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Po rox zeoco� y ania inheritance Tax P �
WUtRISBUR� PA ��,za-oao� � �nformation Notice DEPARTMENTOFREVENUE
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ACN 13503452
DA7E p8•29-2013
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Type of Accpunt
Estate of WILLIAM C ZIMMERMAN Security
SSIV SEC Acct
date af Death 08•04-2013 Stock
SCOTT B 2IMNERXAN CountyCUMBERLAND Bonds
680 NOON BEAM LN
BEL6RADE MT 59T24-75p6 �
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E�ARD JDMfS provided the department with the infarmation betow ir+dicat�ng th�f'at the de�h of the�
abpve-named dececient ou were a 'oint owner or beneficia of the accou t identified.
Aexiaunt Na.27o Re�mt Payment and Foi�ns to:
Date EstabllsMed REGISTER OF WII,LS '
AacouM Balance $809,242.41 1 COUR7HOUSE SpUARE
Percent Ta�cabie X 5Q CARLI$1.E PA 17Qt3 ,
Amount Subject#o T� $404,62121
Ta�c Rate X 0.045 i�
Potentiak Fau Due g y g,p47,95 NOTE': If tax payments�re made within thrae months ot the
decedenYs dste of deaftr,dedutx a S perc�t discouM on#te tasc
With 5��Discourrt{Tgx x¢.95} ${��NC}TE'} due. Arry inheritance ta�c due will become delinquent nine months
after the date of death.
PAt�r Ste 1: Piease cneck tne a
� p pproprlate boxes below.
A �No tax is due. 1 am the apouse af the decea�aci or 1 em the parent of a decede�t who was
21 y�rs oId cir your�r at date of death.
Proceed to�tep 2 on reverse. Da not check any other boxes and disregard the amount
shown abo�as PotenNal Tax Due.
g �The infomaa6on is 1`he sfioi+e mforrn�tioiiis ixirreet,no deductions are bein�taken,and paymer�t wili be sent
carrect. with my response:
Prpceed to 5t�p 2 on reverse. Da not check any other boxes.
� ❑The ta�c rate is incanecY. � 4.5°� t sm a Grreai beneficiary{parent,t�ild,grandchiki,eta)of the deceased.
{Select correct tan rate at
right,and complete Part � 12°�, I em a sibling of the deceased.
3 on reverse.)
( � 15% A!i other relatia�ships{incptding tror�e}.
' p ❑Changes or deductions 7he information above is incorrect and/or debts and deductiona were paicl.
Hsted. Comptefe�ert 2 and part 3 as appropriate an the herdc of ihis famr.
E Asset wili be reported on The above-iderrtifi�ci asset has been or will ba reported and teuc paid with the PA Inheritaeice Tax
�mheritar�ce tax form Fietum filed by the;estate repreeentative.
REV-1540: Proceed to�Yep 2 on reverse, qa nof chack ariy a�er boxes.
Ptease sign and date the back of the form when iinished. . �
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' PA� Debfs and Deductions
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_ Allowable debts end deductiona must meet both of the following criteria:
A. The decedent was legaily responsit�te for paymerrt,arrc!the estate is instiffiCieni to pay the deductible ftems.
e. You paid the debts atter the death of the decedent and can fumish proof of payment if requested by the department.
(If addftionai space is required,You may attach 81J2"x 11"sheets oi paper.}
' Date Pflid Payee Description , dmqunF;P�+d
' Total Enter on Line 5 of Ta�r Caicutation $
PART T1X C�ICUI�IOCI
3 H y'au��(nQ��ur�pn�tMs�t d�l(L�!i}�CO4u1M F�d�fline 2),o►Re►cent taxab�e Nne 3),
:- Pieu�se bb�in a vv�Tlf�n�#�m�hp flep�eii��d aitirch!f��thls fonn.
1. Enter the date the account was est�lished or titled as it existed pt the date of death.
2. Enter tha total badance of the account indudirrg any inieres#accrued at the date of death.
3. Enter the pQrcs�t�e of�he ar.�unt that is ta�cable to you.
a. First,detertninB tF�a owned bY ihe deCeden�
� i. AccnuMa that sro hefd`irt{�st for"eno[her or oUrere wero 140%owned by the decedent
ii. For jpint accour� more than one:year prior to the data of dea�h,the percantage taxable is 100%divided
by the fotal nurnber of'owneis including the decedeM. (For euartq�le:2 pwrrers=50%,3 ownera•39:339b;'4 ovpners
_�%,etc.) �
b. Ne�ct,diulde tlre owned by the oumbar of survivirsQ ow�aerc�'bo�f'iciaries.
' 4. The amount aubjeCt to tax is dal��ed by muNiptyirq the axoyM batanCe'by fh9t pa+�t taxable.
5. Enter thatt#at of anp dabts at� ctiwts claimed from Part 2.
6. The amcYiUUat taucabla is determined tiy subtracting the del�and d�ona hum M��mount subject to fax,
7. EMer the ttl�z ialeireuer 9 based or�Your � to�he , ,,. ,
if i�irEg a�tt,tax r#ter;ptease "
' your reiationsliip to�he decedent:�,_,,._
1. QBte ESf�ishBd 1
' 2. Account Bglance 2 $
3. Percent Tauabte 3 X
4. Rmount Subje�t ta Ta�c 4 $
5. Debts arid Deductions 5 -
6. Amount Ta�cabie 6 �
; 7} Tax Rate 7 X
Si Tax Que 8 S ___
„ 9f With 5�o Discount(Ta�c x,95) 9 X
`Z: Sipn end dat�A F�e1aMl. 6ipiuFfr'��d ar�.sip�ed ci�6s to t�e t¢r of Wiil&.�9kid•On 3ha kaM M this Eorm,
! a ng with a cMedc for any pnymsnt you are makirg. Ghecks must be m�3e P�Y�Ie to ' ist�of Y�B,P�i." Qo r�at send
,4 p$yment directiy to the Dapartment of Rev�ue.
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Under penaity pf perjury, i declare that ttie(ects l have reported a4ove are true,canrect and compiete ta the best df my knowledge and
b$lief.
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Taxpa er Signat Telephone Number Date
IF YOU NE�13' FUFii'NER ASS' �'�tNGE, Cf3k�T;ACT" ��t�'YL�NtA €�PAFi'Ftu(�t�t'[ f�F :,,.� EPVUE
; GMISTRIGT OF�lGE, (�1 TME t Efi1TANCE TAX D�YISION AT 7f7-787-8327. SERV'ICES FOR
'� � T�IXPAYERS WITH SPECIAI. HE tNG AND/OR SPEAKING NEEDS ONLY: 1-800-4d7-3020
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ltNtEAU OF tN6IVI�Wi TAJCES Penns ivania inheritence Ta7c � P��nsylvama
Ptl 60X 2l0601 Information Notice DEPARTMENT OF REVENIIE
HARRISlURG PA 17126-q601 v[v�isra�ER ue�ex[c cee��ti
. And Taupayer Respanse Fi�E No.2� - �3�$'tti{
ACN 13503450
DATE 08-29-2013
Type of Accpunt
Eetate of WILLtAM C ZIMMERMAN Security
SSN SEC AAt�t
date of C3eath 08-042013 Stack
WILLIAM S ZIMMERMAN CountyCUMBERLAND Bonds
720 SQUTHBROdK DR
LONPOC CA 43436-8i06
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�l�WWJ1RD JONBS provided the department with the infarmation below indicating th t at the death of the
above-named decedent yau were a 'oint owner or benefici of the account identified.
Act�M No.270 Remk Payment and Forms to:
DMe Estabil#hed RCOURTHOUSE S�UARE
Account Balance $809,242.41 Cp,RI.ISLE PA 17013
Percent Ta�cabie X SO
Amount SubJect to Tau �A04,62121
Ta�c Rate X 0.045 NOTE": If tax paymeMS are made within three moMhs of the
Potentia!Tsu Dus $18>207.95 decedenYs date af death,deduct a 5 percent discaurrt ar�iMe ta�c
With 59'a Dis�wunt{Ta+c x 0.95} ${�Npl'E'} due. Any inheritance tax due wiit become deiinquent nine moMfis
after the date of death.
PARt St@Ei '1: P�ka�aheck ihe a#�ryropr'iste boXes t�eiow.
t
A �No tex Is due. ►am the spouse of tl�deceaared or i am the parsr►t af a decedent who was
21 years oid ar younger at date af death.
Prcrceed to Step 2 on reverse. Dn not chedc any other boxes snd disregarti the amount
shown abova as Po[ential Tax Due.
g �The i�ormation is The atrove informatia�is correct„no deductians are being taken,and payment wil!be serrt
cartect. with my response.
Praceed to Step 2 on reverse. Da not check any other doxes.
� �The taY rate is incarrect. � 4.5% 1 am a lirreai benef�ciary{�rerrt,chikl,grandchfld,etc.}af the deceased.
{Selecf carcect tau rate at
right,and complete Part � y��, I am a sibling of the deceased.
3 on reverse.)
� t 5°k A!I ather retatlajships(inciuding none}.
p ❑Char�ges or deductions The information a4ove is incorrect and/or debts and deductions were paid.
tisted. Comptete Part 2 attd pati 3 as apprr�riate ort fhe back of ihu fomr.
E �Asaet will berep�rted on 7he above-identifled asset has been or will be reported and te3c peid with the PA Inheritance Tax
inheMance tau form Reiutn filed by tfse estate representative.
REV-15D6. Prac�ed to Step 2 an rsverse. Do nof chectc any ofher boxes. ,,.
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Piease sign and date the back of the form when tinished. ��,�
.
PA� Debts and Deductions
z
Allowable debts arid deductians musi meet both of#7e followirig oriteria:
A. The decedent was Iegatly respon&ible for payment,arx!the estate is insuffrcient to pay the ded�Ie ftems.
B. You paid the tlebts after the death pf the decedent and can furnish proof of payment if requested by the department.
{ifiadr�tlonai space is required,you may attach 8 7!2"x 11"sheets of paper.)
' Date Paid Peyee Deecription Amaur�t P,aid
Tatai EMer an Line 5 of Tax Calcwlation $
PART Tax Calculation
a ft yau�e rn�ieing a�r�s ta#!�s eti�lplHhm�t ti�e{i.�e 1}accpuM�{LI�2},or percent taxatrie{Llr�3},
phluns ObUdn S W�Rm�t7aotFom trom�fe thundrN�On and aldMCh tt t0 thta fonn.
1. Enter the date the account was eafahtished or tiHed as it existed at the date of death.
2. Enter the tatel ba4ance of khe accouM includi�g any iMerest accrued at the date of death.
3. EMec the pqrce�af tMe aceounf tha#is t�w,sble ta yau.
a. First,determine the�Nape ownad by the decedent.
i. Accnunts that are hekt"in bu�for"another or athers were 100%owned by the decedent.
li. For jant accour�ts; . rtxxe ihen cme year priw to the date ot death,the percentage i��ble is 104%divided
6y the total number of owners irrcluding the decederst. (for exampie:2 amers=50qd,3 owners�3'3.33%;4 owners
=2590,etc.)
b. Next,divide the decedbM's�ownedby the number of surviving owners�rr beneficiaries.
4. The amount subject ta t�is deietrrilrre(f#�y muft�ty+inp the account baiar�ce kay fhe percent taxabie.
5. Enter the totai of any debts arxi rbductions claimed from PsK 2.
6. The amoum tarcab�e is determined by subtraating the debts and deductions from the arndunt subject ro tax.
7. Enter the�ptopt�6e t�e rate#tNh�1 besed on yaur relatianship to the d8cedqnt.
If indicati+l9 a�'�tt t�rate,p)eaes s#ate
tt
your relationship to the decedeM:
1. Date Established 1
2. Account Balarree 2 $
3. Percent Taxable 3 X
4. Amount Subjecttp 7ax 4 $
5. debts and D�uckions 5 -
6. Amount Taxable 6 $
7. - Tax Rate 7 X -
$. Ta�c Due 8 S
f 9. W ith 5%Discount(Tax x,9S) 9 X
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' S��i�'. S�7n and c��. �m tW�DcnmP������to the E�ister of V+Id��d�tlie fr�S of lhis form,
' abng with a cf�ck for any payment you are msking. Checks must be m�ie payahie to"Aegister of WiNs,Agenf." Do rrot send
payment directly to the DepaAmenf of Revenue.
Under penaity af perjury, 1 dec(are thai the facts t ts�ve reported sbove are true,correct and compiete ta tha�st ot rny knowledge and
belief.
WOrk '71 -� - /
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Taxpayer Sigraa r Telephone Number Da#e
E� YQll NEED FtlRTFiER ASSfSTANCE, GON'!`AGT PEi�lNSYt�YANlA DEPAR'fMENT OF R NUE
DISTRIGT OFFICE, aR THE thtt�RITANCE TAX DtV1Stt3N AT 717-787-8327. S�RVICES FOR
; 'TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020
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