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Home My WebLink About01-21-14 BUREAU OF INDIVIDWL TAXES Pennsylvania lnheritance Tax � pennsylvania PO dOX 280601 DEPARTMENT OF REVENUE HARRYSdUR6 PA 1y128-o60� Information Notice REY-1563 EX DocEXEC(�6-12) And Taxpayer Response FILE NO.2� ''/� � . � ACN 14101315 DATE 01-10-2014 . Type of Accoun# Estate of JOHN E JONES Savings Checking Date of Death 02-07-2013 Trust PA�4INE A JONES County CUMBERLAND Certificate lI� N LOCUST POINT RD MECHANICSBURG PA 17050-2618 �-,,, � ,� �Ct � - �. �.�'_ � ,..�-�, __ � � � a �.�.. �,'P" � y � � � � � � � sANTAND�R s�MK provided the department with the information below indicatir�ti�t�t the dea��the above-named decedent ou were a joint owner or beneficia of the account id�h�i � -v �' A ``°�1 . 91234 Remit Payment and Forn�►�bs�� w-+ � � cc�un��. 6'►�17 ..»� rv �, Date�ts!'�lished 08-2:i-2006 REGISTER OF WILLS � ,,;,�: � p Account Balance � $1,4 Sp.2g 1 CQUR'fMOU�SQUARE �� '"*) : Percent Taxable X 5p CARLISLE Pq 17013 , Amount Subject to Tax $575.15 � , Tax Rate X 0.150 . NOTE': If tax payments are mad�within three mor�hs of the Potential Tax Due $86.27 ' decedent's date ot death,deduct a 5 percent di�count on tt�e tax With 59�o Drsccw�t,(T'ax�.0.95) $(see NOTE') due. Any inheritance tax due wilt become detinquent nine months • � - after the date of death. P� StE�.p 1: Please check the appropria�e boxes below. � a [I/ No tax is due. 1 am the spouse of the deceased or I am the�arent of a decedent who was 21 years o�d or younger at date o#death. . Prnoee�d to Ste�2'on reverse. Do not check any other boxes and disnegard ihe amount sl�own above as Poteniisl Tax Due. _ .�.�P--��_____�:�___-�.,_,_--�___�.�.__ ___.__:__.... _-.___�.��____�_ ___---__________ _ �___�_,________ _ g �� The'mfocri�tstion is The above i�formation is correct,no deductions are ` being taken,and payment will be sent correct. , with my respanse. Proceed to Step 2 on reverse. Do not check any other boxes. C �TMe tax rate is incocrect. � 4.5% I am a lineal beneficiary(parent,child,grandchild,ete.)of the deceased. (Select�orrecf tax rate at right,and complete Part � ��o I am a sibling of the deceased. 3 on reverse.) � � 15% All other relationships(including none). p �Changes or deductions The information above is incorrect and/or debts and deduciions were paid. listed. Complete Part 2 and part 3 as appropriate on the back of this form. E �1�►sse#-will be reparted on The above-identi�ed asset has been or will be reported and tax paid with the PA Inherytance Tax � irtlierit�nce tax fQ�m - Retum�I�d by the ss�te represen�a#ive. ' � REY-1�00. Proceed�o Step 2 on reverse. Do not check ar�y 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), piease obtain a writ�n correction from ti�e financiai 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. If indicating a different tax rate, please state � � ' � � ` �� ' � ��;�� your relationship to the decedent: . ' , ��e��i��3�� , 1. Date Established 1 ; � ��,� � ;� , � , , � �� `� � � _ 2. Account Balance 2 $ ��.� � \ � 3. Percent Taxable 3 X �' � ` 4. Amount Subject to Tax 4 $ � �: i �� , � , 5. Debts and Deductions 5 - �. � �� 6. Amount Taxable 6 $ � ° ; ; , : �3 ` ' � ; _ ; � �3;; R3t° 7 X � � : . . " � �� . � , �,; 8. Tax Due 8 $ �� ' 9. With 5% 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 reported above are true, correct and complete to the best of my knowledge and belief. �_ ' �' �� Work ..r� r��, ; ;' f 7 r'7 �y,, �iS � oi , �,� . _ �,. ,� H o m e /� � ,,,.� ,, , -� 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 - i � F� � M� � z � �. 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