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Home My WebLink About01-29-14 (2) PO dOX 28060/IYIDUAL TAXES Pennsylvania lnheritance Tax i pennsylvan�a HARRISBI�G PA 17128-0601 Information Notice DEPARTMENT OF REVENUE REV-ISf3A EX DecE7IEC(06-12> And Taxpayer Response FILE NO.2113-0�0� ACN 14500112 DATE 01-13-2014 � Type of Account Estate of ROBERT J HOLLIS , ,.,,, Security �,;;; C Acct Date of Death 06-10-2013 � -= �fc NATkSHA A GLOGER �County CUMBERLAND � � C.-- - nds 814 KENNETH PL SE � LEESBURG VA 20175-8984 m � � N � � . � � � � � � � � � � � Q � � � � � c� � � � � � <,� � �..., � � " c� -� � � � � _ ----- . . _ . _ � :� .� ____�____:,_ _ M: ---�---�� --- . ,� ; vANSUARn provided the department with the information below indicating that at the death of the above-named decedent ou were a joint owner or beneficia of the account identi#ied. Ac:count No.4988054548543 Remit Payment and Forms to: Date Established REGISTER OF WILLS Account Balance $13,607.70 1 COURTHOUSE SQlJARE Percent Taxable X 50 CARUSLE PA 17013 Amount Subject to Tax $6,803.85 ° � � Tax Rate X 0.045 , , ,� : Potential Tax Due �306,�7 NOTE*: If tax payments are made within three months of the decedent's date of death,dedu�t a 5 percent discaurrt Qn the tax With 5�o Discount(Tax x 0.95) $(see NOTE") due. Any inheritance tax due will become delinquent r�ine months - after the date of death. �� '�i1�E:� 1:Ptease check the appropr�ate boxes below. 1 : A �tfiia fax is due. I arn the spouse of the deceased or I am the�parent of a decedent who was 21 �e�c►Id��ar younger at date of death. - Procaeed to Step�on reverse. Do not chedc any other boxes and disr�egani the amount _ - -- _ __. ,. :_. shown abave as Potential Tax Due. _____T_'_._�.... _�.__._.__ _ �__.._..,.._ __ __�___�_�_F�_. ._..._.._.___,. _____ - -- -------____.._. __.� _- - _�.__ _....�_------ - -.__ _ �_ g �The informa#ion is The above infiormation 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. � 4.5% I am a lineal beneficiary(parent,child,grandchild,etc.)of the deceaseci. -(Select correc�tax rate at right,and complete Part � 12% I am a sibling of the deceased. 3 on reverse.) Q 15% All other relationships(including none). p �Changes or deductions � The information ab�ove is incorrect and/or debts and deductions were paid. , � listed. Complete Part 2 and part 3 as appropriate on the back of this form. �. . „ . , � �. , �Asset w�1-be reported on TF�e above-ider�tified asset has been or will be reported and tax paid with the PA Inher�tance Ta�c inheritance#ax+#brrn � Return#iled by�the estate representative. ; RE�/-1500. Fr�eed to Step 2 on r�everse. Do not check ar�y othec 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), �pl�as�obtair�a�nrritt��V�rrEit��frc��th�fi�a�rcial instifu��ion and attach it io t�his Torm. 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 � �'� � �� `�� 9 ; ��.1.��:'�� ., your relationship to the decedent: . � ��,�� 1. Date Established 1 "� �� `�� ` `� 2. Account Balance 2 $ �� \ , � 3. Percent Taxable 3 X � � �- � � � � � ��_ 4. Amount Subject to Tax 4 $ � �.. . 5. Debts and Deductions 5 - � , � �� ' � � �� .; 6. Amount Taxable 6 $ � �� '�� '� �` �� TaY Rate � 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��.�2?�1 �-- �-V�� /'� Home - C.7 ��-- I I�`� 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