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Home My WebLink About02-14-14 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 77128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 018764 PEARSON KEITH D 38 COURTYARD DRIVE CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER ------- fold ---------- -------- 14106845 � 547.06 ESTATE INFORMATION: sstv: � 14106846 � S 12.83 FILE NUMBER: 2114-0137 � �ECE�E►vT tvAME: PEARSON MILDRED E � DATE OF PAYMENT: 02/14/2014 � POSTMARK DATE: 02/14/2014 � CoUrvTY: CUMBERLAND � DATE OF DEATH: 01/29/201 4 � � TOTAL AMOUNT PAID: 559.89 REMARKS: CHECK# 743 INITIALS: CJ SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES Pennsylvania lnheritance Tax � � pel'11'1S�/(,Va�'lld PO BOX 280601 HARRISBURG PA 17128-0601 k'1fQC�l�Notice DEPARTMENT OF REVENUE �^�r �r�r,��r. ir��:' �' �� - � REV-I543 EX UocEXEC (OB-12) Ar�d'T�xp�y Response r: . . �`.`�.' j FILE NO.21 — /�-Q�3� ACN 14106846 DATE 02-10-2014 `;��:+ �:� � �a.� y: 40 �, Type of Account r� � _ Estate of MILDRED E PEARSON Savings t�� "+�-�,'�J;; . ��-+,� C�J,V;EF;� G'` ' Checking l.� ��i_� �[)„ P,�pate of Death 01-29-2014 Trust KEITH D PEARSON CountyCUMBERLAND Certificate 38 COURTYARD DR CARLISLE PA 17013-4908 MEMBERS isr Fcu provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Account No.324630 Remit Payment and Forms to: Date Established 04-06-2009 REGISTER OF WILLS Account Balance $600.26 1 COURTHOUSE SGIUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $300.13 Tax Rate X 0.045 Potential Tax Due � �3.51 NOTE*: If tax payments are made within three months of the With 5% Discount(Tax x 0.95) $(see NOTE' decedenYs date of death, deduct a 5 percent discount on the tax � ��' 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 othe�boxes and disregard the amount shown above as Pofentia/Tax Due. B dhe 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. � 4.5% I am a lineal beneficiary (parent, child,grandchild, etc.)of the deceased. (Select correct tax rate at right, and complete Part � �2��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. Comp/ete Part 2 and part 3 as appropriate on the back of this form. E �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 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), 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. 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 decedenYs 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: �,��o�� \��o��\�\\� � ��\\\,\.,p \�\\�\�� \� ...� � � \ � :\� .: ��\�\\��\;��\ 1. Date Established 1 ��\��\��;`��`�`�\��\��\��`;�\��\�\\;\�� \:��\ ��o�\ ��\�, ��\,\\"��\\\\��\`��\:`�\�� \� � �� A_ � � � A \ \ � �� 2. ACCOUfIt 88�811C@ 2 $ � �� o� \� �� \ �� Ay�A\� \��\\\\V0�\�A\ �\��A��\�\\��\��yy \\V�� 3. P6�C2nt T1X8ble 3 X ��`�`��`� \\\�� A\\��A��A�\��\\\�`��\��`�\V `� �"��`�"��`" \\\V��A�� A��\��V �\�� \� �� \ ��\\�\��\� �� 4. Amount Sub'ect to Tax 4 $ \\�� ,� � � � �� °��° ��o�� \��` ��\��\`�\��\`��\��y��\��\\��\ �� \ � � � � \V�\�A�� o rJ. �BbtS 8f1C� �@C�UCtIOf1S rJ - ��AV�� `��\\\V`V �0��\�� \VA\\\�AA`�� A\� � � �� . ��A\�: �� V��V�VV��V�� F). Af110Ul1t T3X8bI8 6 $ ��\ �� ` ��`�� \��A�AV �� \VA\\ � �� A��A\\\\ �A�� 7. Tax Rate � X ��`�°��\Y�� a�� A�\��A�\\\� �� 0��\��\�A�� \� ��A\��' ��c�� V�V��\��'��V0��V��\�� 8. T8X �U@ 8 � �� `�V\��`�V��\\��V`\��\�\\��Y��V�\�� `� �y�v v��s�y,�� yv v�y� � ,�� 9. With 5% Discount (Tax x .95) 9 X „�o��..!��e�: o��`�..�� .,,,� � �,�� :� a��: 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 Wilis,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 (�'i �� (S (o ( Home ��Z - C.{� J Taxpayer Sign ture 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 BUREAU OF INDIVIDUAL TAXES Pennsy�vania �nheritance Tax � Pe'I'11'1S�/�V8111a PO BOX 280601 HARRISBUR6 PA 17128-0601 nr. � : �+ �;_��QCmat1011 NOtICe DEPARTMENT OF REVENUE rfrn F `�L �� REV-1543 EX UocEXEL (OB-12) R�Il�lc�i axpayer Response I(� I37 -- - _�-•= FILE NO.21 " - ACN 14106845 DATE 02-10-2014 ,�j, ; ,. �� r �, . Type of Account ( � ;, � � ,� Estate of MILDRED E PEARSON Savings -�. �,. r� �f� C��i�,1_r ,�_r.�I_) ��!. . X Checking Date of D e a t h 0 1-2 9-2 0 1 4 Trust KEITH D PEARSON County CUMBERLAND Certificate 38 COURTYARD DR CARLISLE PA 17013-4908 MEMBERS isr Fcu provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Account No.324630 Remit Payment and Forms to: Date Established 03-03-2008 REGISTER OF WILLS Account Balance $2,2p1.g2 1 COURTHOUSE S�UARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $ 1,100.81 Tax Rate X 0.045 Potential Tax Due $49.54 NOTE*: If tax payments are made within three months of the With 5%Discount Tax x 0.95 decedenYs date of death,deduct a 5 percent discount on the tax � ) $(see NOTE') . n due. Any inheritance tax due will become delinquent nine months after the date of death. PART Ste 1 : Please check the a p � p ppro riate 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. B �he 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. � 4.5% I am a lineal beneficiary(parent, child, grandchild,etc.) of the deceased. (Select correct tax rate at right, and complete Part � 12% 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. Comp/ete Part 2 and part 3 as appropriate on the back of this form. E �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 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), 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. 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 decedenYs 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. \\\��\�\�� - �y �� \� �\��\\\��\ \��\ If indicating a different tax rate, please state �� 5� �� \��\\�\�\ our relationshi to the decedent: �� \ �� o � ��\��\`�,�� \��Q\� \ � \ �\��\\�� \ \\\��\�\�� \�\�\ Y P \��\��\ �� '�\\��\�� \�� \�� #s ��\�\\\��\\\� ��\�\\\\� �\� ��\�� \�\�\ o��\��\\��\\��\��\ �� 1. Date Established 1 ; ��s�`��\�� \ �� \��\��\��\��\\��\��\\�\�\��\� \��\�\��O�\ �\��\��..\� �� . \� \O �\ � \ 2. Account Balance `Z $ ��\`��\ \ `�` ` � ``��\�\� "\ �� \\�\��\��\�� \o��y�s��\�\��\�\�� \��\\�o��\�\��\��"�\��\�` � \��\��a�\� v�� \��\�� \ 3. Percent Taxable 3 �" �`�;,��\ ��,�� `��` V� � � X ��A��A\��\��\��A�\\\��`\�\��\V �\�\�� AV�� A� .� A ��A\�A�� V�\�A �� 4. Af1l0Ufit SUI�fBCt t0 T8X 4 $ �V�VA�� A�°�`��A�� \�`\V �V�\\V \�� V� �� A��VA��a\�a�\��\�A��`�A`��A0��A��V��\�A�� J. �@btS 8f1C� �@CjUC110f1S � �J - ��\�� A�j� � \�� ` ��VA �\ ��\�� V\ �� \\\��A\��A�\��A ��`��` .�� V�VV��A ��Vv��A,��A��\\V��V�� 6. AmOUnt Tax3ble 6 $ �� A��Z`�`��A��;��`�� `�\��V� �s�� 7. Tc1X RatP. 7 X �V\�A��\��V`��\�\A\\��A�\��0�V\�V��VAA�\V��A\ ��A��p�\�; �VA\��\�` \\�\\\ \ � � ��\VV�� \�� Ao�` ��A��V\V��\�i�V�'�� p��q��AV�� $. T3X �U8 $ $ 5��5��0��`�\��AA�AV��VA��AA��A � � \ �� \ 9. With 5% Discount(Tax x .95) 9 X ��`� � � � ,,.: ` � �� :��..,..�\\�\��\\�\\\\\� \ aa\�\.�>��.��\\\\�\ .�\�eo �,��a.a��o��\�\O\\.,\\ 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 � �� S � f j �(,�� Home �2� � �/L� �cC� Taxpayer Signature Telephone Number Date � �/ �/r ��. 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