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HomeMy WebLinkAbout04-11-14 BUREAU OF INDIVIDUAL TAXES Pennsylvania Inheritance Tax / enns{(tvania BU EAU OF IB1 Y f- .i HARRISBURG PA 1 712 8-0601 Information Notice DEPARTMENT OF REVENUE And Taxpayer Response REV°5"EX°°"°" "8"2' FILE NO.2114.0237 ACN 14116408 DATE 03-27-2014 Type of Account Estate of MARY F HEICHER Savings SSN Checking Date of Death 02-02.2014 Trust SUSAN M FETZER County CUMBERLAND X Certificate APT 3330 325 WESLEY DR MECHANICSBURG PA 17055-3517 ^' c m ao m C'> � `ao rns �' a r— F_- rn m a Cn scr � • . o 0 c ° co r= M -a r PSECU provided the department with the information below indicating that at the death of the above-named decedent you were ajoint owner or beneficiary of the account identified. Account No.8401078434 Remit Payrnent and Forms to: Date Established 03-03-2008 REGISTER OF WILLS Account Balance $13,266.65 1 COURTHOUSE SQUARE Percent Taxable X 16.667 CARLISLE PA 17013 Amount Subject to Tax $2,211.15 Tax Rate X 0.045 Potential Tax Due $99.50 NOTE If Sax payments are made within three months of the decedent's 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 F-I 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 F�The tax rate is incorrect. 4.5% 1 am a lineal beneficiary(parent, child,grandchild,etc.)of the deceased. (Select correct tax rate at right,and complete Part F-] 12% 1 am a sibling of the deceased. 3 on reverse.) 15% All other relationships (including none). D ❑Changes or deductions The information above is incorrect and/or debts and deductions were paid. listed. Complete Part 2 and pail 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 81/2"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 y g ( ) { ) 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. Enter4he percentage of the account that is taxable to you. a. First,determine the percentage owned by the decedent. i. Accounts that are held"intrust 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 Official Use Only ❑AAF 1 your relationship to the decedent: PA Department of Revenue 1. Date Established 1 I 2. Account Balance 2 $ PAD 3. Percent Taxable 3 X 2 4, Amount Subject to Tax 4 $ 3 i 5. Debts and Deductions 5 - 4 6. Amount Taxable 6 $ 5 7. Tax Rate 7 X _6 8. Tax Due 8 $ 8 9. With 50%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 -117- 737-871c I Home Taxpa r 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 BUREAU OF INDIVIDUAL TAXES Pennsylvania Inheritance Tax • pen sytvania PU BOX 280601 DEPARTMENT OF REVENUE HARRISBURG PA 1 7128-0601 Information Notice And Taxpayer Response "D°Ex" `0' �2' FILE NO. 2114-0237 ACN 14116409 DATE 03-27-2014 Type of Account Estate of MARY F HEICHER Savings SSN Checking Date of Death 02-02.2014 Trust DAVID W HEICHER County CUMBERLAND X Certificate 432 OLD FERRY RD NEWPORT PA 17074-7203 ry 0 c -� m o m cv a' V C' r'TZt-3 tn � _ n 1� �rn ?_ r> C� o c o co r= m v 'f r PSECU provided the department with the information below indicating that at the death of the to above-named decedent you were a joint owner or be ficiary of the account identified. Account No.8401078434 Remit Payment and Forms to: Date Established 03-03-2008 REGISTER OF WILLS Account Balance $13,266.65 1 COURTHOUSE SQUARE Percent Taxable X 16.667 CARLISLE PA 17013 Amount Subject to Tax $2,21115 Tax Rate X 0.045 Potential Tax Due $99.50 NOTE*: payments are made within three months of the decedent's 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 taxis 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 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. 04.5% 1 am a lineal beneficiary (parent,child,grandchild,etc.)of the deceased. (Select correct tax rate at right, and complete Part 012% 1 am a sibling of the deceased. 3 on reverse.) 15% All other relationships (including none). D Changes or deductions The information above is incorrect and/or debts and deductions were paid. listed. Complete Part 2 and part 3 as appropriate on the back of this form. v 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. ii Please sign and date the back of the form when finished. A\A 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 8112"x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ P Tax Calculation 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"intrust for"another or others were 1000/0 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. S. 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 Official Use Only Q AAF your relationship to the decedent: PA Department of Revenue 1. Date Established 1 2. Account Balance 2 $ PAD l 3. Percent Taxable 3 X 1 4, Amount Subject to Tax 4 $ 3 5. Debts and Deductions 5 4 6. Amount Taxable 6 $ 5 7. Tax Rate 7 X 6 8. Tax Due 8 $ 7 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 717-737-87101 I-aytoAft Home ylg//y 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 BUREAU OF INOIVIUUAL TAXES 280601 Y Penns lvania Inheritance Tax • enns tvania BU AU HARRISBURG PA 17128-8601 Information Notice DEPARTMENT OF REVENUE And Taxpayer Response °E` 5s° E.°°""" FILE NO.2114-0237 ACN 14116410 DATE 03-27-2014 Type of Account Estate of MARY F HEICHER Savings SSN Checking Date of Death 02-02-2014 Trust SUSAN M FETZER County CUMBERLAND Certificate APT 3330 325 WESLEY DR MECHANICSBURG PA 17055-3517 N_ � x m c � rn M �? d r,.I rte— ,' rn ~ Mm f , a a a o • C? � � t7 w r m —i F- PSECU provided the department with the information below indicating that at the deathPof the s r" above-named decedent you were a joint owner or beneficiary of the account identified. Account No.8401078434 Remit Payment and Forms to: Date Established 02-20-2009 REGISTER OF WILLS Account Balance $6,363.64 1 COURTHOUSE SQUARE Percent Taxable X 16.667 CARLISLE PA 17013 Amount Subject to Tax $1,060.63 Tax Rate X 0.045 Potential Tax Due $47.73 NOTE If tax payments are made within three months the decedent's 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 t 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 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. EJ 4.5% 1 am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased. (Select correct tax rate at right,and complete Part 012% 1 am a sibling of the deceased. 3 on reverse.) 015% All other relationships (including none). D ❑Changes or deductions The information above is incorrect and/or debts and deductions were paid. listed. Complete Part 2 and part 3 as appropriate on the back of this form. - .1 <. 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. ti\�� 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 y g ( ) { j 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. 1 Enter the percentage of the account that is taxable to you. a. rirst,determine the percentage owned by the decedent. i. Accounts that are held"intrust 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 Official Use Only ❑AAF your relationship to the decedent: PA Department of Revenue 1. Date Established 1 2. Account Balance 2 $ PAD 3. Percent Taxable 3 x 2 j 4. Amount Subject to Tax 4 $ 3 5. Debts and Deductions 5 4 6. Amount Taxable 6 $ 5 7. Tax Rate 7 x 6 8. Tax Due 8 $ 8 9. With 50%Discount(Tax x.95) 9 x _v 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 711--137-876/ epktz 4!�Eh� Home MIN Taxpayer Signaftw 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 Taxss PD BOX 28D603 Pennsylvania Inheritance Tax i pennsyLvania HARRISBURG PA 17178-0601 Information Notice DEPARTMENT OF REVENUE And Taxpayer Response FILE NO,2114-0237 ACN 14116411 DATE 03-27-2014 Type of Account Estate of MARY F HEICHER Savings SSN Checking Date of Death 02-02-2014 Trust DAVID W HEICHER County CUMBERLAND X Certificate 432 OLD FERRY RD -_ NEWPORT PA 17074-7203 o c 37 t c M C7 �7 _D Q co C7 -i r- ` rrr,I c J r.i m o C-� CD m -n c r- m - � oo r m - C;J rn C> cn PSECU provided the department with the information below indicating that at the death of the above-named decedent you were a'oint owner or beneficiary of the account identified. Account No.8401078434 Remit Payment and Farms to: Date Established 02-20-2009 REGISTER OF WILLS Account Balance $6,363.64 1 COURTHOUSE SOUARE Percent Taxable X 16.667 CARLISLE PA 17013 Amount Subject to Tax $ 1,060.63 Tax Rate X 0.045 Potential Tax Due $47.73 NOTE*: payments are made within three months of the decedent's 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 taxis 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% 1 am a sibling of the deceased. 3 on reverse.) 015% All other relationships(including none). D Changes or deductions The information above is incorrect 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 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 8 112"x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on tine 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. Eriter 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"intrust 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 Official Use Only ❑AAF your relationship to the decedent: PA Department of Revenue 1. Date Established t 2. Account Balance 2 $ PAD 3. Percent Taxable 3 X 2 1 4. Amount Subject to Tax 4 $ 3 5. Debts and Deductions 5 4 6. Amount Taxable 6 $ 5 7. Tax Rate 7 X 6 8. Tax Due 8 $ 7 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 717-1,37 97(ol Home 0/0( Taxpayer Signatu a %Q 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 1H01vmHAl. TAXES 280601 Y Penns lvania Inheritance Tax ` pennsytvania BU AU HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE And Taxpayer Response U...XK FILE NO.2114-0237 ACN 14116412 DATE 03-27-2014 Type of Account Estate of MARY F HEICHER Savings SSN Checking Date of Death 02.02.2014 Trust SUSAN M FETZER County CUMBERLAND X Certificate APT 3330 325 WESLEY DR MECHANICSBURG PA 17055-3517 rw M rn a rn r, rn 9 ty to Z ..t p rn rn rn .. C7 C) ,p =r) -n -n. t7o r rn —t r PSECU provided the department with the information below indicating that at the deathof the c n -" above-named decedent you were a joint owner or beneficiary of the account identified. Account No.8401078434 Remit Payment and Forms to: Date Established 12-27-2004 REGISTER OF WILLS Account Balance $12,961,54 1 COURTHOUSE SOUARE PerceMTaxabie X76.667 CARLISLE PA 17013 Amount Subject to Tax $2,160.30 Tax Rate X 0.045 Potential Tax Due $9721 NOTE`: If tax payments are made within three months of the decedent's 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 to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. B F�The irifoimation 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. 04.5% 1 am a lineal beneficiary(parent,child,grandchild,etc.) of the deceased. (Select correct tax rate at right,and complete Part 12% 1 am a sibling of the deceased. 3 on reverse.) 15% All other relationships (including none). D F�Changes or deductions The information above is incorrect 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 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 8112"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 y g ( } { ) 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. Oirst,determine the percentage owned by the decedent. i. Accounts that are held"intrust 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 Official Use Only ❑AAF your relationship to the decedent: PA Department of Revenue 1. Date Established 1 2. Account Balance 2 $ PAD 3. Percent Taxable 3 X 1 ' 4. Amount Subject to Tax 4 $ 3 5. Debts and Deductions 5 4 6. Amount Taxable 6 $ 5 7. Tax Rate 7 x 6 8. Tax Due 8 $ 8 9. With 50%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 717-137-SW rxt i ¢�b�9wtt Home ';✓/91�/ Taxpayer Signat a 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 �Pennsylvania Inheritance Tax enns tva is PO BOX 280601 Y P Y HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE And Taxpayer Response Z,O°E.0 FILE NO.2114-0237 ACN 14116413 DATE 03-27-2014 Type of Account Estate of MARY F HEICHER Savings SSN Checking Date of Death 02-02-2014 Trust DAVID W HEICHER County CUMBERLAND �y;; X Certificate 432 OLD FERRY RD NEWPORT PA 17074-7203 rrn :;0 u� Maa co rr1 n rn { c 0, Cn Cil n J'1 PsEcu 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. Remit Payment and Forms to: Account No.8401078434 Date Established 12.27-2004 REGISTER OF WILLS Account Balance $12,961.54 1 COURTHOUSE SQUARE CARLISLE PA 17013 Percent Taxable X 16.667 Amount Subject to Tax $2,160.30 Tax Rate X 0.045 NOTE`: if tax payments are made within three months of the Potential Tax Due $97.21 decedent's date of death,deduct a 5 percent discount on the tax With 5%Discount(Tax x 0.95) _${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 taxis due. 1 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 to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. B 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% 1 am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased. (Select correct tax rate at right,and complete Part F-1 12% 1 am a sibling of the deceased. 3 on reverse.) E] 15% All other relationships(including none). D ❑Changes or deductions The information above is incorrect and/or debts and deductions were paid. listed. Complete Part 2 and part 3 as appropriate on tNe back of this form:. . -, E W]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 farm when finished. t�Rr Debts and Deductions PART - 2 pay the deductible items. responsible for payment,and the estate is insufficient Allowable debts and deductions top Y Proof of payment if requested by the department. must meet both of the following criteria: A. The decedent was legally You may attach 81ro x 1�"sheets of paper.) B. You paid the debts after the death of the decedent and can furnish P Amount Paid (If additional space is required,y Description Payee Date Paid .r w v- Total Enter on Line 5 of Tax Calculation $ r Tax Calculation rcent taxable(Line 3), PART r' 3 1- r titled as it existed at the date of death. -'o'btain�a written correction from the financial institution and attach it to this form. If you are making a correction to the establishment date(Line t)account balance(Line ,o please interest accrued at the date of death. Enter the date the account was established o r2, Enter the total balance-of the account including any 3. Enter the percentage of the account that is taxable to Yo ned by the decedent. ° the decedent. the percentage taxable is 100%divided a, First,determine the percentage owned 3 owners l 3is 100 4 owners year prior to the date of death, i. Accounts that are held"intrust for" anot?he decedent(For e0xample:2 owners= 50%,more byrthe total number of owners nclud ng one y P unts=25% etc.) percent taxable. subject to tax is determined by multiplying the account balance by the p b. Next,divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount sub) 5. Enter the total of any debts and deductions claimed from Part 2. ount le i tax rate from Step 1 based on your relationship to the decedent. 6. The amount taxable is determined by subtracting the debts and deductions from Official USeUOnly AAF 7. Enter the appropriate n to PA Department Ot Revenue If indicating a different tax rate,please state your relationship to the decedent:------ PAD I t. Date Established 2 $ 1 2. Account Balance 3 X 2 ] 3. Percent Taxable 4 $ 3 I 4. Amount Subject to Tax 5 4 5. Debts and Deductions 5$ 6. Amount Taxable 6 6 7 X 6 7. Tax Rate 6 $ 8 8, Tax Due 9, With 5%Discount(Tax x .95) 9 X signed copies to the Register of Wills liste Agent."o a Do notf se'nd Step 2: Sign and date below. ow. you are makin Checks must be made payable to"Register of Wills, ow. Return TWO completed and sig along with a check for any payment knowledge ar payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true,correct andcomplete to the best o mY belief. Work 7q-1 7, & q �3 Home Date Telephone Number Taxpayer Signat IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT SERVICES E F DISTRICT OFFICE, OR THEEI H AND OR SPEAKING NOEEDS ONLY78 800?447 3020 F( TAXPAYERS WITH SPECIAL H