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Home My WebLink About06-12-14 REV-1162 EX111-96) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,Pa,�,zs-oso, PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N�. CD 019294 SIMS CAROL A 13876 SWISS LANE TRUCKEE, CA 96161 ACN ASSESSMENT AMOUNT CONTROL NUMBER ---------- -------- fold 13155842 � 590.49 ESTATE INFORMATION: ssrv: � I FILE NUMBER: 21 1 3-1 031 � DECEDENT NAME: SIMS DAVID C I DATE OF PAYMENT: 06/1 2/2014 � POSTMARK DATE: 06/12/2014 � CoUNTY: CUMBERLAND � DATE OF DEATH: 09/19/2013 � � TOTAL AMOUNT PAID: 590.49 REMARKS: CHECK# 2020 INITIALS: CJ SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES Pennsylvania inheritance Tax � �� '� PennS�/LV8t11c1. PO BoX 260601 IIlfO(fll'clt1011 NOtIC@ DEPARTMENT OF REVENUE HARRIS6URG PA 17128-0601 �� - REY4543 EI UoeEXEC cee-iz> ��,T�p�t�B��onse FILE NO.2113-ia31 �L. �`'t"�"E`+ r.r- * * * ACN 13155842 **"' `�E�I��G�ICE DATE 03-24-2014 � 1� P� 12 `�s Type of Account ��-��i;"� ��` Estate of DAVID C SIMS Savings ��;� SN 190- 2013 Trust CAROL A S I MS r'�''�'�� i"' �!`; fL j ��9�nty CUMBERLAND CertifiCSte 13876 SWISS LN TRUCKEE CA 96161-7117 PNC BANK NA 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.5140219701 Date Established 05-01-1978 REGISTER OF WILLS Account Balance $12,065.28 7 COURTHOUSE S(iUARE CARLISLE PA 17013 Percent Ta�cable X 16.667 Amount Subject to Tax $2,010.92 Tax Rate X 0.045 NOTE': If tax payments are made within three months of the Potential Tax Due $90.49 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 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 chedc any ofher boxes and disregard the amount shown above as Potential Tax Due. g �7he 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. G �The tau 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). � �Changes or deductions The inf Com�lete Part 2 and part 3 a�appropnate on the back of this form. listed. 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 Return�raceed t Step 2 onpreve�eatiDo not check any other boxes. REV-1500. 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 Iegally 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 Qescription 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 ta�cable(Line 3), please obtain a wr�tten correction from the financia!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 heid"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 peroentage taxable is 100%divided by the total number of owners including the decedent. (For example:2 owners=50/o,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 ta�c. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent �, � > �� .� If indicating a different t�rate,please state � ' �. . : �� your relationship to the decedent: � �� , �_� ... �; �� 1. Date Established �° � �- .:� .� 2 $ .�� -� � ��<� 2. Account Balance � �� 3 X :� � �,� �� 3. Percent Taxable � " �• ��.� � �fi� �� 4. Amount Subject to Tax 4 $ �.,„, � � � ��'� 5. Debts and Deductions 5 � �° �°�' � �� ' � � �. 6. Amount Taxable 6 $ ` �x�e� �" F�.� �� '� �� 7. Tax Rate 7 X �� : �`��x �'�� 8. Tax Due 8 $ �� „� �,,_ �;;-�: ' � . : 9. With 5%Discount(Tax x.95) 9 X � ;��;��:�� :. � 3�� . �:��.� �:��.,. �� 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. wo� S3o- a��- �a5 � �'��-9 ��1�,�w� .Home �30 5�Z ��a�� (�.. �� _��1 Taxpayer Signature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE T XPA'YERS�WITH SPECIAL HEARING'AND OR S EAK�ING N E STONLY?8 800-447-30 ORVICES FOR