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Home My WebLink About11-14-13 REV-1162 EX(11-96) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N O. C D 018404 BORTZ ANDREA 3061 MOSSER DR ALLENTOWN, PA 18103 ' ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold ---------- 13147606 � $1,925.31 ESTATE INFORMATION: sstv: I FILE NUMBER: 2113-1060 � DECEDENT NAME: STEWART MILTON E I DATE OF PAYMENT: 1 1/14/2013 � POSTMARK DATE: 11/12/2013 � COUNTY: CUMBERLAND I DATE OF DEATH: 08/18/2013 � � TOTAL AMOUNT PAID: $1,925.31 REMARKS: CHECK# 674 INITIALS: HMW SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL T�ES Penns Ivania lnheritance Tax � pennsylvania PO BOX 280601 y } } Q DEPARTMENT OF REVENUE W►RRISBUR6 PA 17I28-0601 II1�OI�IY��LIOI7 NOLIC�i REY-15f3 EX DeeEXEL(�8-12) And Taxpayer Response F��E NO.2� �--I�'/�� ACN 13147606 DATE 09-10-2013 . Type of Account. Estate of MlLTON E STEWART Savings SSN 162-05-7875 Checking Date of 2013 X Trust ANDREA BORTZ County CUMBERLAND n � ��tie 3061 MOSSER DR ALLENTOWN PA 18103-3b35 � � � �,rnj Q � � � M � � �„ Z � ..� �y C� � � � O �+ C� � � �D '.t� "�t 4 C � � � � : �0 F--+ r"~ � , ��.► '"�. �_- .._:� � � _ _ r FULTON BANK NA provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. . Remit Payment and Forms to: Account No.520 Date Established 08-09-2010 REGISTER OF WILLS Account Balance $45,036.50 1 COURTHOUSE SQUARE . CARUSLE PA 17013 Percent Taxable X 100 Amount Subject to Tax $45,036.50 Tax Rate X 0.045 NOTE*: If taac payments are made wi#hin three months of the Potential Tax Due $2,026.64 ,< decedent's date of death,d�duct a 5 percent discourrt on the tax ) $(see NOTE } � �S 3 � due. An inheritance tax due`will become delin uent nine months With 5%Discount(Tax x 0.95 * . y Q after the date of death. PA� StGp 1 : P,lea�e check the appropriate boxes below. 1 A []No tax is due. I am the spouse of the deceased or 1 am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do nof check any oiher boxes and disr+egard the amount shown above as Pofeniial Tax Due. - . ,.� �A-_�_ .. _.__.._�_._.. _..., _._.�_�..��..�__ _ _ g ��T�he mformation is The above information is correct, no deductions are being taken,and payment will be sent r .�lcorrect. ��.�� with my response. Proceed to Step 2 on reverse. Do not check any other boxes. C �The tax rate is incorrect. � 4.5% I am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased. (Select correct tax rate at right,and complete Part � 12% I am a sibling of the deceased. 3 on reverse.) � 15% All other relationships(including none). p �Changes or deductions The information above is incorrect and/or debts and deductions were paid. � listed. Y Complete Part 2 ar�l part 3 as appropriate on the back of this form. E �Asset wilf be reported on- The above-identified asset has been or will be reported and ta�c paid with,the PA Inheritance Ta�t inher'itance tax form � Return�led by the estste representative. REV-1500. Proc�eed to Step�2 on reverse. I�not check any other boxes. Please sign and date the back of the form when finished. PART 2 Debts and Deductions Ailowable 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), }�!ea�e��t�i�?��ri#ten corrs��i�n from#he 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 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. tf 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 $ �� ; � � � 7. Tax Rate 7 X �°: ; � ; ,. ,;. ; �� ------_�_ �;.: � , `, , �, � � ;�� , ,�, � �� 8. Tax Due g $ : � , , , , „ � � � �� ,�� ,; • � 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 alon with a check for an ., „ � 9 y 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 t have reported above are true, correct and complete to the best of my knowledge and belief. � '� �� - 4 t �� -� 1�� *, _ � _ � � �. Home �,� 1 � �'�� .��,,� -, � �, � � � .� 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 � mu y .�. � i� a �. W - - ;ed � - w a O , __ - - �a�n�� c�� a� - �� _ : RE�1ST�� OF 1�1�.1.s � ,,�.•• _ _ - � - _ - � . . i�OU 1`� P�1 1 �� - � �3 ,� � _ - � �. - _ CCEF�K 4� � _ � � � pRPHANS' C4URY . �- �: � ��,,. � ��:��►�RL�►NU C��• P .� _ � � _ � � + � � � _ r � _ �: �'} ,�. �� - � � � .;. j . ^ — M �� _ f ' � . . . �I► . — � s� , � t� �� ('� �"' � � � ..�. � � - - - T � I - • � �� _- d� � - � � -- - .-� � "� - � � '� � . .. - � �i _ t � � �'" � _ 1 _ . t _ � - _ .�.� � 1 � v - - - � . > M � _ 4 '� r .i W - .�+ . _ � �p� � - � !i� � � cJ � i - � O � � - ` � � _ � � 0 � . - � 0 ` , - s'J `r - i _ �:,..