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Home My WebLink About10-11-13 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE REV-1162 EX(11-96) BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 018241 BOOK ANGELA J DUPLICATE 24 E COUNTRYSIDE DRIVE BOILING SPRINGS, PA 17007 ACN ASSESSMENT AMOUNT CONTROL NUMBER ---------- -------- 13145164 $1 ,743.33 ESTATE IN FILE NUMBER: 2113-0088 DECEDENT NAME: STONE CHARLOTTE F DATE OF PAYMENT: 10/11/2013 POSTMARK DATE: 10/10/2013 COUNTY: CUMBERLAND DATE OF DEATH: 01/1 2/2013 TOTAL AMOUNT PAID: $1 ,743.33 REMARKS: RECEIPT TO ATTY CHECK# 5726 INITIALS: WZ SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES Penns lvania Inheritance Tax '' Denns tvania PO BOX 2BD601 y • / HARRISBURG PA I 7128-0601 Information Notice DEPARTMENT OF REVENUE And Taxpayer Response FILE NO.2113-0088 ACN 13145164 DATE 08-26-2013 RECORD-Eg flFrICE OF REGISTER OF PALLS Type of Account 613 I;J i 1 Estate of CHARLOTTE F STONE Savings F� IZ Ob Checking Date of Death 01-12-2013 Trust ANGELA J BOOK CLERK V County CUMBERLAND Certificate 24 E BOILING OSPRINGSEPAR17"34$;7'2'15,S' COURT CUMBERLAND Co., PA ORRSTOWN FINANCIAL ADVISORS 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. Account No.0 Remit Payment and Forms to: Date Established 01-12-2013 REGISTER OF WILLS Account Balance $232,439.00 1 COURTHOUSE SQUARE Percent Taxable X76.667 CARLISLE PA 17013 Amount Subject to Tax $38,740.61 Tax Rate X 0.045 Potential Tax Due $1,743.33 NOTE If tax payments are made within three months Of the decedent's date of death,deduct a 5 percent discount on the tax With 5%Discount(Tax x 0.95) $(see NOTE") due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1 : Please check the appropriate boxes below. 1 A ONO taxis 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. B ( The information is The above information is correct, no deductions are being taken,and payment will be sent X�--!'correct. with my response. Proceed to Step 2 on reverse. Do not check any other boxes. C The tax rate is incorrect. ( 4.5% 1 am a lineal beneficiary (parent, child,grandchild,etc.) of the deceased. (Select correct tax rate at T right,and complete Part ❑ 12% 1 am a sibling of the deceased. 3 on reverse.) 15% All other relationships (including none). D F�Changes or deductions The information above is incorrect and/or debts and deductions were paid. listed. Complete Part 2 and part 3 as appropriate on the back of this form. E F�Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax inheritance tax form Return filed by the estate representative. n REV-1500. Proceed to Step 2 on reverse. 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 8112"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"intrust 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 6t0,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 Official Use Only ❑AAF your relationship to the decedent: PA Department of Revenue 1. Date Established 1 2. Account Balance 2 $ PAD 3. Percent Taxable 3 X 1 4. Amount Subject to Tax 4 $ 3 t 5. Debts and Deductions 5 - 4 6. Amount Taxable 6 $ 5 7. Tax Rate 7 X 6 8. Tax Due 8 $ 8 9. With 5°l0 Discount(Tax x.95) 9 X 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. 61mfj N . Work Home 71 7,fvd a Taxpayer ig ure Telephone Number Date E NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE T OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR ERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-840-447-3420 � N � fN n L -• b'G Y o� -:1 r' t�s1 _ g01UNGSA v � D Co