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HomeMy WebLinkAbout08-05-13 REV-1162 EX111-96) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 1 7 1 28-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 017978 HEGGLIN MARIE T 1007 HARRISBURG PIKR CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER ---------- "-"'— fald 13136399 � 5705.68 ESTATE INFORMATION: SSN: 2�4-o3-s��3 � FILE NUMBER: 211 3-0664 � DECEDENT NAME: ROCCATI HELEN L I � DATE OF PAYMENT: 08/05/2013 � POSTMARK DATE: 08/05/2013 � couNTY: CUMBERLAND I DATE OF DEATH: 05/30/2013 � � TOTAL AMOUNT PAID: 5705.68 REMARKS: CHECK# 1129 INITIALS: CJ SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS R B £� oF INDIVIDUAL TAXES Pennsy�vania �nheritance Tax � PennS�/LVa111a �;'�BOX 280601 IllfOrlllat1011 NOtIC@ DEPARTMENT OF REVENUE F{/�((A�SBURG PA Z71Za-�601 ' "' REV-1543 E%DocEXEG (08-12) And Taxpayer Response FILE NO.2113-0664 ACN 13136399 DATE 07-01-2013 Type of Account Estate of HELEN L ROCCATI Savings SSN 214-03-8713 X Checking Date of Death 05-30-2013 Trust MARIE T HEGGLIN CountyCUMBERLAND Certificate 1007 HARRISBURG PIKE CARLISLE PA 17013-1616 r= � C � W � n � =T Y ',.;= c�.� %� c..:- W "^;3 C> w�", :� I"Fl !� C,+ .,..t �:�§ %Y7 �> C_' ,, Z,y,i I'— f'7 � .,:,� a�3 '�' V� '.::' �� �::� _ - i''. � �.� _.;�_ "�,.m.' _— — e""* :=�s � �°r c-� �='' - , : e, t�y.� 4;_, ..,. P �Sr7 f--" , S�Y�� `�7 �' � Clry �' PNC BANK NA provided the department with the information below indicating th� at the d�th of the above-named decedent you were a joint owner or beneficiary of the account identified. Remit Payment and Forms to: Account No.5501286708 Date Established 02-16-2005 REGISTER OF WILLS Account Balance $41,978.00 1 COURTHOUSE S(�UARE CARLISLE PA 17013 Percent Taxable X 50 Amount Subjeci to Tax $20,989.00 Tax Rate X 0.150 NOTE': If tax payments are made within three months of the Potential Tax Due $3,148.35 decedenYs date of death,deduct a 5 percent discount on the tax With 5%Discount(Tax x 0.95) $(see NOTE') due. Any inheritance tax due will become delinquent nine months after the date of death. PART �te� 1 : Please check the appropriate boxes below. 1 A �Mo tax i�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 of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Patential Tax Due. g �The information is The above information is correct, no deductions are being taken,and payment will be sent correct. with my response. Proceed to Step 2 on reverse. Do nof check any other boxes. C �The tax rate is incorrect. � 4.5% I am a lineal beneficiary (parent chil grandchild, etc.) of the deceased. (Select correct tax rate at right, and complete Part � 12% I am a sibling of the deceased. 3 on reverse.) � 15% All other relati�nships (including none). p �Changes or deductions The information above is incorrect and/or debts and deductions were paid. listed. Complete Part 2 and part 3 as appropriate on the back of this form. E �Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax inheritance tax form Return filed by the estate representative. REV-1500. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. • ti � " �' PART Debts and Deductions 2 Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient 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, you may attach 8 1/2"x 11"sheets of paper.) Date Paid Description Amount Paid Total (Enter on Line 5 of Tax Calculation) $ PART Tax Calculation 3 If you are making a correction to the establishment date(Line 1)account balance(Line 2),or percent taxabie(Line 3), — please obtain a written correction from the financial institution and attach it to this form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held"in trust 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 total number of owners including the decedent. (For example:2 owners= 50%, 3 owners=33.33%, 4 owners =25%,etc.) b. Next,divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Errter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. �nter the appropriate tax rate from Step 1 based on your relationship to the decedent. \� �� � �y.� �\��� � � ��� �„:� \���� If ind,•cating a different tax rate, please ate �%����� ����� � � � `�\`� ��\ C% \\��\\O�� � ��� �������\� � � ��� \�� � ��� your reiationship to the decedent� � �A�� ��� � ` �� � y� O ��\�\ \\� .��� �\��� � \\ \' �� 1. Date Establishe� 1 � ��'� ��\���� \��: �\����� ��\�� \\�� �� \o� � A ���o����� �� ��� � �� �� � � �� �� 2. Account Balance 2 � �/ l�7�. � ;, �� � �\V ���� �������� \ � � —� � ��\ �� �� ��\\�� ���\ �� �. �. ��\��� �\ � 3. Percent Taxable 3 X SO �\�� �A��y���\ �� �� ;� �,A V� � ",��� ��\\� �\�\ \��\\` ���\�\ . ����� �� � �\\� 4. Amount Subject ta Tax 4 $ �� ���� `�� �\�\\ \�� `��� " \ \����\ ���� `��� \���;�����o���� ., ��� \��, �a\ 5. Debts and Deductions 5 - 8�• � � `��� ��° ����� �� ""` �" � � � ����s��� ��� \�\\\\��\\ ��������\\ �\.�s \� � �.� ����,,. 6. Amflunt Taxable 6 $ f 51� ` 7� `�\A � ,�� \�V ° ��� ��� e � � �� �\ 7. T8X R3t@ ] X . S a �� �� . � ���� �VA� \\ ����� A ��� Q � Ar` �A � � � � � c V � ���� _. � � � �������� � �VAA�\ .>� 8. Tax Due 8 $ ���• �- �` " � `,� ` � � � � v , `` � ,�\�����\\��\\��\�\�\� �..�` � 9. W ith 5% D i scou nt(Tax x .95) 9 ^ D sl \\�� �\���\\ �����a�����������\\\\ �\�� \� ����\\'\\�����\\������\\\\\S� Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to"Register of Wills,Agent." Do not send payment directiy to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true,correct and complete to the best of my knowledge and belief. 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