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Home My WebLink About11-19-13 BUREAU OF INDIVIDWIL TAXES Penns ivania lnheritance Tax � enns Lvan�a P� BOX 280601 y P Y HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE AI 1�TG�p�yGl� R�iSpOC�SG REY-1543 EX DoeEXEt(�l-12) FILE NO.2113-1066 ACN 13159370 DATE 11-01-2013 � TYPe ofi�count � Estate of FAYE K DEMY � p vings SSN 194-28-7955 ��, ,�,�, � � �h edc�ng Date of Death 09-18-2013 rr� � �, � � �gt PUABOXE3WILT County CUMBERLAND � Za. t`- �,,, �rtj�� LANDISBURG PA �7040-0003 � C�t� � � � � �[ � c�.� ° � �' ��, v � -� " �► , ,�,w , 4 � r� �� n. � tv G��'► � ,i � � � BELCO C�MMUNITY CREDIT UNION provided the department with the information below indicating that at the death of the above=named�decedent ou were a joint owner or beneficia of�he account identi�ied. Account Na 60960 • � Remit Payment and Forms to: Date Established 11-19-�97� REGISTER OF WILLS Account Balance $32,960.57 1 COURTHOUSE:S4UARE Percent Taxable X 16.667 ,CARLISLE PA. 17013 : Amount Subject to Tax $5,�93.54 Tax Rate X 0.150 _ . Po#entiaf Tax Due � - ' NOTE*: If tax paymen#s are made withiin three months of the $824.p3 decedent's date of death,deduct a 5 percent discount on the tax With 59'o Discount(fax x Q.95) $(See NOTE*) due. Any inheri#ar�ce#ax due will become delinquent nine months after the date of death. - �ART St@� 1: Plesse check the appropriate�boxes below. � A �No tax is due. 1 am#he sp�►use 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 not check any other boxes and disregarn►the amount shown above as Poientia!Tax Due. :-_�__ - - - _ _ _ _ _ g�TPi�in�orma�ioFi-is� � The a�iove information is correct, no deductions are being taken,and payment will be sent corred• with my response. Proceed to Step 2 on reverse. Do not check any other boxes. C �The tax rate is incor�ect. � 4.5% I am a lineal beneficiary(parent,child,grandchild,e#c.)of the deceased. ( e ect correct tax rate at r right,and complete Part � ��a 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 virere paid. listed. Complete Part 2 and part 3 as appropriate on the back of tiiPs form. E �Asset will be reported on The atiove-identified asset has been or wiU be reported and tax paid with the PA Inheritance Tax inheritance tax form Retum filed by the�State representative. REV-1500. Proceed to Step 2 on reverse. Do not check any other boxes. Ptease 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), please obtain a written correction from the financial institution and attach it to this form. i. Enter tne date the account was estabiis�ied or titl�d as it existed at the date cf 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: °� ��. ' �� `�� "� 1 L l I ��DI �LI ,� : � \ \\ �,� � ��\ \�\\\\�\ \\ \\�\� \\\\� �\�� 1. Date Established �, � � � �� ` � � � �� :\\� ��\\� � . � , . � � � � n 2. Account Balance 2 .�� :. ��7 �� , � �; ��;�� `��,,;��`�� "�;��`� ___� — � �� \.: � � � �\ �:� \�� • 3. Percent Taxable 3 X ��`'�� ` ��` � � `, � �„�°� ,,� ��`� , � � � � �.� �� p��Q \�� \.\�� ,��\\ � ,� �� 4 $ �� t�U� ��'� �� 4. Amount Subject to Tax � � � � , ' � � ;� � �,;�� lrt . �y� � • , � 5. Debts and Deductions_ 5 - ��" �� ,, � �� ,�; � ��,�.lu.s:��,,� � , 6. Amount Taxable 6 � � � `f�S� Z�( � ' ' � , � , � � � . + � ��, ` �� 7. Tax Rate 7 X -1 Z-- ° � ;� , � �� ;� ,� �' �� ,�� ,� �� :� � � � � 8. Tax Due R $ '�..�,�A�1. l0� ; �� . . � �� :�, � �� 9. With 5% Discount (Tax x .95) 9 X ��. �� :� .�..��. ...... . _._ .. ......,_.. , , .,..�.. ��,.; �.�,�. �� .._, .�,.��.. .., �.h..�� a.. 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 perju e that the facts I have reported above are true,correct and complete to the best of my knowledge and belief. Work � �"�-�`f �'--1�.��.� Home � � � (S� ?-�G' " Taxpay r Sig atu -�� ``�-` ��- Telephone Number Date IF YO NEED F THER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE DISTRI T OFF , OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAY ITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020