARTMENT QF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVECES FOR TAXPAYERS WITH SPECIAL HEARING ANDIOR SPEAKING NEEDS ONLY: 1-$Q4-447-342Q , .,�. :� � �� .�..�.. _ �. �„ _ �.� r . � 4 , � . ; , - - _--- _ u. . .. , . ,. B�R�,� o� IN�IVI�� T,��s Pennsy�vania �nheritance Tax � QEt1C1S�f�Vc�Cila PO BOX 28060! � pEPARTMENT 4F REVENUE HARRISBURG PA 17128-0601 Information Notice REV-]543 EX OocEXEC (OB-12) And Taxpayer Response }�,-�}�7� Fl�E NC}.21-- ACN 13134433 DATE Q6-25-2013 _-..1 v.,, , .,. . . , . ��-.i e . � 1 . �° . Type of Account � " ; ,:�; �y "�� '� 1 �s�l��l of ELWOR DOUVILLE Savings " -` � 91-20-5456 Ghecking Date of Death 04-11-2013 Trust DAV F D J DOUV I L L E �: . County CUMBERLANQ Certificate s��e-z s�7 �A,-,�,.��1 ;.- , � - cnnr �.�ri_c�n►� � u ��5 b��'!` •�i 0.r��3�t� ' t M � i..�(�lE»��I_.4 U'.�� r� PSECU pravided the department with the infarmation belaw indicating that at the death of the above-named decedent you were a joint awner ar beneficiary of the account identified. Remit Payment and Forms to: Accaunt No.8106182721 Date Established 02-08-t983 REGISTER OF WILLS Account Balance $2,�2g,35 1 COURTHOUSE S�UARE Percent Taxable X 16.667 GARLIS�E PA 17013 Amount Subject to Tax $354.40 Tax Ra#e X 0.045 NtJTE': If tax payments are made within three manths of the Potential Tax Due $ 15.95 decedenYs date of death,deduct a 5 percent discount on the tax With 5°la Discaunt{Tax x 0.95} $(see NpTE`) due. Any inheritance tax due will become delinquent nine months after the date of death. PART St�p 1 : Please check the appropriate baxes 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 af 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 informatian is The abave infarmatian is carrect, no deductions are being taken,and payment wiil be sent correct. with my response. Praceed to Step 2 on reverse. Da not check any ofher boxes. G �The tax rate is incorrect. � 4.5% I am a linea!beneficiary{parent,child,grandch+ld,eic.}of the deceased. (Select eorrect tax rate at right,and complete Part � �2% I am a sibling of the deceased. 3 on reverse.) � 15% All ather relationships(including none}. p �Changes or deductians The informatian above is incorrect and/or debts and deductions were paid. listed. Gomplete Part 2 and part 3 as appropriate on the back of this form. � �Asset wil!be reported an The above-identified asset has been ar wiH be reported and tax paid with the PA lnheritance Tax inheritance tax form Return filed by the astate representative. REV-1500. Proceed to Step 2 on reverse. Do nat 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 folfowing criteria: A. The decedent was legally responsible far payment,and the estats is insufficisnt 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,yau may attach 8 1/2"x 11"sheets af paper.) Date Paid Payee Description Amount Paid y i6 i T,-,'- �- �t ,-:�Je �` � r 5�r-s�. �o � � P�. r o� � �. S, t� f s � ,a n� , �,+'" O 'c,o / Total Enter on Line 5 af T�Calculation} $ PAftT Tax �alculation 3 If you are making a correctian to the establishment date(Line 1)account balance(Line 2),or percent taxable(Line 3), please obtain a wr�tten correction fram the financial institution and attach it to this form. 1. Enter the date the account was established ar titled as it existed at the date of death. 2. Enter the tatal balance af the account including any interest accrued at the date of death. 3. Enter the percentage af the account that is taxabie to you. a. First,determine the percentage owned by the decedent. i. Accounts that are held"in trust for"another ar athers were 100°I�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°l0,3 awners=33.33°l0,4 owners =25°l0,atc.} b. Next,divide the decedent's percentage awned by the number of surviving awners or beneficiaries. 4. The amaunt subject to tax is de#ermined by multiplying the account balance by the percent taxable. 5. Enter the tatal of any debts and deductions claimed from Part 2. 6. The amount taxable is determinsd by subtracting the dsbts 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 It1C�ICatltl�c��1{fGP@tlt t3X(clt$��B1SB St1t2 ��Aa�� ... � �,,� � �� , ,� � ,tc�� ,,�� your relationship to the decedent: . �'�� ' � ;� �� ` �� , � � � �� 1. Date Established 1 ��'�G ` �� y �� V� �� '�� 2. Account Balance 2 $ o"t..l �-ta - 3.✓'� �� " �� , ;�� ,�. � :.� 3. Percent Taxable 3 X l�- L"'� � '� � � c�v'�� S�� `a. � . 4. Amount Subject to Tax 4 $ ` � � � � �� \� �� \�;��` �, , ��\ 5. Debts and D�ductians 5 - �,l�'7• p� ��\� �� `� ' �� 6. Amount Taxable 6 $ � ��\�� .�; � \�" \ \ �� \ 7. Tax Rate 7 X ,�� ,,� \ �;�\'\ . �., : . . >. �� , � � �� , �.. : � � 8. Tax Due 8 $ �"" � � , �� r\ 9. With 5°lo Qiscoun#{Ta�c x.95} 9 X �`��:': �"� ��' � �' � ��' '�� . ��o: Step 2: Sign and date below. Return TWO completed and signed capies#o the Register of Wills listed on the front of this farm, alang with a check for any payment yau are making. Ghecks must be made payable to""Registsr of Wills,Agent." Da not send payment directly ta the Qepartment of Revenue. Under penalty af perjury, l declare that the facts I have reported above are true,carrect and complete to the best of my knowledge and belief. ��.{`r' � �.� _ �} �' � � q Home g" � "I Taxpayer Sig ature Teiephone Number Date � � � IF YOU NEED FURTHER ASS{STANCE, CtJNTACT PENNSY�VANIA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL NEARING ANDIQR SPEAKING NEEDS ON�Y: 1-800-447-3020 �:��..�. �;;; �E;. � :�;T �il` ;� �i: �"� �� 5� � i,r; �..:. �.� ;N..� i..r. � V {d} �»1 h. ta? �i't? t�� 67 �ta . � ~ ��7"`' �-- � ,�V .�� , � � � � -� °i � �. � � � 4� � � � �`� _�� .a �� Y •y��, f�' � S^' � T � ww� �` t � ! � � L 4} � 'A � M l � . � - SQ n� . .. ... . .... .. ... . . ' � • Y' . �: �