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Home My WebLink About10-16-13 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT:280601 HARRISBURG,PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 018262 STEWART GLENN A 204 ALANTHIA LANE ETTERS, PA 17319 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold ---------- -------- 13147610 � $2,160.27 ESTATE INFORMATION: ssN: I FILE NUMBER: 2113-1060 � DECEDENT NAME: STEWART MILTON E � DATE OF PAYMENT: 10/16/2013 � POSTMARK DATE: 10/15/2013 � � COUNTY: CUMBERLAND � DATE OF DEATH: 08/18/2013 I � TOTAL AMOUNT PAID: $2,160.27 REMAfiKS: CHECK# 755 INITIALS: HMW SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS TAXPAYER BUREAU OF INDIVIDUAL TAXES Penns Ivania lnheritance Tax � pennsylvan�a Po sox 2ao6oi Y HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE REY-15f3�XApeEXEC��l12Y A And Taxpayer Response ��;.- ��,� FILE N0.21-� �� ACN 13147610 DATE 09-10-2013 Type of Account Estate of MILTON E STEWART Savings Checking Date of Death 08-18-2013 X Trust GLENN A STEWART County CUMBERLAND Certificate 204 ALANTHIA LN ETTERS PA 17319-8930 C`-- G7 �? � � � � �� N �": � .....�. ,_�-� C� t.�. ,y £..... } .. :�� .,�» �.:�.. •�.., a.. � �° � � �� .� > t,�} ,� Y,,.,, . .. — - � ��;:,, C.,�'� :,.,[ ��'� ,.J , ,, ; - _.__ _ _ i:.1.M; 3 ,.. t--3 ..a,.,k `�'�• � — �.,C'' �''°^� �" +�,� Y s� � C`,� C_'� ti�z. i� Fu ro � �..,provid�l"�pe department with the information below indicatin that at the death of the 9 above- d�eedent yo�vere a joint owner or benefieia of the account identified. Accoun#No.52 Remit Paymer�t and Forms to: Date Established 01-10-2011 REGISTER OF WILLS Account Balance $b0,532.59 1 COURTHOUSE SQUARE Percent Taxable X 100 CARUSLE PA 17013 Amount Subject to Tax $50,532.59 Tax Rate X 0:045 Potential Tax Due $2,273,97 NOTE*: If#ax payments are made within three months of the decedent's date of death,deduct a 5 percent discour�#on the tax With 5°�n Discount(Tax x 0.95j ${see NOTE*) due. Any inheritance tax due will become delinqUent nine months . after the date of death. P�� S�@p 1: Please check the appropriate boxes below. � A Q No tax js 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 Potential Tax Due. _.�--- r�_�.._ ._ _,_ __ _ ._ ___ ___ g TF�e infiormatiort is The above infiormation�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 ��'he tax ra#e i�incorrect. � 4.5% 1 am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased. (Selec�correct tax rate at right,and complete Part � 12qo 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. lis#ed. Comp/ete Part 2 and part 3 as appropriate on the back of thls form. . . _ E �i wi11 be reported on The�bove-id�n�ified asset has been or witl be reported and tax paid with the PA Inheritance'��x �inheri�ance taz form � �Retum filed b th�e&tate re resentative. - REV-15�0. Proce d to Step 2 onpre�erse. Do not chedc any otherboxes. 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 writtP�correction from the financial institu#ion and attach it to thi�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 indicatin a different tax rate, please state � �� 9 ��,��1��.��.... � your relationship to the decedent: . � �� ; ; 1. Date Established 1 ' ' � "�� , � ` �� ` � �� 2. Account Balance 2 $ �� ` � � � � � ;� �� , �� X , 3. Percent Taxable 3 � �` � � � ,; ;; � , � �� ;�.: � ... � `�� .: . ,, ` �� 4. Amount Subject to Tax 4 $ � �� ° ;�� , �� ,_ � ,. 5. Debts and Deductions 5 - � ' ' ' '' � ! °: _, � � .. �� .. � 6. Amount Taxable 6 $ � �� , � �� 7. Tax Rate 7 X �� . � �� , �� -----------�---_—___—_ �. �� 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. � P d , �� ; , , .-��I`�C---.._. `I � ` __.-- ...._.._.. . � . ,� '�� Home �i y� 5��'' � - � -/ ..� < 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 i — � � � — - ? 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