HomeMy WebLinkAbout08-19-13 (2) i�u .
BUik&lV OF IN6IVIpWtt Ta%ES � pennsytvania
PO eox zeasui Pennsyivania inheritance Tax
xnxaisewzc Pa i7ize-oaoi infarmation Notice ���T DEPARTMENT OF REVENUE
And T�payer Resporrse "EV uan ex oe�exec neazs
Fi�e Na.21 -13-�:5
AGN 73143335
pATE 0&-13-207 3
Type of Account
Estate of LAWRENCE MALLiSON �Savings
SSN Ghecking
Dats of Death 07-26-2013 Trust
sTACY J 2�RN County CUMBERLAND Certificate
lql WILLOW MILL PARK RD
MECNANICS&URG FA 17050-17b1
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NEkBERS 1ST FCU provided the department with the information belaw indica�g that atdtxe dbat�of the
above-named decedent you were a joint owner or beneficia of the account identi�ed. °'
Accaunt No. 182527 ��t Payment end Forms to:
Date Established 03-12-1999 REGISTER OF WILLS
Account Balance $ y,57p.7� t GOURTHOUSE SQUARE
Percent Taxable X 16.667 CARUSLE pA 17013
Amount Subject to T� $261.79
7az Rate X 4.045 NOTE': If tax payments ara made within three morrths of the
Potentia!Tax Due $11.78 decedenYs date of death,deduct a 5 percent discount on the t�
With 5%Discount{Tax x 0.95) �see NOTE") due. Any inheritance tax due will become delinquent nine mon[hs
after the date of death.
PA� St@�? 1: Please check the approprlate boxes below.
�
A �Na tax is due. t am the spouse of ihe deceased or 1 am the parent of a decedent who was
21 pears old a�younger at date nf death.
Proceed to Stap 2 on reverse. Do not ohadr any other boxes and disregard the amount
shown abQVe as Patential7ax Due.
g �7he informatipn is 1'he above informatian is correct, no deduetions are being takan,and payment wi}i be sent
correct. wifh my respor�se.
Proceed to Step 2 on reverse. Do not check any o[her boxes.
� �The tax rate is ineorcect. � 4.55o I am a Iineai beneficiary{parent,chiid,grandchiid,etc.}of the deceased.
(Select corrsct tax rate at
right,and complete Part � 12°f, I am a sibling of the deceased.
3 on reverse.)
� 15°lo AI{other relationships (inciuding nona).
p �Changes or deductions The informatipn above„is incomect and/or debts and deductions were paid.
iisted. Comptete.Patt 2 and part 3 as a,apropdate orr the back of thrs fomr.
E Asset wiil be reported on The above-identified asset has bean pr wiit be reported and taa�paid with the PA lnheritance Tax
inMeritance ta�s form Return f11sd by the estate representative.
REV-1500. Proceed tn Step 2 on reverse. Do not cReck any other boxes.
Pfease sign and date the back of the form when finished. \t(}�
tf r'
RART Debts and Deductions
2
Altowabie debts and deductions must meet bath of the#oNowing criTeria:
A. The decedeni was legalty responsible for payment,and the estaTe is insufficient to pay the deducti6le items.
B. You paid the debts after the death of the decedent and can furnish proof of payme�t]f reques2ed by the departmeni.
(If additfonal apace is required,you may attach 8 7f2"x 17"sheets of paper.)
Date Paid Payee Description Amount Paid
Ta#al EMar on tine 5 af Tax Caicuiation $
PART Tc"�X Cr3IGt1Ic'�tiOtl
3 1f a�arB mak
Y ir�a s:arsectton to the esk�isMmenf c�te(�ine 1}accpun#t�pMnce iLfne 2y,m percent taurbie(line 3),
pleaaoe ol�ain a wt'itMn comectlon fram tfie flnanc1a11nsNkiNon ar�t!aibch R ta thb torm.
1. Enter the date the account was established or titled as i[existed a!the date of death.
2. Enter the total balance of the acoount including any interest accrued at the date of death.
3. Enter tfie perceMage of the account that is ta�cabie to you.
a. First,determine the perc�rhtaige owned by tfie decedent.
i. Accou�ts that are heid"in tn�st for"anott�er ar athers were 180g,owned by the decederrt.
ii. For jani accouats e&tablished moce then one year prior to the da#e of death,the�rceMage taxatsie is 100%divided
by the total number of owners including the decedent. {Far example:2 owners=54%,3 owners=33,33%,4 awners
=25%, etc.}
b. Ne�ct,divide the decedeM's p�cerNage owned by the number o1 surviving owners or tieneficiaries.
4. The amaunt subjeci to tac is determfried by mu4qplyir�t#te account batsnce by the percent taxable.
5. Enter the totel af any debts and dedtr�tio�s claimed from Part 2.
6. The amount taxable is determ+ned by subVacting the debts and deductians from the amount subject to tax.
7. Enter the appropriate tex rate frnrn Step 7 based an your relationship to the decedent.
If indicating�,diiferent tax rate,please state
your reta[ionsfiip to the decedent:
t. Date Estabiished 1
2. Account Baiance 2 $
3. PerceM Ta�tabie 3 X
4. Amount 8ubject to Tau 4 $
5. Debts and Deductions 5 -
6. Amount Taxable 6 $
7. Tau Rats 7 X
8. Tax pue 8 $
9. With 5%Discount(7au x.95) 9 X
Sf@(�1;�: Sign and date beipw. Rekum 7W0 completed and signed copies to tfie Register ot Wiiis liated on the front of this fam,
abng with a check for any payment yau are makYng. Checks must be made payabte to"Regisfer of Wiils,Agent" Do not sand
payment directly to the Department of Revenue.
Under penaliy of peraury, E declare that Ehe facts 1 have reported above are True,correct a�d compiete to the bes#of my knowledge and
belief.
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�l.i"� �!?'J^.. Fiame ���,-��1�—�+� �'�t�{-��
Taxpayer g ture Telephone Number Date
IF YdU NEED FURI`H�R ASSlSTANCE, GON'tAGT PENNSY�VAN}IA DEPARTMENT OF FiE1�EKIUE
DISTRICT OFFIGE, OR TFfE IMH�tii"ANGE 7AX DIVlSION AT 717-787-8327. SEfiVICES FOR
TAXPAYERS WITH SPEGIAL HEARING ANDlOR SPEAKING NEEpS ONLY: 1-804-447-302Q