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Home My WebLink About10-31-13 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 018344 DESANTIS RALPH J 325 W MfADOW DR MECHANICSBURG, PA 17055 ACN ASSESSMENT AMOUNT � CONTROL NUMBER -------- fold ---------- °------ 13143136 � �3,559.65 ESTATE INFORMATION: ssN: � FILE NUMBER: 2113-1 152 � DECEDENT NAME: DESANTIS SARAH ( DATE OF PAYM ENT: 10/31/2013 � POSTMARK DATE: 10/30/2013 � COUNTY: CUMBERLAND � DATE OF DEATH: 08/O 1/2013 � � TOTAL AMOUNT PAID: 53,559.65 REMARKS: CHECK# 107 INITIALS: HMW SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL T�ES Penns Ivania lnheritance Tax � pennsylvania PO BOX 280601 y HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE REY-1543 EX DoeEXEt(/!- ) And Taxpayer Response FILE NO.2�•—/.�— /��,st ACN 13143136 DATE 08-13-2013 TYpe of Aceount. Estate of SARAH DESANTIS Savings Checking Date of Death 08-01-2013� ,��; � Trust RA�PH J"DESANTIS County CUMBERLAND � o �-•' � �"Certificate 32� W M�ADOW DR MECHANICSBURG PA 17055-5165 � �' �} � �# t`t'1 -��r- � --{ � � %tJ �,. f" W _ � 6'�� .. . . . � � ��p � � /°W � � � � � � �� .`�'�,�.. • ;.�.ti; �? !� r� �? c'� � � -� � {""•. ..,y.� C� �-} }�-` `�- � i`"" "�7, � � C�l? d : - - __ - -- _ ,_ _ - � -r-� lx�,_._.. (�--- , .. _�, ._. A. ._ � UTILITIES EMPLOYEES cu 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. AcCO�Int No:714194 Remit Payn�ent and Forms to: Date Established 08-20-2010 REGISTER OF WILLS Account Balance $g�,702.1 p 1 COtlR7�K3USE SQUARE Percent Taxable X 100 CARL.ISLE PA 17013 Amount Subject to Tax $91,702.10 Tax Rate X 0.045 NOTE�: If tax ; Poten�ial�'auc Due _ _ $4,126.59 payments are made�within three mo�tfis�of the dec�dent's date of death,deducfi a 5 per�cent disGOUnt on the tax W�th 5%o Discount(Tax�`0:85)�' $(see�IOTE*) due. My inheritance tax due will become delinquent'nine months after the date of death. P� St��i 1: Please check the appropria#e boxes below. � A [�No tax is due. I�m the spouse of the decea�ci or 1 am the parent o�a decedent who was 21 years old or younger ai d�t�e of`death. Proc�e�e,d to�tep 2 on reverse. �not check any other boxes and disregard the amount � shown�6ove as Potential Tax Due. ,-- _.�.__ � __ � ..�. _ __. __ _ _ __ - _ _ __ B Ttte informati4rt is The abave information is correct,no deductions are being taken,and payment will,be sent rrect. with my response. Proceed to Step 2 on r�everse. Un not check any other boxes. C �The t�x rate is incorrect. � 4.5% 1 am a lineal beneficiary(parent;child,grandchild,etc.)of the d�ceased. (Select correct tax rate at , . right,and complete Part � ��a I am a sibling of the deceased. � 3 on reverse.) � 15% All other relationstiips(including none). . p !Changes or deductions The information above is incorrect and/or debts and deductions were paid. listed. Complete Part 2 and part 3 as ap�propriate on the back of this form. �' E �Asset will be reported on The above-identified asset has been or wilt be reported and tax paid with the PA Inheritance�ax inheritance ta�i form Rettirn frled by th�estate repr+esient�e. � REV-1500. P�oceed to Step 2 on reverse, D�o hot 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 � ly �;��3 ►cl,::�c�;;�;�, �"�nt r.:l t�mZ.,, �,,-,�r;.i `7� °lb C? n� �• t;�� ,_�c=h � e� -r� � Er=.l�t <:,c�r�. �„5 ? 3� . `t��- J 5 ��i� V��S � C.vc��t C�°! �� l�' � ��` �'� ��t3 C`�,�t ��- �t�J�ri C:,•�n.��.�-<� �' 1 �> > � Q Total (Enter on Line 5 of Tax Calculation) $ '-!� �l� �� PART TaX CaICUIatI0C1 3 If you are making a correction to the establishment date(Line 1)account balance(Line 2),or percent taxable(Line 3), ; �ica�e��tai�a vrrit��c�rr�cti��frcm fh�fi�a�cia� �r.�t�t�tior:and at#a�h i#t�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 , � ��,��'��F�,�,� �;' your relationship to the decedent: �� "`�� ' �� ` `'�� ` �( i ' � ��,�``�,�� ;��,�1��'�� ; 1. DalPi ESLa�I�.ShPi� I i7 �V �L'f ` ; ��\��\��\\\�\\�\� �� \ � �\� \��\�\\\�\\ �\� �\ � \\� � �\\ \ ., �\� \\ \� � , q ''] ��\ �\�� \\�\\��\ �� \� ��.� \ �\�� \\ J'�� \\�\��\�� \\� � � � � \ � � 2. ACCOUfIt Bc1Iaf1C2 2 � ! I ' I �� A��\\��` � �� `�� \�� `�� I - _ � ��\�\\��\��\��\ :� � � � �\ �� \\�� .\�� \ : �� \� X � O/►-y .��\��\��. �\��\� �� C �� \ . 3. Percent Taxable 3 �� `�� \\� ��\�� 1 ' �V� �:� �� \�� \ �� \. \ , �\� � \ \�. 4. Amount Sub'ect to Tax 4 $ � �� `��° 1 -/ � �� , �, � , , � , � � ' � � � �� \��p�� 5. Debts and Deductions 5 - � ��`��y• �� ;�� ,�`�� ', � � � �� A�� 6. Amount Taxable 6 $ �� '�'�� f `, �\�� \�\\\\�� \\�� \ � , \ � . �[ (�w}, (�`j�/`" � ��VA ��A`�� 7. T�X R7.tP_. 7 „ �l c \l /✓ �\��\�� \��\\��\\\�\\��\\ �� \ \ � � � \�� \�\�� \� � �� : . . 8. TaxDue 8 $ �� '�� . j ) �r � \�� \\�� \��\ p�� \ \ _,�. � ,/ �7� � ��\ \\\�\�� \� 9. With 5% Discount (Tax x .95) 9 X �� i .� � " � �� ' �... .... .�.. • .\�.\\\��.'�.a......�� \�:\��.a�\�o�\,\.��.....:.....� �..., ..�...._.:\�....\� ��.. .\ �� ...' 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. ;, ,�� T, �� ?� � � 7'�r� _ �`j ,� �:� � � r � Work + � � � � — c_�C' ' ��,.��'j �;� ��' �'�,` � �� Home ?I �� - 7 7 �� t 1 I � �U�� 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 _ � - --- — - - -� - - .,.�-�- - _ � �, _ � � _ 5 � - -_ _ � W : _ _ a `o — - - _ ; ��, ; - � - � - -- _ , � _, i � - - - � - � — - ;� *-. � - w j�� ' - - . . . � . � � _ _- - . . � ��'-.. � . � � �MY�. . _ _ . . , : . � .. � '"�1! . -- _ .� � M � � - - - � �' °� � � - _ � � Q � :� - � c5 �� - _ : �' � J !� "� _ - _ � �' �. - — , .�,� ��,•.�, �. . � .;� - _ _ - .,�. - ;::, -- - - � ,�� ,,�"" - : . .� -_ �� - �� - _ - t� � - _ _ _ . �-�}- �..,. - ' � -_ - _ � � 4 _ - - � � -� - - - - - � -.�„ � - _ � _ V S. - -- E "'h- j `� - - - � 4 —' _ - - - ' --•• ""'�' � - - �Jv s � � - - _ � � � - - . l� _ - __ _ - �! � - - - - �,� - - - - �n � - _ _ .� � - - _ _ - �i �r� - _ - � � � .. . . - _- - __ _ �� -�..�� . _ . --�-=�o :.,� -�' � _ _ - � � =l��E�� ,,�� _ _ _ � � _ ��. - - - C� �.� ,.�: ; �� .�� - - c� �...a * � � _ - _ � y. � �� =- T �� T�'�-�� i�� - - - � � � J, ,� � � . - - , : �� ,��f�,�� .... �-` � �F --.� � �4 ��t.�� C��}��'� - _ - c�� J �: , - _ �- . - - - .� . .- _ , . . _ _ . � - � � °.' � - _ _ _ - _ = c% � � -