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Home My WebLink About11-04-13 (5) _ ___ -� BUREAU OF INDIVIDUAL TAXES Penns Ivania lnheritance Tax � pennsylvania PO a0X 280601 y DEPARTMENT OF REVENUE HARRISBlH26 PA 17128-0601 Information Notice REY-3543 EX DocEXEC(�e-12) And Taxpayer Response FILE NO.2113-osss ACN 13156712 DATE 10-25-2013 Type of,Account , : ` , _ Estate of AN(�IE G:PATTISON Savings : _- � Checking . . Date of Death 09-05-2013 _ . Trust BRUCE A WYRICK County CUMBERLAND � Cettificate 7 E WALNUT ST , LEBANON Pa 170�i2�5476 �.; , . : . _ :- , C w � t't1 , C�dr � � � �' . �'r� � � � � � � z � � t� �"��1 • A. � � :�:3 � �: .. � C> � l:7 C`� � ,� '.�Mt "� � � ..,..� � ""�7 • . �'"�.:� '' __ � .��""'' _ . : �C3 F--' .,�.., � . "t7 ,�,� ~� � !"�i �„ .:.� � � CITIZENS SANK OF PENNSYLVANIA provided the department with the inf�rmation belowir�dicating#hat at the dea#h of the above-nar�ed decedent you were a jornt owner or benefi+cia �fi the account identi�ed. : , Remit Payment and Forms to: ��ap�n�Nt�.6�4Q88T440 Date Established 04-04-1988 REGIST�.R OF WILLS Account Balance $10,347.40 1 COUR'�HC?USE SQUARE Percent Taxable k 5d CARUSLE PA 17013 _ . . , Amount Subject to Tax $5,173.70 Tax Rate X O:t 50 _ Potential Tax Due $77�.06 � NQTE': If tax payments are made vui�hin three months�f the With 5�o Dis�count ax x p.95 ��er�#�$date of death,deduct a�-perc�t discownt on the tax (T ) �see NOTE*) due. Any inheritance tax due will becon�delinquenf nine months ' after the date of death. PART .�'''"�i"��Bj�,1: Ple��check the appropriate boxes below. :� _ A Q Ne��!s due. I am the s�ause of the deceased or l am the parent of s decedent who was * 21 years oki or younger at date of death. Pror:eed to Step 2 on r�everse. Do not check any other boxes and disr,egard the amount , , ; shown above as Potential-Tax Due. , _ . �_ . _ � "��'B�"�'"F�ie°t�1-€c�n�t�'ti�`i�� R'�' � Ttf��a�v�informa`�r`on�is�or�ect, no deductions are being taken,and payment wiN be sent correct. with my response. Proceed to Step 2 on reverse. Do not check any other boxes. C �The�tax rafe is ir�orrect. � 4.5% I am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased. ' (Select�correct tax rat�at right,ar�d corr�plete Part � 12% � I am a sibling of the deceased. 3 on reverse.) ` � � 15% All other relationships(including none). ��Ch,�nges 4r deductions The information above is incorrect and/or debts and deductions were paid. ; g lisfed. � Complete Part 2 and part 3 as appropriate on the beck of this form. . , E Asset will be reported on The above-identified asset has been or will be reported and tax paid with the RA Inheri�ance Tax inheritance°tax form Return filed by#he es#ate representative. �- REV-1500. Proceed#o Step 2 on reverse. Do not check any oth�r�x�s. � � 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 establishment date(l.ine 1)account balance(Liiie 2),Qr percent taxable(Line 3), F.'�ase��#ai,�a�r��ittAn��r�-e�#��#rorr�#h�fi��ncial 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: � �`� � � �'�' �� ' �� `� � � � ��.��3��'��?�� . . �.' � � , 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. � Work , Home [ DC.�'�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