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Home My WebLink About12-23-13 ` BUREAU OF INDIYIDWL TAXES Pennsylvania lnheritance Tax , � Penr1S�/LVa1118 PO �OX taocol DEPARTMENT OF REVENUE WUtRISHUR6 PA �,��.-060� Information Notice And Taxpayer Response ��Y�F%EC I0�-lt> FILE N0.2113-0711 ACN 13168320 DATE 12-13-2013 r� _ m � R�G�`��. . �� .'e� Type of Account t��,� ' `-` `� �i-� v Estate of CAROLYN G HUMPHREYS Savings � SSN 203-12-4764 Checking Date of Death 05•19-20t3 Trust PATRICIA A HOESCH -� � r�- �_� ,r ,_ County CUMBERLAND CertifiCate APT 17 �"`'','` v`� 3609 KOHLER PL Q ,!,�,;`� (°` ' CAMP HILL PA 17011-27 � ' ��.�i��:�...� ��.,I�' _ CITIZENS BANK OF PENNSYLVANIA provided the department with the information below indicating that at the death of the above-rtamed decedent ou were a joint owner or beneficia of the account identified. Remft Payment and Fomns to: Account No.6700384926 Date Established 10-01-1983 REGISTER OF WILLS Account Balance $4,374.01 1 COURTHOUSE SQUARE Peroent Taxable x 5p CARLISLE PA 17013 Amount Subject to Tax $2,187.01 Tax Rate X 0.150 NOTE': If tax payments are made within three months of the Potential Tan Due $328.05 decedent's date of death,deduct a 5 percent discount on the tax Wdh 5%Discount(Tax x 0.95) $�see NOTE') due. Any inheritance tax due will become delirsquent nine months after the date of death. P�� Step 1: Please check the approp�iate boxes below. A allo tax is due. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younge�at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregaid the amount shown above as Potentiaf Tax Due. B ❑7rie intormation is The above iniormation is co�tect,no deducdons are being taken,and payment will be sent correct. with my response. Proceed to Step 2 on reverse. Do not check any other boxes. � �The tax rate is irscor�ect. � 4.5% I am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased. (Select correct tax rate at right,and compiete Part � �p/o I am a sibling of the deceased. 3 on reverse.) � 15�o All other relationships(including noney. p �Changes or deductions The information above is incorrect and/or debts and deductions were paid. listed. Complete Part 2 arrd part 3 as app�pdate on the back af this lorm. E �Asset will be reported on The above-ide�tified asset has been or will be reported and tax paid with the PA Inheritance Tax inheritance tax form Retum filed by the estate representative. 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. P"� Debts and Deductions 2 Allowabte debts and deductions must meet both of the following criteria: A. The decedent was legally responsibfe tor payment,and the estate is insufficieM to pay ihe daductible items. B. You paid the debts aRer the death of the decedent and can tumish proof of payment if�equested by the department. (If additional space is required,you may attach 81/2"x 11'sheets of paper.) Date Paid Payee Description Amount Paid Total EMe�on Line 5 0(Tax Calculation $ PART Tax Calculation 3 It you are making a correction to the establfshment date(Line 1)eccount balance(Une 2),or percent taxable(Llne 3), please obtain a written correction irom the flnancial fnstftutlon and attach it to this iorm. 1. Enter the date the account was established or GGed as it existed at the date oi death. 2. Enter the totai balance oi the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxabte to you. a. Frst,determine the percentage owned by the decedent. i. Accounts that are held"in trust fo�'anolher or others were 100%owned by the decedent. ii. For joint accounts established more than one year prior to the date of death,the pe�centage taxable is 100%divided by the total numbe�of owners including the decedent. (For example:2 owners=509�0,3 owners=33.339�0,4 owners =25%,etc.) b. Next,d'nride the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by muidptying the account balance by the percent taxable. 5. Enter the total of any debls and deductions claimed from Part 2. 6. The amount taxable is detetmined by subt�acting 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 ;;Q[fj�i�:.Q�Iy,�!pp�,�-` ;, ; , your relationship to the decedent: •• . ;:. p .,. , ., :; :. .. PA; of,:R A• evenue. t � '�'>,�,:��M - 1. Oate Established ,, :.,�" � .. ,.. .. 2. Account Balance 2 $ PAD� �- r , — �, 3. Percent Taxable 3 X I� � S- .:r /� a 4. Amount Subject to Tax 4 $ 3, _ - - . _ _ .. . .. _ . . . ` : . . . , . , , , . 5. Debts and Deductions 5 - 4, � 6. Amount Taxabte 6 $ 5 ' X w' r I 0 7 Tax Aate 7 +�;�:?:; ��.,., ,�.;: ._...,r.. ,�...' ' .,�,j`. ��, ', 'z�� ,` �� . ./rii.1'/.ti•a;!P1L•:''...�'.L'ev;y�rc.{i%f44_)1 �� .,..i �a!_...: ..�, � .;i�..�!�:1� . ;. 8. Tax Due 8 8� L i . r : `� �, � % �i �,:: � •. . � 9. With 5qa Discount(Tax x.95) 9 x - � . . _ _� ,_: ... . _;", Step 2: Sign and date below. Retum TWO completed and signed copies to the Registe�of Wills listed on the f�ont of this form, alonp�nnth a check for any payment you are making. Checks must be made payable to"Register of wlls,Agent." Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts 1 have repoAed above are true,correct and complete to the best of my knowledge arsd belief. work`? I 7 -- 4�'a-— �539� ��, �, `� '�wC' Home Taxpayer Signature �SS�-sa Telephone Number Date �a„ � �i3 IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE DISTRICT OFFICE, �R THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING APID/OR SPEAKING NEEDS ONLY: 1-800-447-3020 x D � A � 'm r m m � n � _ � � � P m o Z � o � � rl i m � � � � k � N Z D � � � v D V � � ,1 � � � D o � ro Z ro � v ,..:. ....i r°: €:� � .�E D fn` � j/ � / � �� r tt�7 � , . =� � '°!" � �' � - G ��<� �: , � � � �; � -.� -r- n' ;�� ' �' �:� �� .� :..� � _ � � f� � � U� � :- o � /� ci .�t � i- / 1 y., .,'y`.� 4 � �� l ��. _�.. G\" �, ^ � �, �, � ` ;#, - � � '!. � ��, 2013 G � � �