HomeMy WebLinkAbout08-19-13 (4) voRemcU zao oilvmun� Tnzes }�2CIRSYIV2ftid �t1h@CftaflG2 T2?C � ����r"Jy�Yt���4�
HpReISBURG PA �,�ze-o6o� . lnformation Notice L1EPAqTMENTOFREVENUE
And Taxpayer Response "EV-isas ex m�cxec�ne-�x�
FizE Na.zi -ti3-�S
AGN i314333i
DATE 08-13-2013
Type of Accourrt
Estate of t1tWRENCE MALLt50N �Savings
SSN c� Checking
Date of Death 07-28-2413 � Tru� �
5TACY J ZORN County CUMBERLAND � ° Ce�fi�te
101 WILLOW MILL PARK RQ � 'r c , �e-� ,�
MECHANiCSEURG PA 17050-1761 � �= � ��-� �,y �
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MEMBERS isr �cu provided tfie department with the information beiow indicating that at the death of the
above-named decedent you were a joint owner or beneficia of the account idenfified.
AccouM No.134921 RemR Payment and Porms to:
Date EstabHshed 08-241943 REGISTER OF W(l[.S
Account Balance $4,335.69 "1 COURTH�USE SQUARE
Percent Ta�cable X 7pQ
CARLISLE PA 77013
Amount Subject to Ta�c $4,335.69
Tax Rate X 0.045 NdTE': !t tax payments are made within thres manths ot the
Potentiai Ta�c Due $195.11 decedenYs date of death,deduct a 5 perceni discount on the t�
With 5°lo discount(Tax x 0.95) $(see NOTE*) due. Any inheritance tax due will become delinquent nine months
after the date of death.
PA� St@�3 1 : Piease cheak the appropNate boxes betow.
y
A �No tax is due. I am the spouse of the deceased or i am the pareM of a decedent who was
21 years atd ar younger et date of death.
Proceed to Step 2 on reverse. i?a r+ot check any other boxes and disregard the amount
shpwn above as Potential Tax Due.
g �The information is The a.t�ve infarmation is oorrect, �a ded�ctions are being taken,and payment wili be sent
correct. with my response.
Aroceed to Step 2 on reverse. Da not check any other boxes.
G ❑The tatt rafe is incorrect. � 4.5% 1 am a lineal beneficiary{pare�t,chitd,gran�hild,etc.)of the deceased.
(Select correct tax rate at
right,and camplete Part � �pq, I am a sibfing of the deceased.
3 on reverse.j
� 75°/< Aif other relationships{including none).
p ❑Ghanges o�detiucNons The informatlon ahove is incarrect andior debts and deductions were paid.
listed. Camplete Part 2 and pd�'t 8 as appropriate on the back of this form.
E �set will be reported crn The above-identified asset has been or wiH be reported and tau paid with the PA Inheri#ance Tax
�t�'mheritance tax form Retum filed by the estate representaGve.
REV-t 500. Proceed to Step 2 on reverse. Do noi check any ofher boxes.
Please sign and date the back of the form when finished. ��
p'4� pebts and Deductions
z
Allowebie debts anr!deductions must meet both af the follawing criteria:
A. The decedent was tegally responsible for payment,and the estate is insufficient to pay the deductible items.
B. You paid the debts after khe death of the decedent and can fumish proof of payment if requested by tfie department.
(If additfonal space is required,you may attach 81/2"x 11"sheets of paper.}
Date Paid Payee Description Amount Pski
Total E�ter�Line 5 af Tax Calculadon $
PART Tr'�X Gc"�ICi1Ic1t10►1
3 1f yau are making a carrectlon ta�re est�lt�h�t�o{Line t}acaount b�Nuica 4Lku 2},or perc�et fszable{Lir�e 3),
pfease�U►in a wrliten corroctbn fiam Me flnar�ctal in�►tlon antl ia�ch R ta thie{wm.
1. Enter the date the account was establiehed or titled as it existed at the date of death.
2. Enter the total balance of the account inciuding any interasi accrued at the dste of death.
3. Enter the percent7ga o(the account that is ta�cabie to you.
a. Flrst,determine the percent�e owned by tha decedent.
i. Accounts that are heid"in kntst for"snother or others were 1 QO°lo owned by tha decedent.
ii. For joint accnunts rr�ore than one year prior to the dafe of death,the percentage ia�cabfe is 100%divided
by the totai number of owners including the decedent (�or example:2 owners=50%,3 owrweFs=33':33%;d own�rrs
=25°/a,Btc.)
b. NeM,divide the decedet�t's per�eritage avrtted by the number ot surviving owners ar be�eficiaries.
4. The artwunt subject to tax is determined by multiplylr�!he account ti8larrce by the percent ta�cable.
5. Enter the total of any debts and deductions olaimad from Part 2.
S. The amount taxable is determined by subtractin�the debts and deductions from the amount subject to ta�c.
7. Enter the appropr4atre tau rate fram Step 1 based on your relationsfiip to the decede�t.
If indic,ating a�tfarant tau rate,please state
your relationsfiip to tfie decedent:
i. DateEstablished 1
2. Account Balance 2 $
3. Percent Taxable 3 X
4. Amount Subject to Tax 4 $
5. Debts and Deductions 5 -
6. Amount Tauable 6 $
7. 7ax Rate 7 X
8. Tax Due 8 $
9. With 5%Discount{Tax x:95) 9 X
.�l�8�! �: Sign and date¢ebw. Retum TWO t�npiated and sign�d copies to the Ftegister af UY�I{&Y�ted An Ihe froM of this form,
atong wi4h a chsek for any payment you are making. Ghecks must be made payable to"Register of VY'ilis,AgenL" Do not send
payment directly[o the Department of Revenue.
Under penaity of perjury, I decfare that the facts 1 have reported abave are true,correct anti compiete to the best of my knowledqe and
belief.
WOrk
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Ta3cpayer i ure Teiephane Number date
IF YdU NEED FURTHER ASSISTANGE, CONTAGT P�l�t+�181FLVANlA DEPART�AEt�JT ()F RE1/ENUE
D4STRICT OFFICE, OR THE INWERtTANCE TAX DIVIS10�1 AT 717-787-8827. SERVfGES FOR
1'AXPAYERS WITH SPECIAL HEARING AND/OR SPEAKfNG NEEDS ONLY: 1-800-4<t7-3020