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Home My WebLink About02-18-14 _._._._. �._. .__._ _ -_ -_. . _ _ - ___.. . _ . .. B��►� oF INDIYIDUAL TAXES Pennsylvania lnheritance Tax � pennsylvania PO BOX 280601 DEPARTMENT OF REVENUE HARRISBI�tG PA ��28-060� Information Notice REY-l5iS EX DeeEXEC(�l-12) And Taxpayer Response /, 1_ /, ` FILE NO.21 — �� •7 ACN 14104915 DATE 01-29-2014 , Type of Account � Estate of BETTY L LEITZEL Savings Checking Date of Death 01-15-2014 Trust RUTN q�A�tEN County CUMBERLAND Certificate �� _ c► . ! �� t'ldn ��f� �Q �." � � �� , � �� ; -� �--�� -z�� -� � ��_� �,I, ( t�'�,e !��— � , �-'�. �-- cv � :; z? � I'�'1 � =�,��.-. � � �:,�, �...- ` �.- � ,,r...�.,f �`_-.; CA :1__�� .K._.�-�r� �7�-', -'��' � ��; -� r--- ��.�w w� . _ -� � t .... ;�€'t � __ __ � . , � �-� ..__.._.. �, - - --e .. � _ _ � � � �''� -� CENTRIC BANK provided the department with the information below indicati�g that at the death of the above-nam�d decedent ou were a joint owner or beneficia of the accounfi identified. Account N4.109T732 :, Remit Payment and Forms to: Date Established 09-1&2003 REGISTER OF WILLS Account Balance $3,759.14 1 COUt�THOUSE�UARE Percent Taxable X 8.333 CARLISLL PA 17013. Amount Subject to Tax $313.25 ,. Tax Rate X 0.045 NQTE*: lf #a�c:pa}�me�#s are rr�ad�v�th�thi�e month�,Af the Potential Ta�c Du� $1'4.10` decedent's c�ate of death,d�duct`a 5 percent discount oa the tax . . ,... . Vliith 59r Discount(Ta�c x 0.95) $(see NO'fE•) , due. Any inheritance tax due will becxyme delinquent nine months � after the date of death. - P'�� Step 1: Plea�e check the appropriate boxes below. f : . A [�No tax is due. I.am the spouse.af the deceased or 1 am the parent of a decedent who was 2� years old or younger at date of death. Pror,eed to Step 2 on r�everse. Do not check any ofher boxes and disregard i�he amouni ____�__ _.�..-: shown above as _Potentiat 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 � ��, 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 we�e paid. listed. - Comp/ete Part 2 and part 3 as appropriate on'the back of this form. E o 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 . Retum;fi�ed by the esta#�representative. _ . _ '� RE'�-15Q0. 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 tfiis 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: \� � ��;��3��,�,�� 1. Date Established 1 , , �; �� ,, ,,; ��,��`��,��, ��,��`�� :\ . �� \ �� \ \�� \� �\\\�� \ „ �\\� \ � \�\\� � \�� \�\\\�� \�\\�\��\\�\�\��\�� \�\�\\��\�\��\�� 2. Account Balance 2 $ � � : , � �? ° �� o.�� '�� ` � 3. Percent Taxable 3 X �` � �. � ' � `� �� `��`� :: � � ,��i , , �` .� 4. Amount Subject to Tax 4 $ ° ; \ �: �� 5. Debts and Deductions 5 - �� ,: �� „ � � 6. Amount Taxable 6 � �� . � ,v, �� , , ,�:�,� � �. Tax na�c , � . 8. Tax Due 8 $ � � � ��` � �� `�� ; � �� : � ;� 9. With 5% Discount(Tax x .95) 9 X �� ,; � ., . ....,,, ,.,,.. .,... � � �� ,r� .....� �,,. _ ��.,�- . , .�� . 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 � .� � �;�' �, �; �.�-_.. �....:�- ��. ��..�- Home ��., , ._ � _.��- �:.. �i��_ :�� /1 r a..�� S �„ it, ��; � �}a: Tax ayer 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 COMMONWEALTH OF PENNSYLVANIA REV-1162 EXi11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANC� AND ESTATE TAX OFFICIAL RECEIPT NO. CD 018776 ALLEN RUTH A 3134 RIVER BRANCH CIRCLE KISSIMMEE, FL 34741 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold ---------- -------- 14104915 � $13.40 ESTATE INFORMATION: sSN: ( - FILE NUMBER: 2114-0144 � DECEDENT NAME: LEITZEL BETTY L � DATE OF PAYMENT: 02/19/2014 � POSTMARK DATE: 02/12/2014 � COUNTY: CUMBERLAND � DATE OF DEATH: 01/15/2014 � I � TOTAL AMOUNT PAID: $13.40 REMARKS: CHECK# 337 INITIALS: HMW sEA� RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS TAXPAYER . � .r.,-, - .....- _ ._-- . . . f - - . . � . . � � � ti a _- �.�r��.�.. _ -- �. 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