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Home My WebLink About06-12-14 (2) COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 1 7 7 28-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 019295 SIMS CAROL A 13876 SWISS LANE TRUCKEE, CA 96161 ACN ASSESSMENT AMOUNT CONTROL NUMBER ""'___ fold _'__"____ "'__"' 13155844 � 539.98 ESTATE INFORMATION: SSrv: I FILE NUMBER: 21 1 3-1031 � DECEDENT NAME: SIMS DAVID C � DATE OF PAYMENT: 06/12/2014 � POSTMARK DATE: 06/1 1/2014 � COU►vTY: CUMBERLAND � DATE OF DEATH: 09/19/2013 � � TOTAL AMOUNT PAID: 539.98 REMARKS: CHECK# 2021 INITIALS: CJ SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDU/1L TAXES Pennsylvania lnheritance Tax �� ;� pennS�/�Va111d PO BOX 280601 /� yy��ja { p DEPARTMENT OF REVENUE HARRISBURG PA 17128-060��U(�j�r�L� �j� f��d�Of111GlIOn NOGICG � - REV-1543 E%OacE%EG U!•32) � �Taxpayer Response FILE N�.2113-1031 ��;:� . i; �-':� ,`', ACN 13155844 .. * "`' REVISED NOTICE "'`" DATE 03-24-2014 i ��;`'- ;i ��+ Type of Account ^^;r � _<<� �n Estate of DAVID C SIMS Savings Q�i�-`"�```� �'''�,�� Checking �(�r�3�:'� ' ' '`+; n�.� �� Date of Death 09-19-2013 Trust cARO� A SIMS County CUMBERLAND Certificate 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 ou were a joint owner or beneficia of the account identified. Remit Payment and Forms to: Account No.5005798755 Date Established 07-27-2010 REGISTER OF WILLS Account Balance $9,195.32 1 COURTHOUSE StIUARE CARLISLE PA 17013 Percent Taxable X 16.667 Amount Subject to Tax $1,532.58 Tax Rate X 0.045 NOTE': If tax payments are made within three months of the Potential Tax Due $68.97 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 St@p 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 uThe information is The a'twve information is correct,no deductions are being taken,and paymei�t wiii be sent correct. with my response. Proceed fo Sfep 2 on reverse. Do not check any ofher 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 debts and deductions were paid. listed. Complete Part 2 and part 3 as appropriate on the back of fhis form. E �Asset will be reported on The above-identified assei has been or will be reported and tax paid with the PA Inheritance Tax inheritance tax form Retum 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 deductibie items. B. You paid the debts after the death of the decedent and can fumish proof of payment if requested by the department. (tf additional space is required,you may attach 81/2"x 11"sheets of paper.) Date Paid Payee Description Amount Paid eo �. Zo C t � ��. � . �-�,i.w�o '.� �" 4-, 2., � r Total Enter on Line 5 of Tax Calculation $ lo `�l`�� Z> PART Tax Calculation 3 If you are making a correction to the establlshment date(Line'I)account balance{Line 2),or percent taxable(Line 3), please obtatn a written correction from the financia!institution and attach it to this form. 1. Enter the date the account was estabtished 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 taacable to you. a. First,determine the percentage owned by the decedent. i. Accounts that are held"in trust for"another or others were 100°k owned by the decedent. �� by the rotal number of oIw er�s nclud nq the decedenrt r(Fo hexamplef 2 o n'e se p50%n3 owners�--I 33 33°�/4 owners =25%,etc.) b• Next,divide ihe 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 a�y 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. Errter the appropriate tax rate from Step 1 based on your relationship to the decedent If indicating a different tax rate,please state ��"'�,�;� _��#'!��`; At�k`, r��` � your relationship to the decedent: • ��-��,�� - �� `� �� 1. Date Established 1 U'i • D� - �`j� Q ' �� 'N �� :�� *� � 2 $ ��5 3� P� � � � .�. ��z� 2. Account Balance � �:� ' �'� ��`�''� • ` �``�'�'� � �'" "�� 3 X �te . �,u �1 `"l0 3� � a ��t �.� '� ' � � {� � � ;� 3. Percent Taxable � �� _.��s�'�" � 6- °x � a. Amount Subject to Tax 4 � ►5 3 2_ �' � .; � ,�.�"��,,,��k 5. Debts and Deductions 5 - �y� • �'' � ;; ,� ,�q�,�� -� l .� ��` � '"�� _ s $ � Q � 33 � : � � ��. 6. Amount T�able � �: � �� "_ � ��" 7. Tax Rate 7 X K.5`1�, � ��. ,;� , � ,�,, � ,�.. '� � (� q �,3 � j 8 �P •� I t� A°'".� 3 3§rh ,�. �6 2 8. Tax Due �`�� v _, <. ... . _,. 9. With 5%Discount(Ta�c x.95) 9 X s'_.` '.� ' w"`&"�" ' � � � step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, atong w�th a check for any payment you are making. Checks must be made payable to"Register of Wills,Agent" Do�ot send payment directly to the Department of Revenue. Under penalty of perjury,I declare that the facts I have reported above are true,conect and complete to the best of my knawledge and belief. WOrk J`?�.7 �� - 1�`� ,�._ � �--� �, � Home 53i� ��;� - `� a'�t� �'�, U ti�� Taxpayer Signature Telephone Number Date �,- ,p � ��i IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE DIST A�YERS�WITH SPECIAL HEARINGIAND OR SPEAKING NEEDS ONLY�g 8 0 447-3020RVICES FOR TAXP � �J �•� ¢ u� r 4� a /�o ♦� �G �- � � ti../� �i � ciOmu�.Z �� 1\� n.a��-o �-�o .`' �y �7 Z j¢ �,o �`� -' V � o :` f � � t+ !�� _� 1 . � ^� �� n +� � � N�F �+.� ~� O � � r �� o .`\' O� � i� ~p 1 ..`` ;b �� Q f� �� d � , � Q � s � � ; a .` � -r � � � +:. JI � S � � wi J � � �\ v � � � ��I , ,n ,� / ifi � � lJ � ii 9� v `�' � �, i�f : w•� t�� •.. .�., , �,� ..0 , � i:, ; j�::��Y(1� . � S2�f�CJ �;��Hd�Q g _,°� „"-,-°�n � ft, � ,�/ � � sR zr t�d �� r hlaz � � : � � s r��,�:; �� _�.�.s�� N �0 3Jt��? ��Q�'d�3� � � � � �