HomeMy WebLinkAbout10-01-13 a�,,u � �Y��,� TAXES "`i� pennsylvania
t+o smc 2ee a� Pennsylvania inheritance Tax
wvaetsouRClv,� 1i128-9691 information Notice r '� oeranrraEwr os Revemue
And Taxpayer Res}aanse � tEY-0SiD E[pecEXEC (YO-12>
FILE NO.21
ACN 13147955
DATE 09�12-2013
Type of Account
I Estate of JEREMY J CONNELL Ssvings
SSN ,., , Checking
Date of Death 08-30-20i3 ;�.�, � Trust
DEB A 1. CHESTNUT Caunty CUMBERLAND ;G w ertfficate
22 EBO RD � � � � y� ,�
CAR SSLE PA 17015-4326 m � � � �
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u provided the department with the information below indicating that at the death of the
abov named decedent you were a joint owner or benef'tci oE the accaunt identified.
nt Mo.3164T8 AemK Paymen#and Forms to:
Dats stWpshed 70�17-2l167 REGISTER OF WiLt3
Acco nt Baiance $ggg,3p y ����Q�E S�lARE
Pe t Taxable X$0 CARU9LE PA 77018
Am nt Subject to Tau $484.7 5
Taac ate X 0.150
Pot tiai Tsx Due $72,g2 NOTE': If tax payments are rnade within three mar�ths of the
decedenYs dste of death,deduct a 5 percent discauM on the ta�c
With �o Discwurrt(Tax x 0.95) $(Sge NOTE") due. Any inheritance tan due wiii become delirrquent n+ne months
aftsr the date of death.
PA :�t8�1 1: Ptease check the appropriate boxes beiow.
y
A No tsx is due. {am the spouse of the diaa�esad ar i am thc parent of s decedent who was
2'i ysera oid or younger st date of deaih.
F'ra,�aed to Sta�2 on reverse. Do not Wredc any other boxes end d'rsragard the amount
shown sbove as Patentia!7a�c D�.
g iniortrtaiion is The above intormation is oorrect,no deductions are being taken,and payment wll!he sent
correct. with my respanse.
Proceed to Step 2 on reverse. ths nai check any other boxes.
� The tsz rate is incorrect. � 4.5°/, I am a lineai beneficiary(parent,child,grandchild,etc.)af the dgceased.
{Seiect correot ta�c rate at
right,and complste Part � �p��, I am a sibling of the deceased.
3 on reverse.) r—, /
i � yn�% All otber relationships (inoluding rrone).
�,..
p�Changes or deduotions The informaFion.above is incorrect and/or debts and deductions were paid.
listed. Comptete Part 2 and paa 3 as app+npriate on the bacic nf this torm.
�Asset wi41 be reported pn The above-identified asset fias been or wiii be reported ar+d teu paid with the PA Inheritance Tau
mheritance tau form Retum nled by the estats representative.
REV-1500. Proceed to Step 2 on reverser. Do nat check sny other boxes.
i Piease sign and date the back of the form whe�finished. `y�
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pA� Qebts and Deductions
z
Allowable debts arxi ciaductions must meet both of the follawinq crikeria:
A. The dec�cignt was lsgally responsit�for payment,and�e eatate is insufficient ta pay the deductible items.
B. You paid the debts after the death of the decedeni and can fumish proof of payment if requested by The department.
(If addiiionai cpace ia i�Ired,you may atiaeh 81l2"x t i"sheets of paper.)
Dale Paaci Fayee Qescriptian Amount Paid
! -. � �
Total E�der on l.i�5 ot Tax Caleuietion $ r
PART '�'� �+��,���
3
l ptei W a �M�aoer�p�l���� �i��� " "�� ` YtE(i �,��'orpsrCenits�tl�ris{4Ntie3),
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t. Enter the date the account was eatqbliehed or dtlec!as it e�eted ffi Yhe date af death.
2. Enter the totai bat�rwe of the account inciuding any interest accrued ai iha date of death.
3. Enl+sr the persentAqe of tM�nt q�t ia tauable to you.
a. First,determil�fhe pers�q Gwned by the.decr9dant.
i. Aeca�r�t9 thffi are hekl""ur�t for"arrod�er w btlrero w�e iQ6'Ya awned by the deeedCnt.
ii. For joint a�our� t�!�an arcee�u prior to the date af daath,the percent��x�bte is 104°k divit�ed
by the totai number n#owners�ncl�ding the decederrt. (For exampte:2 owners�50%,9 owi��33:3�l6,4 ejtiKmers
=25°10,etc.)
b. Ne�ct,divide�e�ceder�Y�t: �wir�e�l-by the number of survining rnvne�s w benancasvles.
4. The amoun2 ss�bjeet to tati is determined'by mt�ying tl�accaunt 681ence by ttte pM�nt taxsbie.
5. Enter the totai of any debts and c�Ctions daimed ftan Part 2. i
6. The amount tauabie is determir�ed by suhtraetir+g the det#s arM ded�etic�s hOm#he BmouM s�jeet ta t&x. }
7. E�'ikad fieat r4t�1rom-8�i-1 ba�ad trn yaur r�tbnship W the deGeq�R• `
� . plaasa amta , �
youi refatibn�ji to�rs ' _ M: . �
1. Dats Estebliehed t 1Q-4�Z �
2. Account Belance 2 $ ��:,;� �i
8. Percent Taacable 3 X �(� �
4. Amqunt Subj9ct to Taa[ 4 $ �Ei (r'J ��
5. Rebts and Deduetions 5 -
6. Art�,wnt Taxable 8 $ � �.'
7, T2X RHts 7 X � �'r'a � �'
8. Tax Due 8 S ��,�f �'
9. With 5%Discount(Tax x.&6} 9 X ,
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w*"�:r�.,&�;�ns1 c#�►h�kk�lM.. t3etum 71Mp c�P�ted and si�d ao�s to t�t ot ih�4il�am#t��t at this form, ��
aidn{�wiFfi a check for any p�yment}rou are maMcing. Ghecks must be made payahle to te�of M��tlt." Cb trot eend .�;
payment directly to the Depertmern of Revenue. .��
Under penalty of perjury, I declare that the ta�cts f Ffdve reparted above are true,correcY and campleta to ihe best of rny knowledge and ��
belief.
WBrk :i;
tiotn�. _ '. � ,��
payer Signature Talephane Nurtrber C3ate ;��
IF YOU NEED F{JRTfi f'� P;�uSF�'�E. C€Nri�'ACT 1�t��liAiif�il�ik.��Pp�l'�'S' GN�- RE�E� 4��
DiSTRtCT OFFIGE, {�4 T� '��kNCE TAX diV1$�i 1tl` 717-787-8327. �RVIGES FL"3R � !�� ,
TAXPAYERS WITH SFECiAL tiEARtNG ANDIOR BPEAKING NEEQS ONLY: i-800-447-3024 j�
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I "-���i�+ti.,+,line.mem}yersist.org/tJnlineBanking/AccauntSumrnarytAccountDetail.px 9/30/2013