HomeMy WebLinkAbout01-21-14 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG,PA 1 7 1 28-0601
PENNSYLVANIA
RECEIVED FROM: . INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 018673
NICKEY VICKI A
748 BLOSERVILLE RD
NEWVILLE, PA 17241
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
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13135390 � $.56
ESTATE INFORMATION: ssN: I
FILE NUMBER: 2114-0068 �
DECEDENT NAME: MCKEE ROBERT H �
DATE OF PAYMENT:' 01/21/2014 �
POSTMARK DATE: 01/17/2014 ( �
COUNTY: CUMBERLAND (
DATE OF DEATH: 06/08/2013 �
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TOTAL AMOUNT PAID: 5.56
REMARKS:
CHECK# 747
INITIALS: HMW
sEa� RECEIVED BY: LISA M. GRAYSON, ESQ.
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES Penns Ivania inheritance Tax � pennsylvania
PO BOX 280601 y DEPARTMENT OF REVENUE
HARRISBURG PA 17128-0601 Information Notice
REV-1543 EX�EXE=�6-� �
And Taxpayer Response FILE NO.2� -�---
ACN 13135390
DATE 06-26-2013
Type of Account
Estate of ROBERT H MCKEE Savings
Checking
Da#e of Death 06-08-2013 Trust
VICKI A NICKEY County CUMBERLAND Certificate
748 BLOSERVILLE RD
NEWVILLE PA 17241-8751
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CORNERSTONE Fcu provided the department with the information below indicatin a �the.�at�f�e
above-named decedent you were a joint owner or beneficia of the account iden ' '� � �
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Remit Payment and Forms to:: �
Account No.2422101 � � � � �
Date Established 02-29-2008 REGISTER OF WILLS � � "�'M
Account Balance $25,p2 1 COURTHOUSE SQUARE :
CARLISLE PA 17013
Percent Taxable X 50 .. ...
Amount Subject to Tax $12.51
Tax Rate X 0.045
$0.56 NOTE*: If tax payments are made within three months of the
Potential Tax Due ,
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.
P 1RT Step 1: Please check the appropriate boxes below.
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 e information is The above information is correct, no deductions are being taken,and payment will be sent
orrect. with my response. '
Proceed to Step 2 on reverse. Do not check any other boxes.
C �The tax rate is incorrect. � 4.5% I am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased.
(Select correct 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 deductions were paid. �
listed. Complefe Part 2 and part 3 as appropriate on the back of this form.
E �Asset will be reported an 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 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),
ple�se 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.
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 indicatin a different tax rate, please state "
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your relationship to the decedent: . ������������,����
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1. Date Established 1 �� � ��� ` � �
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2. Account Balance 2 $ , � ,� , , ;, ;, ,'��
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3. Percent Taxable 3 � , ; � ', ,
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4. Amount Subject to Tax 4 $ �
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5. Debts and Deductions 5 - �. '
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6. Amount Taxable 6 $ � '
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7. Tax Rate 7 � ,� �� ,�
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8. Tax Due 8 � � � �
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9. With 5% Discount(Tax x .95) 9 X ; ........���.. .. ��,....,:..���.....���.. .,.._;._�.. ��� .,..... �.� ,,... .
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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.
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Taxpayer Signatu e - 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
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