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Home My WebLink About09-05-13 (3) BUREAU OF INDIVIDWIL TAXES Pennsylvania lnheritance Tax � pennsyLvan�a PO BOX 280601 DEPARTMENT OF REVENUE HARRISBtN2G PA ��28-060� Information Notice � REV-15f!EX Dee C(�!- And Taxpayer Response FILE NO.2� '" ��'' �Z� ACN 13145422 f�,��,,� �.�;',,�,_ DATE 08-27-2013 li+�W51 i.: 1 �1 f Li •ic��{ i ..�� . .,-.. �,r,� Type of Account �.�:�:3 ��r` � �sta��f�I�,4N�K RHOADS Savings Checking eath 08-15-2013 Trust $US�l�1 ,J CRUSEY c�' �n CUMBERLAND Certificate 1505 HEMLOCK AVE ��PN��S �OU,�� CARLISLE PA 17�13-9390 ��$�� `r �� MEMBERS isr Fcu provided the department with the information below indicating that at the death of the above-named decedent ou were a joint owner or beneficiary of the account identified. Rem�t Payment and Forms to: A�coun#No.i32709 Date EstaWished 05-12-1993 REGISTER OF WILLS Account Balance $3,528.35 1 COURTHOUSE SQUARE Percent Taxable X 5p CARUSLE PA 17013 Amount Subject to Tax $1,764.18 Tax Rate X 0.045 NOTf": If tax payments are made within three morrths of the Potentiat Tax Due $79.39 , decedent s date of death,deduct a 5 percent discount on the tax With 5No Discount(Tax x 0.95) _$�see NOTE*) due. Any inheritance tax due will become delinquent nine months after the date of death. PA� Srt�'p 1: Please check the appropriate boxes below. � A �No tax is due. I am the spouse of the deceased or 1 am.the parent of a decedent who was 21 years old or younger at date of death. Proceed�o Step 2 on reverse. Do not check any other boxes and disr+egerd the amount shown above as Potential Tax Due. g D 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 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°�a I am a sibling of the deceased. 3 on reverse.) � 15% All other relationships(including none). p �Ghanges or deductions The information above is incorrect and/or debts and deduc�ions were paid. . listed. Comp/ete Part 2 and part 3 as appropriate on the b�ck of this form. E < A5s$t will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax inheri#ance tax form Re#um filed by the estate representative. R�V-1500. Proceed to Step 2 on reverse. Do not check any ather boxes. Please sign and date the back of the form when finished. G(� 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 Cal�culation 3 If you are making a correction to the establishment date(Line 1)account balance(Line 2),or percent taxable(Line 3), please obtain a written correction from the financial institution and attach it t�thBs�orr�a. 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. 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 frorn Step 1 based on your relationship to the decedent. If indicating a different tax rate please state ;� �`�� ; ��'�� , ; � ' '� ��V� � �A � �� \V��`°�V�� your relationship to the decedent: � �� "��` � ` °� � � � � �° ` ��` � � � `�"��'��R�� `�`�� i� �� \ ��\\�\�� \�� \\�\\� \�\� �\:�� 1. Date Established 1 ;� �� ,��;�\��\��`��\��,��,\��,��`��,�,��,�� ; � ��\\\� �\��\\��\\\�� \��\� ��\\ � � ��\\�� \\�� `�� \��\\\ ��\��\�\ \� �\\ � 2. Account Balance 2 $ �� ` �� `�� ' ��\�� \��\��`\��\,\��\��:�\\�`��\��\\�\\��\\��\��\��\\\V\��.:� X �� \�\�\�\\\\�� \��\ � \ 3. Percent Taxable 3 � ��\\�\�\�\�\��0��\�� \\��\ \�� \�\��\��\�\��\�� .�� , \\��\� � \\\ \\��\\\\�� ., �� \�\ �:��\ � �� \�� \��\�� , �\\� ;\ 4. Amount Subject to Tax 4 � � � � ��;��; � � � �� ' � � �� .�\�p�� \�\��\\ �. \��p� \\�\ \\��\��\��\\� �� \ � � . ��\� �� . \� \�\ ��\ � �\�\� \� . � � �\ \��\�� - � �� rJ. �ebt$af1C� �eC�UCtIOf1S �J � � � ��A�� o�A\�� A�� \ C� \ �� \\��\�\��:. ��,��\ ��\ \ �\\ �� \�� 6. Amount Taxable v � ��\�\ \��\ ��\\��\��\��\�\\\��\��\\�\��\\\�\\��\\\�\\\�� \\\�\\� \ \ \\ ��\\ \�\ \ �3J+ �A� ��AA�V�� A�� A�� A �V � \\� �� \ 7. Tax Rate 7 X ,,,�,`�0�� \��\��\��Q�\��\�\\\ \`�� \� � � � ��\�� - \ ��\ �\ \� p ; � \\ �\�� .,� �� ;��\� � -� �. 8. Tax Due O � \ \ �\�\\\\\\�\�\��.\�\��\\\\��\�\\�\� ��\\\��\��\��\\\\��\��\ �� A A�� V\��\��V�� \� �� \� , 9. With 5%Discount(Tax x .95) 9 X ��;;.�.�,��,�,�,��..��,.;,��:�.�..�..��.�,..,��,��,�� '�....:` . .. . _o..._.��.�. 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 � � Home ' t �- t.��' '` � /� 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