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Home My WebLink About02-20-14 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAI TAXES - DEPT.280601 HARRISBURG,PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 018787 GARTNER FREDERICK A 84 HONEY SUCKLE DRIVE MECHANICSBURG, PA 17050 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold ---------- •-------- 13171176 � 5461 .45 ESTATE INFORMATION: sstv: � FILE NUMBER: 2114-0155 ( DECEDENT NAME: GARTNER THELMA M � DATE OF PAYMENT: 02/20/2014 � POSTMARK DATE: 02/19/2014 � � COUNTY: CUMBERLAND � DATE OF DEATH: 12/08/2013 � . . � TOTAL AMOUNT PAID: $461 .45 REMARKS: CHECK# 2043 INITIALS: HMW sEA� RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS BIAtEAU OF INDIVIDWL TAXES Penns Ivania lnheritance Tax � pennsylvania� PO dOX 280601 y DEPARTMENT OF REVENUE NARRISdURG PA ��ZS-o6o� . Information Notice � REV-15f3 E7f Doe EC(�l-12) And Taxpayer Res�nse FILE NO.2� "��—�5i� ACN 13171176 DATE 12-25-2013 � . Type of Account Estate of THELMA M GARTNEfi . Savings Checking Date of Oeath 12-0&2013 Trust FREDERICK A GARTNER County CUMBERLAND Certificate 84 HONEYSUCKLE DR MECHANICSBURG PA 17050-3184 � � C'� ...._ �p �-- ,�,- ��"� �:� -""-3 rr"��i =.�, r-3�'J ��f-. � . �� ,- __ _ _ _ _ .� _ .�,.�,�- ",3 -- — . Qi ��-�=�. .� _ _. „_. .. , _ �� C7�,� � � '�:;t::; �-`=' r-r� METRO BANK provided the department with the information below indicating that at the��'th of th�, �� above-named decedent ou were a joint owner or beneficia of the account identified. .r,a, Acxount No.7760481037 Remit Payment and Forms to: Date Established 05-03-2012 REGISTER OF WILLS Account Balance $6,152.59 1 COU�iTHOUSE St�iIARE Percent Taxable X gp CARLISLE PA 17013 Amount Subject to Tax $3,076.30 Tax Rate X 0.150 NOTE*: If tax payrments are made within three rr�onths�f the Potential Tax Due $461.45 decedent's date of death,deduct a 5 percent disc�unt,on the tax With 5°�Discount(Taz x 0:35) $(se�NOTE") due. Any inheritance tax due will become detinqueM�ine months after the date of death. PART� 'St@p 1: Please check the appropriate boxes below. � A �Nv tax is due. I am the spouse of the deceased or I am the parent of a decedent who was � 21 years�old or y�unger at date of death. Proceed io Step 2°on reverse. Do not check any other boxes and disr+egarn►the amount shown abov�as Potential Tax Due. _____ � ;.�..�.. _�-- - - -- _ _. g �The information is The above information is correct, no deductions are being taken,and payment will be sent_ correc�t. 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. (Setect�orrect 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 incor�ect and/or debts and deductions were paid. listed. Complete 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 ir�heritance tax form Retum�iled 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), piease ob�ain a writter�correcfion trom�he financial insfituiion and a�i�aci�it to t�'ris 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: ` `��\�``�� `�� `��` "' � �� "� ��`��\`�"�� \\ �r � �� \�\�� i��r��\��\\\�\O� .:��\Q�\\�\\�\\\\��\��\\\�\�\\��\��\\��\��\\��\\��\��.\�\\��\� �\�\; 1. Date Established 1 �,��,�� \��,��\��;��;��,�� ;�� \ ` ` `\ ��\.\\��\��\\\��\�\\\��\\\�\�\y�\�\\\�C°�� \, 2. Account Balance 2 $ �� ,��,��\��,� , ��,� \�� ,�� \ .\\�\\�� \\ �\��\\�`\\�\\\��\��\��\ �\\�� _ � ��. ��\��\\\\��\\\\\\\\�\��\\��\\\\\��\\\\\\��\\\\\�\�\\�\\\\�\�., ��:\ �� 3. Percent�Taxable 3 X ` � ;,��,��`�� ,��,,,,��; ��,.,��;��;.��,��; ��, ��; � � � ��\� �� \\��\�\��\�\\��\\��\�`� �� \�� \� ��\ � �� \�� \��\\\��p\�\ \�� `��\ 4. Amount Subject to Tax 4 $ � � ; ;� � , � ; �� : �,\�::�\��.\\.\\>\��\;.�\��.��..��\��.��\�.�...��s\.�`��\...,��\: 5. Debts and Deductions 5 \ ' ` - , � , � , �. � �'� � �\�� \\��\��\�� \� � �\\��\� \��\��\ ��\��\ � . . : � : � �.�\��\ ��\ ��\� �� \ ��\�� \\. � � �� \��\\\��\\�\�� \\�� \\\�O \ �\�\�\� �.\� 6. AmOUnt TaX3ble 6 � �, � . ,�� `��o�� o�� ; � �� \\ c � �`��VA�\�A��AV�V�� A��\V��\�� `��, ,'. T a;: P ata 7 X �'�� , � �� ,� � �� , . ` ` � � � � �� . ��`��:� �� ' T Q� ��; ` �� `�: ��. � � �� 8. I aX DuPi � �P � �� \��\��\�\��\\��`�\\�\��\`�\�\\\\��\��\\`�\�\��\��\\\�\\��\�� :\� ��\��\\\��\��`��\\\��\\�\�\\\\\��\\��\�\�\��\\\\��\�\�\\��\��' 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.�.. � � � j� a -' � � r ! Work ��-��Z� ��1�.� j' � j r �i'��n��1."'l," R. � Y/lJV ► �011 IG r� � � �! G �-` J�"f� C'' 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