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Home My WebLink About12-27-13 BUREqU OF INDI4IDUAL TAXES . '�� Po BOX 280601 Pennsylvania lnheritance Tax p�� ! " �,1C't1C1S�(�Vdt118 NARRISBUR6 PA 17128-0601 �nfOrlTiatl011 NOtIC@ DEPARTMENTOFREVENUE And Taxpayer Response ' REV•154D EX DocE%EC�oe-,Z> FILE NO.21 -'/�-�L j�i `� r �t,•-� �� .., � ^Y ACN 13162504 � ` .. � DATE 11-14-2013 �'�'(v�� "� Vi , ��: � �, . _:._.� ��':� r�+� �? i-l:� -! � Type of Account 1 �� Estate of MARGARET J KEITER SSN 236-48-2g06 5avings DEAN C KEITERJR �L� ',` , Date of Death 08-71-2012 Checking 122 PEACH LN r � County CUMBERLAND Trust CARLISLE PA 1701��gb��`��•� � � ''t; Certificate Ci��E��i,,'`'� s ; �jR METR---�K provided the department with the information below indicating that at the death of above-named decedent you were a joint owner or beneficiary of the account identified. the Account No.537581332 Remit Payment and Farms to: Date Established 10-27-2006 Account Balance $837.87 REGISTER OF WI��S Percent Taxable 1 COURTHOUSE SQUARE X 50 CARLISLE PA 17p13 Amount Subject to Tax Tax Rate $47 8.94 Potential 7ax Due X 0.150 $62.84 NOTE`: If tax payments are made within three months of the With 5%Discounf(Tax x 0.95) $(See NOTE') decedent's date of death,deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent nine months after the date of death. PART � Step 1: Piease check the appropriate boxes below. A �No tax is due. i am the spouse of the deceased or I am the ar 21 years old or younger at date of death, p ent of a decedent who was Proceed to Step 2 on reverse. Do not check any othe�boxes and disregard the amount shown above as Potential Tax Due. B �The information is The above information is correct,no deductions are bein correct. with my response. Proceed to Step 2 on reverse. Do not check any o he kboxes.d payment will be sent C �The tax rate is incorrect. � 4.5% I am a lineal beneficiary(parent,child,grandchiid e (Select correct tax rate at right, and complete Part � , tc.)of the deceased. 3 on reverse.) 12% I am a sibiing of the deceased. � 7 5% All other relationships (including none). p �Changes or deductions The information above is incorrect and/or debts and deductions w listed. Complete Part 2 and par�3 as appropriate on the back of th s porm. he above-identified asset has been or wiil be reported and tax paid with the PA fnheritance Tax eturn filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. F.v;e. �� _ .r r � � r...� PART 2 Debts and Deductions Aliowable debts and deductions must meet both of the following criteria: A. The decedent was legaliy 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 3 Tax Calculation 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 financiai insfitutian and attach it to ihis 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 inciuding 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,ihe percentage taxabie 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 multipiying the account balance by the percent taxable. 5. Enter the total of any debts and deductions ciaimed 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,piease state your relationship to the decedent: t �� ;, 1. Date Established 1 ��q�z� � � '� P�I'3 ' PR�e�ar��ae��f Re��rau� � 2. Account Balance 2 g 3. Percent Taxable 3 x � y ' k Y� �� a � � .� , � 4• Amount Subject to Tax 4 $ � �= `�� ; ,� � � ;� � � 5. Debts and Deductions _ � r `3,�` i 5 �� ` �, s � z,�� 6. Amount Taxable �'�k �r � " * � � � ' 6 $ � � � � �� 7. Tax Rate 7 X � �� _ � � f �� 8. Tax Due p Q � �� . V W 3`?� , kk y� : "�y � ! '�' a�,s's}.#t' .�� . ,� �� '� a 5 � �+ 9• With 5%Discount{Tax x .95) 9 X � '�^'��'3 �� `�� 3 r t� �,� ' � � � � ; �� Ste 2. r,� ��, � r� �." � .:� ��_�� p ' Sign and date below. Return TWO completed and signed copies to the Register of Wi►�S�isted on the fr along with a check for any payment you are making. Checks must be made payable to"Register of Wiils A payment directly to the Department of Revenue. ont of this form, , gent." Do not send Under penalty of perjury, I declare that the facts I have reported above are true,correct and complete to the best of my knowled e be�ief. �yC.O��^ l� ��,�Z.� Work �lOb—?U"�� 9 and Home��`�_. �� a`��aoc3 Taxpayer Signature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CC�NTACT PENNSYLVANIA DEPARTMEN DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-g327, S RVI REVENUE TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 CES FOR