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HomeMy WebLinkAbout02-19-14 COMMONWEALTH OF PENNSYWANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUfiEAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 1 7 1 28-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 018778 COHICK JERRY 50 BAKER DRIVE CARLISLE, PA 17015 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold ---------- -------- 13109392 � 539.05 ESTATE INFORMATION: SSN: � FILE NUMBER: 21 1 3-1 1 62 � DECEDENT NAME: COHICK SARA J I DATE OF PAYMENT: 02/1 9/2014 � POSTMARK DATE: 02/19/2014 � CoUNTY: CUMBERLAND I DATE OF DEATH: 02/05/2013 I � TOTAL AMOUNT PAID: $39.05 REMARKS: CHECK# 3671 INITIALS: CJ SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS BURFAU OF INDIVIDUAL TAXES Pennsylvania inheritance Tax � pennsylvania PO BOX 280601 Information Notice DEPARTMENT OF REVENUE FIARRISBURG PA 17128-0601 REV-1543 E%DocE%E[ <oe-�z� And Taxpayer Response FILE NO.2T7U' 21'/3-//�2 ACN 13109392 DATE 02-27-2013 Type of Account Estate of SARA J COHICK Savings SSN 201-16-7318 Checking Date of Death 02-05-2013 Trust JERRY S COHICK County CUMBERLAND X Certificate 599 BI6 SPRING RD NEWVILLE PA 17241-9455 C7 ,-.� r-- _- ��` : ;�7 �' �-� ;*� ��_ ,'.i t=_ "�'i ,....` '�t ' . l..-.+� —� 'j:.--::- "' ' '_�.� FARMERS & MERCHANTS TRUST co provided the department with the information b�r indicatir� that at'_� the death of the above-named decedent you were a joint owner or beneficiary of th�-a�count id�r�tified. ::;� _._`" f i J`_I._ Remit Payment and Forms to: -t; , -- ` �r� Account No.152965701 ="' �a �-�Q Date Established 05-19-2000 REGISTER OF WILLS � T� Account Balance . $1,722.21 1 COURTHOUSE S�UARE CARLISLE PA 17013 Percent Taxable X 50 Amount Subject to Tax $861.11 Tax Rate X 0.045 NOTE': If tax payments are made within three months of the Potential Tax Due $38.75 decedenYs 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. PART Step 1 : Please check the appropriate boxes below. 1 A �No tax is due. I 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 fo Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. g �The 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). � �I stedges or deductions The inf Complete Part 2 and part 3 as/appropr aie o nthe back of th s Porl m. 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�roceed to Steta2 onpe erseat�Do not check any other boxes. REV-1500. P Please sign and date the back of the form when finished. PART 2 Debts and Deductions 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 tauable. 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 frorn 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 2. Account Balance 2 $ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 $ 5. Debts and Deductions 5 - 6. Amount Taxable 6 $ 7. Tax Rate 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 tor 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 1 have reported above are true,correct and complete to the best of my knowledge and b ' . work 717 —a2 yl—/�3 � Home 7/7-?.��$-�6� l axpay Signature Telephone Number Da e IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA 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 PART 2 Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legaliy 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 please obtain a written correction from the financial institution and attach it to this form.)� ��cent taxable(Line 3), 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: 1. Date Estabtished 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 $ 7. Tax Rate 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 b ' . work 717 —02 y9—/�53 � Home 7/7—�.����� � axpay Signature Telephone Number Da e IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787=8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ON LY: 1-800-447-3020 BURFAU OF INDIVIDUAL TAXES Pennsylvania lnheritance Tax � pennsylvania PO BOX 280601 II1fOCIY�atIOC) NOtIC@ DEPARTMENT OF REVENUE WIRRISBURG PA 17128-0601 REV-1543 EX DocESEL(OB-12) And Taxpayer Response FILE NO.2T7Q� ZI'l3-ll�P2 ACN 13109392 DATE 02-27-2013 Type of Account Estate of SARA J COHICK Savings SSN 201-16-7318 Checking Date 2013 Trust JERRY S COHICK County CUMBERLAND X Certificate 599 BIG SPRING RD NEWVILLE PA 17241-9455 �.__, n - ` � �� 1-�-.' �, _-i_i i TT "�'i - ,,.� `_3 t_= t � rl r' ''� :1,� - C:;� =`t7 `�, .-.? "' FARMERS & MERCHANTS TRUST co provided the department with the information be�eMr.indicat�Rj that�at_=� the death of the above-named decedent you were a joint owner or beneficiary of th�aECOUnt id�ntified. �-`=i - ,.; . Remit Payment and Forms to: -� � - __° �; Account No.152965701 L c.� �'�_O Date Established 05-19-2000 REGISTER OF WILLS c� 1 COURTHOUSE SGIUARE Account Balance $1��2221 CARUSLE PA 17013 Percent Taxable X 50 Amount Subject to Tax $861.11 Tax Rate X 0.045 NOTE": If tax payments are made within three months of the Potential Tax Due $38•75 decedenYs date of death,deduct a 5 percent discount on the tax With 5%Discount(Tax x 0.95) $(see NOTE`) after he dateeof death ax due will become delinquent nine months 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 other boxes and disregard the amount shown above as Potential Tax Due. g �The 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 de�b�ate o nihe back of th s form. listed. Complete Part 2 and part 3 as app p 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 Retur pro eed io Step 2 onpeverseat�Do not check any other boxes. REV-1500. 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