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Home My WebLink About11-04-13 (4) BUREAU OF INDIVIDUAL TAXES Penns Ivania lnheritance Tax � pennsylvania PO BOX 280601 � HARRISBUR6 PA 17128-0601 Information Notice DEPARTMENT OF REVENUE - REY-1543 EX DoeE%EC(�6-12) And Taxpayer Response FILE NO.21�3-0989 ACN 13156711 DATE 10-25-2013 Type of AcCaunf ; Estate o�,/�NN�E G PATTISON Savings Checking Date of Desth 09-05-2013 Trust BRUef A WYRICK CountyCUMBERLAND . �Certi�icate 7 E WALNUT ST _ LEBANON PA 1704s��5�+76 � � Q c.� �? � � �7 �' � C'� � � � � � 3"' C7 �' � :Cy �."` 2�"' }--- "".� � e � � � � �� - � � � � C� . .> . ' . � �. - y �. ♦ . - ,. . . . . . , ' .. . ... . . . ., . . . + _...,..�:. .��y ' .:_ ' .'-. . ...�' , . �. .: .. ,...,r.:.'. . ° ::'.-�...-. _ �. ...._ ..< . _ . . . ._..- .. .. _ .�x .-� ..;+il►�ie-.NR�1�-.y.',�- � ' _ �� w-a ,:::: . .�,. � . ..,. . � , Y .. _�t, :.. , . ...... �'.0.�� ..« _ :�. ....,y:..:��.a... .. _.. ._ . .._ . y � � � - , ay� . . ,,.. �. 4 4 d �n.J '4�.rT ..�'"�.._� .._. _.. -... !�!�'\ � � !� � ��.� � w.,., � � ~f �"*^ � CITIZENS BANK OF PENNSYLVANIA provided the department with the informa�ior�below ind�� 't111�+�16�St the death of the above-named decedent you were a'oint a�vvner or beneficia of the account"t�lentifie� . F�mit Payrr�er�t and Fomn�s to� .. � �Acc�oun#-Naa 61�897�4 . ,. . . ... �. Date Established 03-07-1990 REGISTER OF WILLS Account Balance $6,489.71 . 1 GOURTHOUSE SQI�ARE : CARLISLE PA 17013 � Percent Tauable X 50 �� Amount Subject to Tax $3,244.8fi � , ; . ., Tax Rate " : X 0.150 , , Potential Tax Due NOTE*.;;If tax payments are made withi�thr.ee months of the $486.73 � -° ' .d�den#`s date of dea#h,ded�rct a�5 p�ent discoc�nt on the tax With 5�Qisctwnt[(Ta��x A.95) :$(see NOTE*) due. Any inheritance tax due will b�come delinquent nir�e rr�onths after th�date of.death. ; P�►RT. . .� St@p 1:,�le�e,check the appropriate boxes below. � � ,. A [�No�x is due. 1 am the spouse af the deceased or I�m the parent of a decedent�'►hc�was 21 y+ears Q1d or�/ounger at date of death. _ ... , ...: .:P rot�ed to St�sp'on reverse. Do not check any�ther boxes and disr+egard the amount _ � . .;�, -�,..s��,�.��,� � Q�,� v't� . ._ , v ,� . , . . . , , , �.,,�� v ; � : :�,,; sh, ,a�t �s Fotent�a ax ue .,�. : �� _. �, . :�� , �.,. .., . ; � �___,._T--- � _ , - - - arr � - �` v"� �_ atro�r�rs correet, no deductions are being taken,and payment will be sent `, aorrect.s with my response. Proceed to Step 2 on reverse. Do not check any other boxes. C �The tau�rate is incorrect. Q 4.5% F am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased. {Select correct tax,rate�t right,and complete Part � ��, I am a sibling of the deceased. 3 on reverse.) � � 15% All other felationships(including none). p �Changes or deductions The information above is incorrect and/or debts and deductions were paid. tis;ed: . .`' ; ' Complete Part 2 arid part 3 as appropriate on the b�cEc�of this form: E Asse#wilt be reported on The above-identif�ed asset has been or will be reported and tax p�aid with the PA Inheritance Tax inherita;nce tax form Retum filed by th�es#ate representative. REV-1500. Pro�eed to Step 2 on reverse. Do not check any otf�er 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 establisliment date(Line 1)account balance(Line 2),or percent taxable(Line 3), please�btair:a�rritt�r;�rrs�tior�fror�!h�#��e3nc6�t institt�#ion anc+��#ac�:�#to tl��s f��sn. 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 �� ,��r;�� ,��,,,,�;�� your relationship to the decedent: ��` , � ` ` � „� ��,�; 1. Date Established 1 \ �� \ \ .: �, � �� . ��\\ � \��\�\��\�\�\�\�\�\\: �� : \ � \ \ , ' ; � �� \\ �\\� \: 2. Account Balance 2 $ ; � �� ,� � � ; � � � \\ �� : X � � � �, , � �, „ 3. Percent Taxable 3 � ` � � ` \�� , , 4. Amount Subject to Tax 4 $ � � ,...� , , � � , .... :,;. �� .._, .. . � .�:� �. , 5. Debts and Deductions 5 - � ,� - ;� � � � � � � � 6. Amount Taxable 6 $ � � �� ; � � � , , ; � , � � � 7. Tax Rate 7 X � ; �� - � , ,\ \�; �� -- � � �� 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. e�. '� Work � � Home ��- (3 Taxpayer Signature Telephone Number Date IF YOU NEED FURTH R 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