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Home My WebLink About11-04-13 (2) BUREAU OF INDIVIDUAL TAXES Penns ivania lnheritance Tax � pennsylvania PO a0X 280601 y DEPARTMENT OF REVENUE HARRISBUR6 PA ��28-060� Information Notice REY-1543 EX DocEXEL(/6-12) And Taxpayer Response FILE NO.2113-0989 ACN 13156709 DATE 10-25-2013 � �� Type of a�caunt� Estate a#ANNIE G PATTISON Savings Checking Date of Death 09-05-2013 Trust BRUCE A WYRICK County CUMBERLAND Ge'�ifrcate 7 E WALNUT ST LEBAN�N PA ��;4�•�476 '"`� � � � � _ '�, � r; � '� `t7 � � � � � � � �" t�` � 1'"r'i �, '"� ,'��p --� � � '�'; . �' (1« �C � t� � � � � � � ' . _ � .., � ';►"3 e , i ' r- .,e.�_.�k:� � - , __...._..___. . ..�_ <h,�,,,,.,;zw,�.,,,rF,.;>..��,,,w.,t,.-_.____�__^_�_�—.�._. �. �4�'wr�.._��--.e-.-,-. �. . .�. ,�� ,...- -_ . . _ . . .._ . .. - � .. �{�w.,�,r.�� < .. _- _- . . . � � �' ..A.:f �-L--..a. »�...��','��. �ti . #r.. T,�.�� . _ . . - . . � � � - ' �v � �-.� � rn �„ � +�' �° CITIZENS BANK OF PENNSYLVANIA provided the department with the in#ormatio , below ind�icating#hat at the death of the above-named decedent ou were a'oint owner or b�neficiary of�e account identi#'ted. y � _ Remit Payment and forms to: _ ..� . �- - . _ ti y . _ . ..,i . ... .:.. . .. � . . . . ."tS � �.. . . . � . .... .. �:.yw ... , :�:.� ...__ .��t :�i:�� .�.. �... pate`E'stablishe�f 4�-��-01 __ A�F�.T -�wttt� Account Balance : $6'�,735.01 � -i: � , USE Si�UARE � C�R�1Si.� PA 17013 Percent Taxable X�0 ` � Amount Subject to Tax $30,867.51 � Tax Rate X 0.150 NOTE": If tax payments are made within three mpnthS.�f the Potential Tax Due , $4,630.13 „ .de�ede�f'�.da#�.ot death,d�du�ct'a;5 per�ent:disc:oun�:on.the ta�c With 5iDlo Discount(Tax`x��.95) $(see NOTE`) due. Any inheritance tax due will b�come delinquent nine months � after the,d�te of.death, _ PART : 1 $tep 1:Please check the appropriate boxes below. _ A [�No tax�is dae. t am the spouse of the deceased or 1 am the parent of a deceder�t who was 21 yeafs ald or younger at date_of death. Proceed tv Step 2 on reverse. Do not chedc any other boxes and disr�egard the amount shown above as Potential T�x Due. � , :, - � � .,�.. , .. . ....� .._:. . :. .;.�::,. �. ..:. _ _ .T�.._. _ , .�..,.�::j. �__._...�.�� .:. ... � � �� - � v��`t�+��oh'�as correct,no deduct�ons are�being taken,and payment wil}be sent correct. wi#h my response. � Proceed to Step 2 on reverse. Do not check any other boxes. C �T�ie tax,rate is incorrect. � 4.5% I am a lineal beneficiary(parent;�hild,grandchild,etc,)Qf the deceased. (Select correct tax rate at right,and complete Part � 12% I am a sibling of the deceased. - 3 on reverse.) � 15°/a All other relationships(including none). � ` � p �Changes or deductions The information above is incorrect and/or debts and deductions were paid. lis�ech t- � Complete Part 2 and part 3 as appropriaie on fhe back of this form. � , , , ._ , . - n, . E . Asset will be reported on The above-identified asset has been or wiU be-reported and�tax paid with the PA lnheritance Tax inheritance tax form Retum filed by ihe estate representative. R�V-1500. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. _ ; _ W - ; 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), ple�s��tatai:�a writ#ee�c�rr�et�a�frcr�thp#i::ancia! inst:�t;�#iQ�a.^.��tta�h ;t.�thas#orm. 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. �i. For joint accounts established more than one year prior to the date of death,the percentage taxable is 100%divided by the total n�m��r of owners including the decedent. (For example:2 owners=5o�io,3 owners=33.33°io, 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 �� , � `�� ; �� ,��\��,�� ; , � �� \� \\�\�\\� ��\ `� �� \ \ �`� �� \\\��\\�� \ 2. Account Balance 2 $ \\��\�� \��\\�� \ � � � �\ � \\�\\\�\��\ \�� \�\ �,��. : . � �� \ �\�� 3. Percent Taxable 3 X ;, \ . \ , \�� \\�\\\\, ,�\��, , \,, � � 4. Amount Subject to Tax 4 $ � � � �� — � � � � �� ; � �� ;� �...�. ��, � �� 5. Debts and Deductions 5 - � � � � � � � . 6. Amount Taxable 6 � � � � �� X � � �� ` � ` �\��\ \\\\��\� � \' 7. Tax Rate 7 � � �� ' ,,,y; � �� \ � �A�� `�A� �� 8. Tax Due 8 $ �' ; � � � � , , � � �� - \ \,��\\�\\\ � ��\��. 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. � � �` Work , Home ��.�- 3 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