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HomeMy WebLinkAbout12-09-13 (2) COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 1 71 28-0 601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 018499 ANN S. DAVIS 1742 E MAYLAND ST PHILADELPHIA, PA 19137-1114 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold 13152550 $35.00 ESTATE INFORMATION: SSN: FILE NUMBER: 2113-1030 DECEDENT NAME: JONES MILDRED B DATE OF PAYMENT: 12/09/2013 POSTMARK DATE: 12/06/2013 COUNTY: CUMBERLAND DATE OF DEATH: 09/10/2013 TOTAL AMOUNT PAID: $35.00 REMARKS: CHECK# 21591433102 INITIALS: DB1 SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES Pennsylvania Inheritance Tax pennsyLvania PO BOX 280601 y DEPARTMENT OF REVENUE HARRISBURG PA 17128-0601 Information Notice --_,-� REV-3543 E%DocE%EC (08-12) And Taxpayer Response FILE N0.21 — 13.. (03^ ACN 13152550 DATE 10-07-2013 Type of Account Estate of MILDRED B JONES Savings SSN Checking Date of Death 09-10-2013 Trust ANN SMITZ County CUMBERLAND Certificate 1742 E MAYLAND ST PHILADELPHIA PA 19138-1114 n Q ::a C'0 C-:) t 7 � � D• r" � � r-,7 rr; -Ei93 C7 I Q Q C7 C> -c> _23 MEMBERS 1ST Fcu provided the department with the information below indicating th at tha-Aeatt--of above-named decedent you were a joint owner or beneficiary of the account ide`Ifile . Account No.70502 Remit Payment and Forms to: Date Established 04-13-1973 REGISTER OF WILLS Account Balance $ 1,471.73 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $735.87 Tax Rate X 0.045 Potential Tax Due $33.11 NOTE*: If tax payments are made within three months of the decedent's date of death,deduct a 5 percent discount on the tax With 5%Discount(Tax x 0.95) $ see NOTE*) due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1 : Please check the appropriate boxes below. 1 A ❑No tax is due. I am the spouse of the deceased or I 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 disregard the amount shown above as Potential Tax Due. g ' 'The information is The above information is correct, no deductions are being taken,and payment will be sent correct. with my response. Proceed to Step 2 on reverse. Do not check any other boxes. C ❑The tax rate is incorrect. Lq 4.5% I am a lineal beneficiary (parent,child,grandchild, etc.)of the deceased. (Select correct tax rate at right, and complete Part ❑ 12% 1 am a sibling of the deceased. 3 on reverse.) 15% All other relationships (including none). Da 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 F—]Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax inheritance tax form Return 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. PART 2 Debts and Deductions 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 8112"x 11"sheets of paper.) Data 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), 7 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. 1 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 Official Use Only ©RAF your relationship to the decedent: PA Department of Revenue 1. Date Established 1 2. Account Balance 2 $ PAD 3. Percent Taxable 3 X 1 2 4. Amount Subject to Tax 4 $ 3 5. Debts and Deductions 5 4 6. Amount Taxable 6 $ 5 7. Tax Rate 7 X 6 8. Tax Due' 8 $ $ 9. With 596 Discount(Tax x.95) 9 X 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 above are true,correct and complete to the best of my knowledge and belief. Work Home Taxpaye Signat a Telephone Number Date E NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE T OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR ERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 s co � - F- Ca' U 1 Q U t� faq U- 10, - CL W �.j � Qcr- _ U � W r#' 1. 7 � m to c� O 3 co Mn < uj a� ` Q Rl cm i l ��-�'�, '� -- � �� �.. �: r � y r 1 R j Ji r „-- n�J - !, r -- �d k i i 1 _� f '` 1 � J I i 1 r_ .. s ` _ 4 1 '� � i t Z ` ' __ _.� _ s"