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Home My WebLink About01-02-14 (2)� � _ _ � .., — �MMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-961 JEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 � HARRISBURG,PA 17128-0601 PENNSYLVANIA ��RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 018601 COOGAN MICHAEL P 1319 0AK LANE NEW CUMBERLAND, PA 17070-1335 ACN ASSESSMENT AMOUNT CONTROL NUMBER , -------- fold ---------- -------- 13148326 � $59.79 ESTATE INFORMATION: ssN: � FILE NUMBER: 2114-0003 � DECEDENT NAME: COOGAN JAMES P � DATE OF PAYMENT: 01/02/2014 � POSTMARK DATE: 12/31/2013 � COUNTY: CUMBERLAND � DATE OF DEATH: 06/16/2013 � � TOTAL AMOUNT PAID: �59.79 REMARKS: CHECK# 2751 INITIALS: HMW SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIYIDUAL TAXES Penns Ivania lnheritance Tax � enns lvania PO BOX 280601 y p y HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE And Taxpayer Response REY-1543 EX Do xE��.a-12, FILE N0.21'''J'��0�� ACN 13148326 DATE 09-16-2013 �'Ype of Account . fstate'of JAMES P COO��►N'; Savings - CMecking Date of Dea#h 06-16-2013 Trust MT�CHAEL P CODGAN County CUMBERLAND Certificate 1319 �AK LN NEW CUMBERLAND PA 17070.-1335 ;,�; � � � � � � � � -� � � �` � � � _ ._ .,��► ,�C tC? t� � � � � � � � � � � � g � -- -,K.;.x �:,+,..+, - :�_as�o:,::.._ �z.x , . ..,. .. . ,� � - . .. �� . ,`...- �� .. . - � ��p .�r � ..�n .;,_�. , � _.. . _ .. _ _ �_ .v _�..� , . _�.�:��..�.... _._.�.;� �.,�;,..�,.�.,� . . ._..� .,�.,�.r,�.=* >r...—..,,.. - - _ _ _ ; _•a�r�..�__::- . -�:s-. ,,.�s�*�- --- r �,.�.;- .: - ., ___� _ -_ : _ . .-�. - _ �.- . � W � � �" � � '"� PNC BANK NA provided the department with the information below indicating that a#the death of the above-named decedent you were a 'oint owner or beneficiary of the account identified. Account No.5140012911 Remit Payment and Forms to: Date Established 06-01-1964 REGISTER OF WILLS Account Balance $7,972.14 1 COUR'�f�USE SQUARE Percent Taxable : �1 g,�s� CARLI�LE PA 17013 Amount Subject to Tax $�,328,72 Tax Rate X 0.045 Potential Tax Due NOTE*: 'If tax pa�rrnen#s�ar+�mad�an�tt�in.three�mEmths of the $.59.79 ��ent's date of death,deduct a 5 percent dis�our�t on the tax Wifh 5%Discount�'1'�x x�.95) $jsee NOTE") due. Any inheritance tax due will become detinquent nine months after the date of death. PA� St�� 1: Please ch�ck the appropriate boxes below. � A �No tax is due. t am the spouse 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 disregard the amount - shoam above as Pofential Tax Due. , _ ... :. _ __ , . _.___ __ _ �. ___.� ,_,___._ _�._ _ __ _ _ ._.._ �. _. .__ __ �_ _ _ _ _ - ._ . 8��s-��--�~-�� T`he-above in#on�n�tEOn 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 t�rate is incor►ect. � 4.5% I am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased. (Setect correct tax rate at right,and complete Part � �2% I am a sibling of the deceased. 3 on reverse.) � 15% All other relationships(including none). p �Char�ges or deductions_ The information above is incorrect and/or debts and deductions were pafd. �isted: . Complete Part 2 and part 3 as appropriate on the back of this form. E �A�se#wi11 be reported on The above-identified asset has been o�will be reported and tax paid with the PA Iflheritance Tax �nher�t�nce faz�form Return.#iled 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 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), pleas�e ob#ain a wrette�corre�t�on frorr�the ftnancial inst�t!�ti�!?and a#tach �t#o#his f�rrtt. 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. If indicating a different tax rate, please state �� ; �� ' �� , ; � �,` � �� your relationship to the decedent: � ' � ` ��` � � , � � �. „ �� , . � 1. Date Established 1 � � �� .. ; �� ,A�� ; \ , \ 2. Account Balance 2 $ � � ��, �� `� ,� �� , , � ,� X � 3. Percent Taxable 3 � ;� � �° � � ; \ ��,� , 4. Amount Subject to Tax 4 $ � � � � � ; , '.� �� .. . � � , , . ,.. ,,�: , „ ,°�' , � ; 5. Debts and Deductions 5 - � . � � 6. Amount Taxable 6 $ � � � ,,,,�� , � ,� , �� ` � � X � ��,., .. . � �, ��, , , , 7. Tax Rate �� ,.�.�- _; � _._ _,.... �� ..�� ,._. , , 8. Tax Due 8 $ � ;� ��,� , . ;��„" ,,�,,, , � �� A ��;�� `.��:. X ' � 9. With 5% Discount(Tax x .95) 9 �� ... �.....;._ ....: ..__.,�,..,,. ;�_.,,,,��.,.,�� .�. ,..,..:�...,,.. . .�,,,_ .......,. .:,��,.,,; �� . 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 7C��, (� '�� - �.�� Home��.� ��,�� /Gt�� .SG� �t7�� Ta yer Signa ure Telephone Number Da e 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 __ - �R � _ _- _ - i t�� iC�� - _ - _ �?�� 1\ - -- - - � / � - - - ' , l��C� ,`:' . __- - - - � ��)` ` �a � _ - � �J �� - - .+ y - J..�fiOZ _ ' �. � � 'REC�RQ�D C}��'1�� +�� _ � � ��1STER 4� '��.'� - - s � �: - .. - _ « '' � —� - i �� j t � � V� � - • M1 �`�� '��1' � � � �.`� '"'-." - L.. �.,- - - ,� — — � ,.,�, — CLE�K �� - - _ w `, . �� , .Y. �,. � � � OaPH�N�' G��1RT �- - - - _ �. - �. - - .� - - - - - r°i CUM�E�L�:�� 0., P �..,, __ - - �:�; M - { w - 1•� wti�, . ..��iwr - - ' ..e^ � - 9 � j �J•� . . - � wr _ - - �� - - - - .�q L'i��' . �� ' - '�.�:. 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