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Home My WebLink About07-21-14 B�R�� oF INDIVIDUAL TAXES Penns Ivania lnheritance Tax � pennsylvania PO BOX 280601 y HARRISBURG PA 17128-0601 IC1fOCI71atIO11 NOtICe DEPARTMENT OF REVENUE '� �� REV-1543B EX DocEXEC (08-12) And Taxpayer Response FILE NO.2114-0535 ACN 14504564 DATE 07-10-2014 Type of Account Estate of DAVID D SHANK Security X SEC Acct Date of Death 05-12-2014 Stock JANET L HOOVER County CUMBERLAND Bonds 635 N HANOVER ST �.::� CARLISLE PA 17013-1934 n �; :k� G� �' � � � ,-�.. � �T.� . C ,.,i � F'r4-� r �-- r,-, r. Ta� r ; - �� E �� r.�:_I .fi".J�, i - -. C?C`` � ' i-: r.�,L_ .�. ;_� .� ..- C . �� j�,� �,�Y r7-+; �' l.�� AMERIPRISE 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.7158005 Date Established REGISTER OF WILLS Account Balance $3,664.57 1 COURTHOUSE SC�UARE Percent Taxable X 33.333 CARLISLE PA 17013 Amount Subject to Tax $1,221.51 Tax Rate X 0.150 Potential Tax Due $183.23 NOTE�: If tax payments are made within three months of the 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 check any other boxes and disregard fhe amount shown above as Potentia/Tax Due. g �The information is The above information is correct, no deductions are being taken,and paymen;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°/a 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 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 si n and date the back of the form when finished. �``v 9 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 this form. 1. tnter the date the accouni was established or titied as it existed at the date of deat�. 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 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 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 `��`��`��\��,� �� ` � �� `� �` �� our relationshi to the decedent: �� \�� "�` �� , �� Y P ��\ �\�� . 1. Date Established 1 �� \ \\� � ��' \� �\ � ` � :�:��u ��. ��:�:��,��.. � s\�.. 0� �� . � � 2. /�CCOUfIt B3�3f1C8 2 $ �� -`-=�� V��' � c �� 3. Percent Taxable 3 X � ' � " 4. Amount Subject to Tax 4 $ �� \ \` �� 5. Debts and Deductions 5 - �` "� � � �� `�� . ��: ��, �� .a�; 6. Amount Taxable 6 � ,�� y � �� \\ � � \� \ � 7. Tax Rate 7 X >�\� �\ �� `� � \� .� 8. Tax Due 8 $ � . . � � � . \\�� .\� \� �� `� � � �. 9. With 5% Discount(Tax x .95) 9 X a`�. ��0� a�� `��A��A�� e�� \ ��. �� 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 Home -7�7 -�i'Y'�' - 5/%Y 7/7/y Taxpayer Signature � �� Telephone Number Date IF YOU NEED FU HER 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 ; � : 3 � � � � � a' �' '� � , � � � �j � � � m J � ra J �— � • � � .� � -� � a � � d �" .� � � . . _ _ �-- '� � ° � - �� t� � � ;` t � ' �F� � � ! � � � 3..f � � ',� � � �r� . �- �--I � � � - � � ;_:� � :�_ , � �p � �-�i-;L . � �� , , r� ,� t'Tl �� : .. � � �� r� ' r -- �� Cn �� pC _ � :�� C"�C; �� -' C� pc �3 iti? r--'� �'~`i � C+�� t`..� W )