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Home My WebLink About11-04-13 (3) BI�EAU OF INDIVIDW4L TAXES Penns Ivania lnheritance Tax i enns Lvania Po soX zao6o� y p y HARRISBUR6 PA 17128-0601 In#ormation Notice DEPARTMENT OF REVENUE And Taxpayer Response REY-1543 EX DocEXEG(/8-12) FILE NO.2113-0989 ACN 13156710 DATE 10-25-2013 Type of Account: Esta�e o�ANNlE G PATT�SON : SaVings Checking Date of[)ea#h 09-05-2013 T�� BRU�E A WYRICK County CUMBERLAND ` ,� ificate 7 E WALNUT ST . � ,_.�. ;_ ' ,. ..: ` LEBANON PA 1704�-5476 � . '. 4.� Q _ t'n � . � � � � � � t?'l � �'7 � � �7 � �,�,. r �'� rn r- � rn ...� � � � �' �, �,, � c� =� �T� X� c� � � � �:�: �� ,"� � � �':� � ,. �. �:.�...__.....,,r,l�,�. _.:. � � .. , . :. ; , . � �`—�� _ __ . ... . , , . . . . . _.._ .� . - . . .. F a:�t..� � d�,� . .,.... �i ....._ _ '.;:. ... ' . . . � ^ .1 :�.�.V... s-a.-..,�.. :.. snn...a.. s+r-.��r Y,wn�,-.. "" .' .'.r,i�}..�w ..n ♦ � ; * ..y,. ...: u .'e^Y • �� C:� _ . . - ry • ' ". . � -..Y ...v :; '� � .t.:�'wy_ ..�;df .....T�^.�'. ....''._.. .._ ..� . ,,.�.�.-. � � . .. ...�.�... CITIZENS ,BANK oF PENNSYLVANIA provided the department with the information below indicating that at the death of the above-named decedent you were a 'oint owner or ben�ficia t�f the�ccount identified. Accoun#No.61408973$6 Remit Payment and forms to: Date Established 09=03-1990 REGISTER OF WILLS ` Account Balance ' $13,228:94 ' 1 �OU�HOUSE SQUARE Percent Taxable X 50.- . CARUSLE PA 17013 Amount Subject to Tax $6,614.47 . ; _ : Tax Rate - X 0.150 . Potentiai Tax Due NOTE`: �#tau payments are made�vithin three mon�hs pf the $992.17 s With 59�o D�scc�tit�T�.�Q:�� $ see NOTE* - ' :decedent's date of death,deduct a 5 percent dis�nt on the tax : ; - � � '�' due. Any inheritance tax due will becom�a clelinquent�irte months after the date of d�ath. PART : � . ��'1: R1��se�heck the appropria#e boxes b�low. ,A [�1�►��dt�e. 1�m the spouse o��the deceased or I am the parent of a c�+�ceder�t who was � 21 yeers o�d or y�unger at date of death. � Pr�eed to St�p 2 on neverse. Do not check any other boxes and disr�eyacd tt�e,�»ount �q� shown at�vve as P,otential Tax Due. =.�.w. ��`�av;.kr'�''�. ,•t S" ',^w y'r�.'�#,5;"° h 7 � . , ,:: ,; .. :`: ; ,., - ... ...Y.:. � .. '. _... .. 4.. .:; . �' ..;•.., . _y. . .-� �--:--...+.*`.......' �- ._.. �� . _ �.. ..., . . . . .��.;�' �. .iTf � <` � �'� " ��pve°��`�tirr is cor�ecf,no deductions are being taken,and payment wiil be sent: � cor�ec� ,' with my response. � _ Proceed to Step 2 on reverse. Do not check any other boxes. � �The f�;rate is ic�ccurec#.. � 4.5% I am a lineal beneficiary(parent,chitd,grandchild,etc.)of the deceasec�. � (Sei�c�=�orrect t�c rate at , right,and complete P�rt � ��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 fncorrect and/or debts and deductions were paid. ��: ' Complete Part 2 and part 3 as appropriate on ihe back of this form. - � ., _ _.. E • Asset wiU be reported on The above-identified asset has been or will be reported and tax paid with#he PA 1�^►heri�e�Tax ' inheritance tax form :Returr�#iled by#he estate representative. . l , . REV-1500. Proceed to Step 2 on reverse. Do not check any otfter boxes. Please sign and date the back of the form when finished. ��) _ . ; . . W f 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), ralease obtain a written correction fram 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 awned 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 indicatin a different tax rate, please state �� ;��.�i�� , � �� 9 � � � � � � � , your relationship to the decedent: �� ,��; ` . \ 1 : � �� , ��\ \\\� 1. Date Established �� ` � ,� �� P'�� ' ` � �� ,� ,� 2. Account Balance 2 $ �� ` � �; � `� � � � � � � � . �� , , , 3. Percent Taxable 3 X � �� ' � � � � � � �� ,.. ..;, �, ; � \ ' 4. Amount Subject to Tax 4 $ � ' ; ,� ;�, � ,� ,, 5. Debts and Deductions 5 - � � �� :, � �� ,,, �� . � � � 6. Amount Taxable 6 � ' � �' � � � � ,� � �r ' � � � � �� , �,�,��, 7. Tax Rate 7 X ` �. �� , � , � � �,� ��,� �� : �, . �, �� . < ;; ,_> ,..,: .,._..,.� ..�: � ��. 8. Tax Due 8 � � : �,; � � � � ; � ��,; ,,�� ;, � �� `�� X � , 9. With 5% Discount(Tax x .95) 9 ..�. ......:.._. ..,.._.,.._,_. .�,._._., . :._...,. ',._.. �._. ......,_.,...... ,..�.... ....,.., ..,,.. 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. p 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