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Home My WebLink About10-29-13 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) . DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 1 7 1 28-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 018332 COYLE SALLY L 548 ALLENVIEW DIVE MECHANICSBURG, PA 17055 ACN � � ASSESSMENT AMOUNT CONTROL NUMBER -°----- fold ---------- -------- 13151939 � $399.91 ESTATE INFORMATION: sstv: � FILE NUMBER: 2113-1138 � DECEDENT NAME: WINTERS JANE L � DATE OF PAYMENT: 10/29/2013 � POSTMARK DATE: 10/26/2013 � COUNTY: CUMBERLAND � DATE OF DEATH: 11/21/2012 � � TOTAL AMOUNT PAID: 5399.91 REMARKS: CHECK# 6533 INITIALS: HMW sEA� RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS __ _ __ _.__ __. _ _ _ _� B��►� oF I"DIVI°W� T,�ES Pennsylvania lnheritance Tax pe'nnS�/LVdt1'�8 PO dOX 280601 HARRISBI�i� PA 17128-0601 I11fOY1118tIOC1 NOtIC@ DEPARTMENT OF REVENUE REV-15i3 EX DoeEXEC.(�6-12 And Taxpayer Response ,.� /I�� ,. FILE NO.21 " 3- � , ° --�1CN 13151939 �F�� DATE 10-03-2013 ��E�� f�� 1�1�3 Ty�o�Accou�t �J f �$ ��te f�i��E L WINTERS Savings SSN CheckiRg ��€��of Death 11-21-2012 Trust SAL L Y L COYL E nty�UMBERLAND Cert+ficate 548 ALLENYIEW DR ��' ��f,�7` MECHANICSBURG PA 17055-6197 �(J�� +' �� SOVEREI6N BANK 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 a+ccount identified. A�nt No.1054022411 Remit Payrne�r�t and For�r�#o: Date Established 11-08-2002 REGISTER OF WILLS Account Balance $�7,773.8$ 7 COURTHQUSE SaUARE . Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $8,886.g4 Tax Rate X 0,150 ' NOTE*: If tax payments are m�de within tMree mon�hs bf the Potential Tax Due $1,333.04 decedenYs date of death,deduct a 5 pereent discaunt on the tax With 5%Discount(Tax x 0.95) $�see NOTE*) due. Any inheritance tax due will become d+elinquent nine months after the date�f'death. PART , _ � St@p 1: Please check the appropris#e boxes below. _ A Q No ta�c i�due. I am the spouse of the deceased or I am the parent of a decedent who was 21 years o!d or younger at date of death. � Proceed to S'tep�on reverse. Do t�ot chedc any other boxes and disregard the amounf shown above as Potential Tax Due. _..___ _-- ._ _.____-------_ ___ ___- � ..__ _ ___ .«___ _. ��, _ _ - � g �The inforrnation 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�ax rate is incorrect. �4.5% I am a tineal beneficiary(parent,child,grandchild,etc.)of the deceased: �Setect correct tax rate at right,and complete Part � ��/, 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. listed. Comp/ete Part 2 and part 3 as appropr+ate on the back of this form. E a Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax �nheritance tax form Return�iled by the estate representative. REV-1500. . Proceed to Step 2 on�verse. 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 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 corr�ction from the financial institutian 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: �L�•�i 1� '' �' � � �� `��o �� ` � , i � � � � �� o � �: � 1. Date Established 1 I►��D�- � � ��"�� .�; � � �� AA\� A A\��A�V�� A\�� AV�� o��0��y��A�� A�A�� V�� A�� A��AV �� 2. Account Balance 2 $ �7�77 3� �� ` � �`��A�� A V�� AA �� \V� ��\ � �� \ �� \\�\�� \� ��\� -� l'� '� \� �� \ � . \�� \\. 3. Percent Taxable 3 X SC � � . , ,, � , � . � ,,,, ; � . � : ' ��\\ \ ; �\` �� ,� \�� \�-` \\� �\ 4. Amount Subject to Tax 4 $ ��`��aa � � , , , '. � , ' °' \ :\� \� �: . �\�� \ \�� 5. Debts and Deductions 5 - �. � � �. � �� \ � 6. Amount Taxable 6 � �`��s� �� ' �,l � .i '�� \�. � \�:� � �� \\ :� \\\��\ �\\\;\\�\��\\��\ 7.. Tax R at� 7 . � X �i �/� �' \ \ \ \. �\ � \\\\ \ \\�\ \� \ � \ \��\�\� �\ �� 8. TaxDue 8 $ ��7r'��/ , �� , � .'\��\ �\��\� � � �\\ � \� \\�\ �� \�\ 9. With 5% 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. ,�' � r , Work ��G � '. ,� � /'� �%�� -� Home �J - �� Taxpayer S gnature ` Telephone Number Date/�� `�S�'� � l 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 _ � o c - _- � _ R�C4�� G��'1�� a�' �' - - �� _ - - - ��t�i�i�� t}� ��1�._�� .� - - - � � � - �?-�� u�i 28 �� . �� a� - _ - _ ..�.� � _ � - C L�r�S �� _- _ ;� . �, - p��A��S' ��R� � � - - - J - -- CUMSERL�i�� •� �'� - -- - _ �. - - _ � - - �� - - - �'� �� _ - - - - -_- � - - �� - - - - - - ,,� -- _ - �� . - - - - � ' - -- _ , _ - . � _ _ - �± � . - _- -= � � t � �� _ - - � - .. � � , - _ _ _ � � � g;,,,,, . - - �:'" • • , _ - � • � -- - .� �.. � `� � � p u �,.� � �. .� , �. _ .. _ -.�. _ --- __ _ - _ �` Q � �; : - _ _ _ .� � � � ; � �,, c`` � }.ia. l — w,,. w ` — ..�. ..+ - wr ' _ .i�r.�• -- r - _ ws. T � r � �� - - •irr . �•. t - - �� - �r_ 1 q�+�/r - - - - �� - - .- in� � - a�M� - - � _- w - . - ,."r!! "�.. �i. - _ - - - � .�.� ._. .._- � - - - _ rr ._._ ..---- - - - l-, - - - � '�1 A . "'�. O�iJ� :� - - - 7C ir � � �t. - C r� - � ~• C - "'� � - � N _ - - > - �� -