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 �
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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
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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.
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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 \� � �.�
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6. Amflunt Taxable 6 $ f 51� ` 7� `�\A � ,�� \�V ° ��� ��� e � � �� �\
7. T8X R3t@ ] X . S a �� �� . � ���� �VA� \\ ����� A ���
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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. Lt-u�i
Work
Home � 3 ��7� � ���`�
T xpayer gn Telephone Number D te
IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE
DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR
TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020
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