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Home My WebLink About11-01-13 (2) BIHtEAU OF INDIYIDWL TAXES � enns lvania Po BoX ZBO6o� Pennsylvania lnheritance Tax p y HI►RRISBUR6 PA 17128-0601 Information Notice DEPARTMENT OF REVENUE REY-1543 EX DocEXEt(�E-12) And Taxpayer Response FI�E No.2113-0959 ACN 13154731 DATE 10-15-2013 Type of Account Estate of LOUISE H JOST Savings Checking Date of Death 07-28-2013 Trust BARBARA L BOOKWALTER County CUMBERLAND Certificate 103 CHANNEL DR CARLISLE PA 1�013-1208 ' .,, � �� 3 � � rn � � � � � � -� � cn � � r�-- �-�+ I�~ �'�-y �"! � '�' � ►-' .�� C� :"� � ;,�C f� �'i . �:�: � � _. , ,__ _�. _ - . . . C� ,�-� � "t'T ""y'} "1"� , _ ,�.� � ..�.� � ,,,,,� "�'1 Nil' � � � � �� ! CITIZENS BANK oF PENNSYLVANIA provided the department with the informai�en below �licafi��at�t the death of the above-named decedent ou were a 'oint owner or beneficia of the account identified. � - Remit Payme�t and Forms to: � Account No.6215431242 Date E�tablished 01-17-2007 REGISTER OF WILLS Account Balance $10,750.55 1 COUR'�HOUSE StiUARE CARLISLE PA 17013 Percent Taxabie � X�0 Amount Subject to Tax $5,375.28 Tax Rate X 0.150 NpTE`: If tax payments are made within three months of the Potential Tax Dus $805.29 decedent's date of death,decluct a 5�rcent discount on the tax With 5��Discount(Tax x 0.95j $(see NOTE*) due. Any inheritance tax due will become delinquent nine moMhs after the date of death. P� _ $'��p 1: Please check the appropriate boxes below. � A �No ta�c is due. 1�m the spQUSe o#the deceased or I am the parent of a decedent who was 27 y�a�s old or younger at da#e o#death. Y' Proceed,to Step 2 on r�everse. Do not check any other boxes and disregard the amount shown abc�ve as Potential Tax Due. _ _, _ ��_ __ __..Y.._ _ _._ __ �_ _ _ .__ --- - _.__ . _. - __ _ - _ __ _ � � The inf�rmation�is� The above information is correct,no deductions are being taken,and payment will be ser�t B �correct. with my response. Proceed to Step 2 on reverse. Do not check any other boxes. C �The tax rate is incorrect. Q 4.5% t am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased. (Setect correct tax rate at right,and complete Part � 1�/o 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. hsted. Complete Part�and part 3 as appropriate�on the back of ihis form. E�As�et will b�reported on The above-identifr�asset has been orwill be reported and tax paid with the PA Inheritance Tax �nherita`nce�tax form Retum#iled by the estate representative. RE1f-.1 SQO. Proceed to Step 2 on reverse. Do not check any other boxes. Please si�n and date the back of the form when finished. PART 2 Debts and Deductions 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(�ine 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"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: ��; � , � ,,;,�,�� ,�� 1. Date Established 1 � � �`��\�\�`� �; � �' �� \��A �� `� �. � � � ��\�� A��V��` � � ��\; \��\�� \��\��\\� ��:��\\��\�\�\��\\\\�`�\\�\�, 2. Account Balance 2 $ �� ' : � � � � ; \ � �� \\\�� \ �� 3. Percent Taxable 3 X � ; � �� .� � � �� ;�� ;�� 4. Amount Subject to Tax 4 $ �, � � �� : � � 5. Debts and Deductions 5 - �, � �� , , ,� �� , � � �� : ' ,�� , , , 6. AmountTaxable 6 $ �� , , ,, �� `�� , � \ � \ � �� \\ � \�� \�� 7. T�X R�t� 7 X ��` �. A��.� �� T �` � �� 8. I aX DUe � W � ; \ \��\ � �� \ �\\��\� \�� ,. � � � � �\ ��A�� \ 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 w�th 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. Work " Home / - _� � 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