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Home My WebLink About09-14-13 (2) COMMONWEALTM OF PENNSVLVANIA REV-7162 EX�11-98) DEPAfiTMENT OF REVENUE BUREAU OF INDIVIDUAL TA%ES DEPT.280801 HARRISBURG,PA 1]128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 018109 NELSON I IRVIN 165 CONODOQUINET MOBILE NEWVILLE, PA 17241-9485 ACN ASSESSMENT AMOUNT CONTROL NUMBER ------- �a�d --------- ----- 13144981 � 584.25 ESTATE INFORMATION: SSN: � FI�E NuMBER: 2113-0944 � DECEDENT NAME: NELSON EDITH S � DATEOFPAYMENT: 09/05/2013 � POSTMARK DATE: 09/04/201 3 I CouNTY: CUMBERLAND I DATEOFDEATH: 07/03/2013 � � TOTAL AMOUNT PAID: 584.25 REMARKS: CHECK# 2109 INITIALS: DB1 SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS auz�,o oF �na��ZOw� rnxES Penns�/ivania inheritance Tarc ' • pennsyEvania P4 BOX 280601 l HI�RRISBURG PA ,��za-o6a�. Information Notice DEPARTMENTOFREVENUE x[vasas[a a«exec ioe-�zx And T�payer Response F��E No.z� ACN 13144981 DATE OB-23-2013 Type of Account Estate of EDITH S NELSON �gavings SSN {;hecking Date of Death 07-43-2013 Trust IIRV2N NELSON CountyCUMBERLAND Certificate 165 CONQDOGUINET MOBILE NEWVILIE PA 2T242-9485 G'> �� ' .�-{ C � ["'t , � �5 �"� . '-"> ESr ,r ' m - � _, z� y;: r- r �. �--, _.� � �' ;;; c: c� c, , _ —`' - �.�� ti . ..::a �� C- N �� PNC 6AMK HA provided the department with the infarmation belaw indicat+ng that abthe death�the� -� abave-named decedent ou were a 'oint owner or beneficia af the account identified. Acca�nt No.5003853B85 Remit Paymeni and Farms to: Date Estabilshed 10�2$-2010 REGIS7ER OF WILLS Account Balance $3,gq�,qg 1 COURTHOU3E S�UARE Pereent Ta�tabie X r�p GARLISi.E PA 1T013 Amount Subject to Ta�c $t,970.74 Tarz Rate X 0.045 PoteMial Ta�c pue $gg,gg NOTE': If tax payments are made within three manths of the decedenYs date af death,deduct a 5 percent dfscaunt on the t� With 5%Discount{Ta�t x 0.95) $(see NOTE*y ¢ Q+{,a S due. Any inheritance tax due witi become delinquent nine manths after the date of death. �A� St�j} 1: Please check the appropriate boxes below. Y A C]#lo ta�t is due. i am the spouse of the deceased or 1 am the parent of a decedent wha was � 21 years oid or yaunger at date af death. � Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shawn above as Potential Tax Due. g �The information is The above information is carrect, �o deductions are being taken,and payment wiI(be sent odrcect. with my response. Praceed to Step 2 on reverse. Da not check any other lapxes. � ❑The ta.�eafe is inoarz�t. � 4.5°lo i am a lineai beneficiary{parent,ehild,grandchild,atc.}ot the deceased. {Selact correct ta�c rate at right, and complete Part � 1 g% I am a sibling qf the deoeased. 3 on reverse.) � 15°fo All other relatipnships(including none}. p �Changes or deductions The information abqve is incorrect and/or debts and deductions were paid. tisted. Comptete Part 2 and part 3 as appropriaie on fhe 6ack of this form. E �Asset will be reported on The above-identified asset has been or will be repbrted and tax paid with the PA Inheritance Tax inheritance?a�c form Fteturn filed ky the estate representallve. REV-150d. Proceed fo Step 2 an 2verse. Do nof check any ottrer 6oxas. Piease sign and date the baok of the form when finished. P"� Debts and Deductions x Allawabie debts and deductiorrs must meet both af ttse foAowing criteria: A. The decedent was legaliy responsibie for payment,and the estate is insufficient to pay the deduotibie items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. {i(additionai space is requi�ed,you mey attach 8 i/2"x t t"sheets of paper.) Date Pald Payee Description AmpuntEaid Tatai Enter on Line 5 of Tau Caiculation $ PART Tax C�Iculation 3 If ya�are makirap a carract[on to U�s e�pbilshmeet c�(IJ�e 1)accwait b�t�ce(lMe 2),or percent ta�cca�e{line 3}, plesse obtaln a writtan corroctlan trom ihtr flnamotai Instkution and attach it ta thia torm. t. Enter the date the account was established ar titled as ft existed at the date of death. 2. Enter the totai balance oC the accau�t including any interest accrued at the d8te of death. 3. Enter the perceritage ot the accourrt that is T�able to you. a. First,determirre the percent�e owned by the decedent. i. Accpunts tbat are hetd"in trust for"another or others were 100q,owned by the decedent. ii. Far joint accounGs est�trlit�hed m€ne than orie year prior to ihe date of death,the percenta�e ta�cabie is 104°!o divided by the total number of owners including tfie decedent. (For example:2 ownars=50°!0,3 e�N+ners=33.8$i6,4 oxners =25%,etc.) b. Next,divide the dscedeM�s pe�'cehFape awned�the number af surviving owners pr beneficiaries. 4. The amount subject to tax is deteimin�i�+muitiptyi�tlae accaant baiance by fhe percer�t taxabfe. 5. Enter the total ot any debts and deduction&claimed from Part 2. 6. The amount taxable is determined by subhacting the debts and deductions trom the amount subjeci to tax. 7. EMer the apprapsiatg#a�c rate irom Step t ba�sed on your relatianship to the decedent. if indicati�a dif�rerrt tau rate,plesse state your retationship ro the decedent: t. Date Established 7 2. Account Balance 2 $ 3. Percent Taxable 3 X 4, Amount Subject to Tax 4 $ 5. Debts and Deductians 5 - 8. Amount Ta�cable 6 $ 7. Tax Rete 7 X 8. Tax Due 8 $ 9. With 5% DiscoUnt(Tax x .95) 9 X S�$f} 2: Sign and da#e bebw. Return'tW0 campieied and sgr�ed copies ta the R�ister of Wiils iis#acf on the frosi af this fam, along with a check for any paymerd you are making. Checks must be made payabie io"Register ot W84S,Agent" Do ne�i serfd payment directly ro the Departrrrent of Revenue. Under penaity af perjury, t declaze thei the faots 1 have reported a6ove are true,correct and cpmp4ete ta the t3est of my know{edge and beliet. �� Work � Home Taxpayer Signature Telephone Number��ry Date � 3 IF YOU NEED FURTNER ASSIS'fANCE, CtN+�7AGT PEhlNSY�VANlA GJEPAR'fMEEt+d� OF R�VENUE DISTRiCT OFFICE, �R THE iNi�RtTI�NCE TAX DIV1Slt3N AT 717-787-8327. SERVIGES F4R TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 � '.� Y • � , Q • y^V � l � ` � . 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