HomeMy WebLinkAbout08-19-13 (5) ���I�I�
BUItEAU OF INDtVIOWI TAXES Penns Ivania inheritance Tax � c��+�V�VQ���
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xARRISeURG PA 1712a-o601 IllfOflll$t1011 NOLICG'� pEPAR7MENT OF REVENUE
MEY�ISf3 F%UacENF[tIBq2)
And Taxpayer Respanse Fi�E No.21�t�-`�S
ACN 13143330
DATE 08-13-2013
7ype of Account
Estate of LAWRENCE MALLISON Savi�gs
SSN Ghecking
Date of Death 07-28-2013 y( Trust
STACY J ZORN County GUMBERL.AND � :=-; C�rtificate
101 WILLOW MILL PARK RD •
' MECHANTCSBUR6 PA 17050-1762 � O � �'t �
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��MSE�s iss Fcu pravided the department with the i�formation belaw indicating that at the death af the
above-named decedent ou were a 'oint owner or beneficiary of the account identified.
Remft Payment�rci Forms ta:
Accam#No.134921
Dete Established OS-241993 REGISTER OF WILLS
Acoount Balance $8,732.01 1 COURTHOUSE Sf]UARE
Percent Ta�cable }{1pp CARUSI.E PA t7013
Amount Subject to Tax $g,732.01
Tau Rate X p.045
Potential T�Due $392.94 NQTE': If tax payments are made within three months of the
decedenYs date of death,deduct a 5 perceM discount on the ta�c
Wiih 5°fa Discount{Tax x 0.95} ${see NOTE*} due. Any inherita�oe tax due wiii become deiinquent�ine months
after the date of death.
�'A� StB� 1: Ftesse check the apprapriate boxes belaw.
1
A �Na tax is due. !am the spouse af the deceased or i am the parent of�decedent who was
21 yesrs oId ar yaunger at date af death.
Proceed to Step 2 on reverse. Do nat check any other 4oxes and disregard the amount
shown above as Potential Tax Due.
g �The information is The above informatiflrt is correet,no deductians are being taken,and paymenE wii!be sent
correct. with my response.
Praceed to Step 2 on revarse. Do not check any other boxes.
� ❑The ta�c rate is incorrect. � 4.5°fo 1 am a lineai bensficiary(€rarertt,chiM,grandchild,etc.)pf the deceased.
{Seiect correct tax rate at
right, and complete Part � 12��, I am a sibling of the deceased.
3 on reverse.)
� 15% AN other relationshtps{inoluding tmrte}.
d �Changes or deductions The information above is incorrect and/or debts and deductions were paid.
listed. Camplefe Part 2 and part 3 as appropriafe on ihe back of fhis forrrr.
��Asset will be reported on The above-identified asset has been or will be reported and tan paid with the PA Inheritance Tax
nheritance ta�c fprm Retum f11ed by the estafe representativs.
REV-1500. Proceed ta Step 2 an reverse. Do nof check any other boxes.
Piease sign and date the back of the form when finished. ��{�'
PART Debts and Deductions
2
Allowable debts and deductions must meet both of the foilowing criteria:
A. The decedant was Iegaliy responsibie for payment,and the estate is insuKicient to pay tfie deduotibie items.
B. Yau paid the debis after the death of the decedent and can furnish proof of payment if requested by the department.
(if addiEionai space is required,you may attach 8 ti2"x 11"sheets af paper.)
Date Paid Payee Description Amount Paid
Total Enier on line 5 of T�CaVCUlation $
' PART Tax Calculation
{ � if ya�are maicinp a correcfia�to ihs mentd�e(Lina 1}�cou�st h�c�a(t.ir�2),or Percent tax�e{Cir�e 3),
please obtain a wrltten corractlon lrom the flnanaiallnsiNtrtlo�ar+d Mtacfi it ta thit iorm.
1. Enter the date the account was established or tiUed as it existed at the date of death.
2. Enter the toEai balance af tfis account including any interest accrued at the date of death.
3. Enter the percentags of the aocounT that is tauable to you.
a. First,determine the percentap8 owned by the deCedent.
i. Accounts that are held"in trust for"another or others ware 100%awned by the decedent.
ii. Far jaint accounGs estaWiSi�mcxe tt�an cne year�lor ta the date of deffih,the percerttage taxabie is 100°Ifl divided
by the totai number of owners inoluding the decedent. (For example:2 owners=50°!0,3 own�rs=33:�,�t otiw3ers
=25%,etc.)
b. Next,divide ihe decede�Ys pernentage ow�ed by the number of surviving owners or beneficiaries.
4. The amount subjeci to ta�c is defei+ni�ed by muk�+g the account balanc�by the percent ta�ca6le.
5. Enter the totai of any debts and deduciions claimed from Part 2.
6. The amount taxable is determined by subtraatiog the debts and deductions from the�mount subject ro ta�c.
7. Enter the appropriate ta�c raEe from Step t based a�yaur reiatlonship to the denedsM.
if indicating a diff8rgrit taac rate,piease'state
you�relationship to tMe decedent:
1. Date Established t
2. Account Balance 2 $
3. Peroent Taxable 3 x
4. Amaunt Subject to Tax 4 $
5. Debts and Deductions 5 -
6. Amount Taxable 6 $
?. Ta�c Rate 7 X
8. Tax Due S $
9. With 5%Discount(Tax x.95) 9 X
.�l���? `L: Sign and date bebia. Retum?WO compieted and sigrted Copies ta tt�e Re¢ie#er of WiIIS Ii�ted on the[rwrt o#this form,
along with a check for any payment you are malting. Checks must be made payabie to'Register af WHis,Agent" Do not aend
payment directly to the Department of Revenue.
tinder penalty af perjury, t ti�ciare that the facts!have repoRed a6ove are fiae,corr�i and campiete to the best o(my k�qwledge and
beiiel.
WOrk
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Taxpayer 5 ure Telephone Number Date
tF YOU NEED FURTHEFt ASS#STANCE, GflNTAGT PEAI�iSYLVRNiA C}EPARTIUIENT t}F R�1�ENUE
DISTRiC7 OFFICE, OR THE IlNWEiiiTANCE TRX DI1ttSit3N AT 717-787-8327. SERIFK;ES FOR
TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020