The URL can be used to link to this page

Home My WebLink About11-27-13 COMMONWEALTH OF EENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 018459 EARLY MARLA S 904 CEDAR ROAD LEWISBERRY, PA 17339 ACN ASSESSMENT AMOUNT CONTROL NUMBER --°°° fold ------°-- 13155058 � $46.81 ESTATE INFORMATION: ssN: � FILE NUMBER: 2113-0144 I DECEDENT NAME: EARLEY DOROTHY J � DATE OF PAYMENT: 1 1/27/2013 � POSTMARK DATE: 1 1/26/2013 � COUNTY: CUMBERLAND � DATE OF DEATH: 01/30/2013 � � TOTAL AMOUNT PAID: $46.81 REMARKS: CHECK# 3483 INITIALS: HMW sEa� RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BIAtEAU OF INDIVIDUAL TAXES PeI�CIS IVSI�IS Il�herltaC�Ce T$X � pen�nsylvan�a PO BOX 280601 y DEPARTMENT OF REVENUE HARRISBUR6 PA �T�Za-o6o� Information Notice REV-15S3 EX DoeEXEt(�s-12) And Taxpayer Response FILE NO.2113-0�� ACN 13155058 DATE 10-17-2013 Type of Account Estate of DOROTHY J EARLEY Savings Chedcing Date of Death 01-30-2013 Trus# AMANT�A��ARLEY County CUMBERLAND �Err.tificate g0�t�'�ED"1CRS.RD.._ . .__ LEM�ISBERRY PA-17339-9570 �. . �..; ._ � � � � °` ' !'�'i ,.: � :['! � �? C �7"1 � t"y � CJ'� � , � �,,. � � � � .� � � � � Q '.� U? ?� C� C� � �j � �? 'fi "'�'f . , : ,�,.,,.�;.��..,_ =�___ .,,�.,�_: � . . _ , a, � �,,,_,,, ,��.. �►;��'�_ � .._ '� � � �.<3 � . � � � EE PATR I DT HONDS provided the department with the information below ndicating t�at the�eath;of the above-named decedent you were a'oint owner or beneficia of the accaunt identified. Account.�0 Remit Payment and Forrr�to: Date E�tabtished 01-30-2013 REGISTER OF WILLS Account Balance $1,040.16 1 COURTHOI�SE SQUARE Percent Taxable X 100 CARLISLE PA 17013 Amount Subject to Tax $1,040.16 Tax Rate X 0.045 Potential T�c Due � $46,g1 NOTE`: If tax payments are made within three months bf tF�e decedent's date of death,deduct a 5 percent discount on the t� With 590 Discount.(Tax x 0.95} $(�{�pTE*) due. Any inheritance tax due wiN k�come delinquent nine months : after the date of death. � PART 'r�� : Rlease ch�ck the appropriat� boxes below. . � � A C]irlo tax i,s d�e. 1 am the spouse of the deceased or I am the parent of a dec�dent who was . ' � � 21 years old or y�unger at d�te of death. ' P'ra�ead 1a 5't+ep 2 on r+�verse. Do not check any'other boxes and disr�eg�nd thQ�amount , shtrwn�bove as�'otential Tax Due. _.�.__. . r.�._.�:�.�_��__,. __�_ _ . .__ _ ,_._._.___ .____ _ _ . _ __. . _ _ _ _ _ _, _ g �The infortnation is The abave information is correct,no deductions are being taken,and payment will be sent cor�e�t. with my r�nse. . � Proceed to Step 2 on reverse. Do not check any other boxes. C �The tax rate is incorrect. Q 4.5% I am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased. f Se�lect correct tax rate at right,and complete Part � ��o I am a sibling of the deceased. 3 on reverse.) ❑ 15% All other relati�nships(including none). p �Changes or deductions The information above is incorrect and/or debts and deductions were paid. listed. _ Complete Part 2 and part 3 as appropriate on the back of this form. E �Asset will be Eeported on The above-identified asset has been or wiA be reported and tax paid with the PA Inheri#ance Tax� -inhe�itance tax'fic�r�n ` : fiet�rn filed by the es�ate represent�t�ve. - _ _ ; , AEV�I5UQ. Proceed to Step 2 on reverse. Do not check any other 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 establishment date(Line 1)account balance(Line 2),or percent taxable(Line 3), p�e��e+�btain a�ritten carr�stio�from#hQ fir��ia!ir�sti#uti�s��d a##�ch�##�this forrn. 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 � '� ` `� ` � �� '� '"�`�� \\� ��\�� \\��\� ��\\\ � ��\\\ � � \�� \��\ �� \ ��A�A�� `VA��A �� A� �� \�� A A\ \ ��A\�VA\�A V V\\A�AA�A��AAV�VA��\\ AV` � 2. Account Balance 2 $ �� \� �\ \� � � �� \��\� � \ � 3. Percent Taxable 3 X � � �� ,�� \�� \� \ \� ��\�� \� �\. 4. Amount Subject to Tax 4 $ � �� , � ,� , �, � � �� ;�� ,,, ,��, � �� .:.. _.... . .. ..�.. ... .. ..�. ..� �. .� � .,. ..: ..! ,. ...�,: 5. Debts and Deductions 5 - � �' ' ' �` \�\�� \\�\ �� \ � �� \\\��\ �� \ �� \�� A ��: 6. Amount Taxable 6 $ � � ' \ ��\�� \� ��\\ � � �� . ' � � �� \ �\� � ��\\� �\ \�\� ��\��\\\\\\\\ \� � � 7. 1 aX flale / '` � \ �� \�� \� \�� \\\\\\�\��' Tp �` ,� � ; ` : .. � �� . � \. �. 8. I aX �ue C7 W � � ��\\�� p��\ �� \\\ \�\�� \ �: � \.��\ \\�\\� �\�\��\�� \\\\ \\ \��\\\ �� \ 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 � . � , a ' � � 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 i , _ _ , _ f �` ,�st' __ - - _ - � � — - '� ---- - - �� QF�'1�E �� - - _ - R��ST�� F 1�1L�.S - - -_ _ 1�13 #�Qv �? �� 1..� �5 - - - - - _ - ci��c �� _ _ QF�Pt�;��S' ��T � _ C�l;��R�A::�Q G�?,, P� — - �(' _ - - - _ - - G� - - _ - _ � _ __ - ¢�. - ...,� - _ _ �# - - - - �. - - - - — t,� -- - _ c� - _ - {,��?y � _ -__ - t i • r` - _ - _ � � � _ - ' _ �r �+r �M �t �. - �� - +� �� - - - ��rw . . �.�'�1: �r� ..`";:�' '�'`i � — — — .... � �zj — ... _ «w. �` :•�; — .�.... � �r _ — ... , s ,. f .. _ — .w •V �+ ' _ � ♦ _ ~. � ;� ��: ' - _ - � --r ��: 'y.;. - - _ - -... � w; - _ .� ��;,€ — �. • �� — ... '�� — - - — — -- ;�x, _ _ .... ,�;,. — — ..•� "rr. ,z�;, � y�: "+`r �f� r''L! _ .;,"„r, �•,t- q»,e, — — .. — w — — .w — — — ,. — — � — — — ",,, '�; � — — — .`� ��, t� � +�"'w. — — w — — '+� — — Wr _ f�y yY�YM� ♦ - - �IYr - � - � - - ---- - � ��. I � _ - �.LLUESPIIyf{ - � ...�'�;. - -- ry, �' - I"v �,; j , r`Y . . ... . S'.� - _ . I�� . . l � - � � �_: � 0 _.-_.__ . , --�1'l^+ _ 0