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Home My WebLink About10-17-13 BUREAU OF INDIVIDUAL TAXES � pennsylvan�a PO EOX 280601 Pennsylvania lnheritance Tax W►RRISBUR6 PA 17128-0601 Information Notice DEPARTMENT OF REVENUE REV-15�3A EX DocEXEt(�l-12) And Taxpayer Response FILE NO.2113-0550 ACN 13503912 DATE 09-18-2013 Type of Account Est�te of NANCY M BARRY Security SEC Acct Date of Death 05-03-2013 :-�=� BRYAN K VANCURA Eounty CUMBERLAND c� � s 101 PLUM CREEK LN � p �-� � p� DRIPPING SPRINGS TX 78620-4613 � `r� �� ;.� =i:a -"{ ,...� C7 �...,.� -�;... � Ww� � � � �� r,.... �,._— .,� �'�i --•,3 i"� ,.;; � . ...� ..Al�,�' . /'^r 4,�.� �.� \w/ w*'�i . ..x..... . -^'r'� � . ^; � � ' �: �� t,.. ^�.w„.� � � ��"� " � •_�_� �`"�"� � � __ __,..;;?' I� VAN6UARD provided the department with the information below indicating that at the death of the above-named decedent ou were a'oint owner or beneficia of the account identified. Account No.10388061311064 Remit Payment and Forms to: Date Established REGISTER OF WILLS Account Balance $43,908.85 1 COURTHOUSE SQUARE Percent Taxable X 25 CARLISLE PA 17013 Amount Subject to Tax $10,977.21 Tax Rate X 0.045 NOTE': If tax payments are made virithin three months of the Potential Tax Due $493.97 - decedent's date of death,deduct a 5 percent discount on tne tax With 5�Discount(Tax x 0.95) $(see NOTE*) due. Any inheritance tax due will become delinquer�i nine months after the date of death. PA� St(�!p �I: �'lease checic the appropria#e boxes below. � A []No tax is 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 chedc any other boxes and disr+egar�d the amount shown above 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 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 benefciary(parent,child,grandchild,etc.)of the deceased. (Select correct#ax rate at right,and complete Part � ��/o I am a sibling of the deceased. 3 on reverse.j � 15% All other relationships(including none). � ��hanges or deductions The information above is incorrect andfor tfebts and deductions were,paid. tisted. - Complete Part 2 and part 3_as appropriate on ihe badc at this form. E .�.Asse�wilf b�reported on The aboy�identifie�l asse�has b�en_or wil)be reported and tax paid with tfie PA Inheritance Tax � inheiit�nce�tax form Return filed by the estate repr+esentative. � 1��1/-1500. Proceed to Step 2 on reverse. Do rio�check any other bozes. 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), 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. 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 � � � � � your relationship to the decedent: � ��;��, ��,� ,�� 1. Date Established 1 \ ��\ �� \\\ . ��o��\�� \\�\\`�\ \� `� ��°�� : _ � . �A�A�� A ��A\\VV\�VA��A� �A\�.�A��A�\ �� .\�� \\�� p��\��\��0��\ �\� ��\�\��\��\ \\� 2. Account Balance 2 $ �`��'_ ` � � � �� ; �� . `�� .�.' .� 3. Percent Taxable 3 X . � ; : � � � , � 4. Amount Subject to Tax 4 $ " :��_ �.; � � . ��: � �� 5. Debts and Deductions 5 - �. \ ,. � , � � ;�� 6. Amount Taxable 6 � � � � � � �� T X � . . � \\� � �� \� �� 7. 1� Rale 7 < �\��p��\�\�\�� \��\ �\ \\��0��\ �Q� \ \�\� \ �� \�\� �\ � �� \�\��\��\��\\� �� \��\�\ \� 8. Tax Due 8 $ \ \ � ��\�\�\��\\�� \��\��\\\��`��\\�\�\�\��\\ \`�� \��.� \\�\��\�� `��\��`��\\� ��\�� \ 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. , � 1 Work ��2"�� 5 Home � ,�. ,�� Taxpa r 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