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Home My WebLink About09-05-13 (2) BUREAU OF INDIVIDUAI TAXES Penns Ivania lnheritance Tax � pennsylvan�a PO BOX 280601 y DEPARTMENT OF REVENUE HARRISBUR6 PA ��28-060� Information Notice And Taxpayer Response REY-15i3 EX DocEXEL(�l-12) FILE NO.21—I3'�/�.� ��.� �i; �� ACN 13145421 �;�; �• D�4TE OS-27-2013 F-. ��3�t ;s;- �. �`-�, � � ' ^� Type of Account ��:� ��j� � �� I �{�. Estate of JJ�I�fET K RHOADS Savings ��, Checking �D of Death 08-15-2013 Trust SUSAN J CRUSEY 0�1��,��'q��1��t1MBERLAND . Certificate 1505 HEMLOCK AVE �;�� .' �� CARLISLE PA 170I3-9390 MEMBERS isr Fcu provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified, Ren�it Payment and Forms to: Account No.132709 Date Established 11-14-1996 REGISTER OF WILLS Account Balance $500.50 7 COURTYIOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $250.25 Tax Rate X 0.045 Potential:Tax Due NOTE*: If tax p�yments are made within three mon#hs of the ��1•26 decedent's date of death,deduct a 5 percent discount on the taz With b%:Discount(Tax x 0.95) $(see'NOTE*) , due. Any inheritance tax due will become delinquent nine months . after the date of death. � PA� �$rt@p 1: Please check the appropriate boxes below. � A [�No ta�c i�due. 1 am the spc�use of the deceased or 1 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 chedc any other boxes and disr�egard the amount shown ebove as Potential Tax Due. __..._.�.._ _ _� .�.,.._-.,.-�� :.-�, _._: .. ._ g The information is The above information is correct, no deductions are being taken,and payment will be sent �correct. with my r�sponse. Proceed to Step 2 on reverse. Do not check any other boxes. � C �The tax rate is incorrect. � 4.5% I am a lineal beneficiary(parent,child,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 relationships(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 o�r�the back of this form. � ` E �sset,will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax inheritance t�xform Retum filed bythe estafe representative. R�V-i 500. Proceed to Step 2 on revense. Do not check any other boxes. Please sign and date the back of the form when finished. , �� 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 Payee 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 taxable(Line 3), nlease c�btain a writ#��n correction from th�financial institution and attach it to this form. 1. Enter the date the account was es#ablished 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. Enter 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. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. If indicating a different tax rate, please state ;' ��, ,��,�� ,,,;, �� ` our relationshi to the decedent: � �� " �� ' � �� `�� Y P �� ,��;��i�� `��.� � 1. Date Established 1 ,�_`�:��\��;��\��,��\��,��,�,�.�,�� A��\�A.� A\��o��\�� .�� \Q \ �:. _�\�� \��\\�\\�\�\\\\��_ 2. Account Balance 2 $ � � ��;�,�� , � ;c �� .,�� ,� , � �. \\\�� \��C��\�\�\�\�� O\�\�� \\\�.��\��\� � �� \\��\\\\��\\\� �\�\��\� �\�� \ \��\�O�\��\�\�� 3. Percent Taxable 3 X ��"� �� `�\��\��\\�\�\\\�\�\\�, � \�\\� \��` ��`��\�\��\\�\\\�� \ � A\ �� A\V��`�� A�� AA ��.\� � � �� \�� 4. Amount Subject to Tax 4 $ � �, ��;�� , ,,�,,�,�,�,� , � ,� � �� :� \ �� \� �� \ � ��.�� \ Q \��\\O\�\p� � � \ \ \\� � \� �_ �� . \� �� \ �� \ 5. Debts and Deductions 5 - �� . �` �� \� ��V`�� , � A \��\� �� A. �` �� \��\�� :� � � `VA�� A� �� \ :�� \� �: \ � .\ �� \ �� \\� 6. Amount Taxable 6 � �� ' ��\�\��\�`\��\�� \��`��\�\\�\��\��\`\\\\�� v \ \ \ \\ � � ��\\� �\�� \� �\\�\� �\_ 7. Tax Rate 7 ^ ��O\�\��\�\��\\�\\� \�� .�� o��..�� \�� \��\Q\\\��\ ..s \�� .��\ ��o\�•�\\\ ��\\�\��\��\`��\\\\�\�� \\�\\�� . . 8. Tax Due 8 $ �� , � � � � �� , � � �� , ,, .��\�\��\\��\\�\�\\\��:��\��\��\��\\\��\��\�\��\��\� �: �\�\ ��\�\�� \��p\ � \\�\� \ �\\\��\��\��\\� ��\ ��. X � �\� , � � �\\�\ \��. � �� . �\�� \�� . 9. With 5% Discount(Tax x .95) 9 .�.: .�..��,��.�� :�,..��,..��.�,.�;��,��.��,��::��,.��....�� ,...�....'. 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 directly 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. Work �G Home l �" � -� (� �� " �� Taxpayer Signature Telephone Number Date 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