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HomeMy WebLinkAbout12-26-13 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF iNDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 17128-0601 PENNSYLVANIA RECEtVED FROM: INHERITANCE AND ESTATE TAX � OFFICIAL RECEIPT NO. CD 018569 ROBERTS KARLA 200 GREEN HILL ROAD NEWVILLE, PA 17241 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold ---------- --°---- 13159443 � S 11 .21 ESTATE INFORMATION: SsN: I FILE NUMBER: 2113-1342 � DECEDENT NAME: WELLER JUNE C � DATE OF PAYMENT: 12/26/2013 I POSTMARK DATE: 12/24/2013 � COUNTY: CUMBERLAND � DATE OF DEATH: 10/22/2013 � � TOTAL AMOUNT PAID: $11 .21 REMARKS: CHECK# 6148 INITIALS: HMW sEa� RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAI TAXES Penns Ivania lnheritance Tax � pennsylvania Po sox 2ao6oi y HARRISBUR6 PA 17128-060� Information Notice DEPARTMENT OF REVENUE REY-154�rX D:c��(,�`'��/_ And Taxpayer Response FILE NO.2� � � * * * REVISED NO�'ICE * * * DATE 125 1�-2013 Type of Account Estate of JUNE C WELLER Savings SSN 184-26-4475 Checking Date of Death.10-22-2013 ` Trust . KARLA J ROBERTS County CUMBERLAND Certificate 200 GREEN HILL RD NEWVILLE PA 17241-9574 h � � � � � � 4 ..�� 4 � t""� .,� -- _��`i 3��. t� � �_� _ � � � � � � � � �.� d � MEMBERS isr Fcu provided the department with the information below indicating th�t a`�tl�de�h o�e, above-named decedent you were a'oint,owner or beneficiary of the aCcount iden#ifii�i� � `�� .�` _ Remit Payment and Forms to: � � � � Account No.373067 ...� ,r,� �,, Date Established 12-03-2009 REti1STER OF WILLS "�' � Account Balance $498.23 1.COURTHOl1SE SQWARE Percent Taxable X 50 CE4RLISLf PA 17013 Amount Subject to Tax $249.12 Tax Rate X 0.045 $��,21 NOTE*: If tax payments are made within three months of the Potential Tax pue , decedent s date of death,deduct a 5 percent discount on the tax ' With 5%Discount(Tax x 0.95j $(see NOTE*) due. Any inheritance tax due will become delinquent nine months after the date of death. P�� 'Sr#�� 1:�Plea�e check the appropriate boxes below. � ; A �]No tax is due. t am the spouse of the deceaxd or 1 am the parent of a decedent who was 21 years old or younger at date of death. ' Pro�.�eed#Q Step 2 on reverse. Do not check any other boxes and disregar+d the amount ' s�iown aboMe�.s Potential T�Due. ..°.g,..�. _ '. .� . _:� -�_a-.�-- , • • .ts carreet,no deductions are being#aken,arrd paymerrt wi11 be se�t correct. with my response. Proceed to Step 2 on reverse. Do not check any other boxes. C �TMe 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�n reverse.) � 15% All other relationships(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 �n�set will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance T`ax entance tax form Return fited by the estate representat�ve. REV-1500. 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), please obtain a written correction from the 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. ����\\��\��\��\\\��� 1� � �\\\ �\ ������\�\\���\�\����\���. If indicating a different tax rate, please state ,�;������„������� ������� �� ���������\������;����� ������������\` \\� � � \� � �� ��\�\�����\��\.\�\\�\\\\�\ �\\\\\�\\� "�� ����\\ �\:;��� ��� � �\��.�������\�\\�\�� \� your relationship to the decedent: ���������, ����� � ` `� ��\"��``��` � ����\����\� `�\� ��������� �::���\\��\\\�\�`�.��.,.�� . � ������ . \����`�\\\���� __:.\���\�:�\�:�\��\�\�\���'�\\���.`\��\\\�\�\\�\\�\�\������`\��\C�\�`..���\�\\\\ I i h d 1 ;�;�,�������\��:\�\`\��.����\��\����\��,\�\�\\\�\�\�\;,\\;\,��\ 1. Date Estab s e � ��� ��� � �� �� \ �� �,����,���\\�\�������\��\�����������\�����\��\�����\y���\�\�\\\�, .������\������\������\��� .����\\�\����\���\��\��\��\�\.\ �\�\�����\ ��\ �\'c���\ \\�\.� \\��::�\\\�\�\Q\ �\\;:\�\�����\.\\\:�\\ ���`\\`\...\\::\.\ 2. Account Balance 2 � �.��:�����\�`:;������������:\\��\��\����`\�:�\\����\����\��\��������:\����\��\ �\����;�,„���\\\\\\�����\���\\�\����\�\����o\\��\���\\�\�� �( ��� \� � � � ��.. � ���\\��\\\\p\\\\��\\���������\\\��� r n T x ble 3 " E �� ���� �. ���������\�����\�:>`���\��\\��\\��\�\�\���:���\�\\�\���\\\�\��\���\\\�\\�\ 3. Pe ce t a a ;;.�\���a-;�\�����\���\����:�����������.\`���c��.������\�����\������������� ���\��\�\�\�\\\��\������\��\\��\������������\�\\\��\ \\��\����\���������� � A ;� \`� �� \ \\�\\��\\\\\��\\\�\\\\ � �\\: 4. Amount Subject to Tax `'F � ��\\\�\\� �\��\ ����\���\\\\��\\��\\�\����\\\����\\\\\\�\�\\\\�\�\����\������\�\ � \ ��\ � \ \\\ \\ �� \�\ \\�\\ �\ ;� �\ : � .� \ �_ �� ��� �.\\ \.\ ��������� �� �� � � 5. Debts and Deductions 5 - � � � � � �\`���\������� ����\�\\�\\O�\ \ � ��\�����\�\\`��\ \ \���\\\\�\\����\�\ �\ � ���� `� ��\\���� � � 6. Amount Taxable 6 � �.,����� � � ,��,����,�,�� � ,�������������� �����,����,�;��;�� � � �\ �\\�\� �\\ ���\������- ������\��\ ��� ���\\�\���\\ � � � � �: �/ �\�\�. : \ \ � �\ �� \ \ � � �, �\\\ . \ , :. 7. Tax Rate 7 /� ��\�\ � \.\\��\�\ �\�����\���\\\��\\����\\�\\������\����\�\��\�\\�\�\\ ��� �\��������\����C����\��\\��\����\\\�����\�\\�����\������\\\��\\���\���\\��\\\\\\����\�\\ 8. Tax Due U � '�\\��\\����� ���������\�\�\\�\\���� �\\\��������������\\��\\��������\\�����\\ �\\��\\' �\\�� ������`������c�������������\\����������\,��������������� �� � � �� � � �� ������������\�A�\�������������\�������� .���. 9. With 5% Discount(Tax x .95) 9 X �� ���� ` " � � �� � � ` � � �� �;\ �.....,.. � .�..a�������.�o\����\������..\3.��`��\��o\\��\\�.����\�\���\\��\�����\��a�a�.�����`.o�������o�° 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 , � � °� �� `(� fu. , � Home %I j -�/�� ���,� �,� � l � 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 _ .. . �.,_.�. _ - � � f F.c�'i � �"��,' . . - - ��. � 1 _ �F �' '�'°�:.:� _ � � - � - - i � � - - _ _ f - - -- � � - � _ _ - � � - - * -y - . . �-:�' �`"5: - - - _ -- „s,:., � y — _ �`:.� �.: �`N _ +: _ �:; �_ - - _ � . � ,...� -,5:� _ - — � � x t — _ w. �1 � ;`:_ - �`� _ - t'� �_ �,' � __ _ -- - - � �,� � ; - -- _ - - `_�_., d' � - - _ �'t � �` : _- _ _ - � -- —�' - _ _ t� � - - _ - � _- - _ - � s= _- - - - _ - Zj c�, r _ � - �..... c n _"„ ` - � - - - - V J r�� • - ..�+.. _ - - '� � � k - •�w - ,� G � � � - � �� :� _ � W � . . � �, ; _ _ _ �. �f _ - �r�ir � . . � � 3 - wr. /�S� Y° .�"` � s y �� D!i► �. - _ � �IM j - - — MYy� _ �M�I�11 � � . - �� . - — �,. _ s� �� � — -� �,� — � f .� _ :� „� -� — '" �' -- — .. — _ � �� ,����} �1�i� � �I�38�1�� �.� � f _ - � 1.�t�t;-� .SN��c��U ' � � - � � �� ��3�� ' _ .. - _ .� ;� , � � �.— � ; _ _ _ - - ,� � � �� �Z ��� ���?? ��, - _ ...�. � �. - - - .� � � - - - - - `� S�i���� .�� �3.�S��3� a��� . � ! - �� j� ��j {/�; tM� � .�E ;.. -��k w _ - +i� �����M/ ��V�V��V �� r - • � 11.- _ r - { - - 1 . , - � _.:._.� -- --. 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