The URL can be used to link to this page

Home My WebLink About07-24-14 B�R�� oF INDIVIDUAL TAXES Penns �vania �nheritance Tax � Per1t'1S�/LVa111a PO BOX 280601 Y HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE '� �� REV-1543B E%DocE%EL (OB-12) And Taxpayer Response FILE NO.2114-0535 ACN 14504559 DATE 07-10-2014 Type of Account Estate of DAVID D SHANK Security X SEC Acct Date of Death 05-12-2014 Stock JASON S SHANK County CUMBERLAND Bonds 18588 PATH VALLEY RD DRY RUN PA 17220-9730 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.58386568 Date Established REGISTER OF WILLS Account Balance $15,800.20 1 COURTHOUSE SGIUARE Percent Taxable X 33.333 CARLISLE PA 17013 Amount Subject to Tax $5,266.68 Tax Rate X 0.045 Potential Tax Due $237.00 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 wh 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any ofher boxes and disregard the arr shown above as Potentia/Tax Due. � g �The informat�on is The above information is correct, no deductions are being taken, and payment will be sen O � O� correct. with my response. v� � �5 Proceed to Step 2 on reverse. Do not check any other boxes. O o � �� C �The tax rate is incorrect. � 4.5% I am a lineal beneficiary(parent,child,grandchild, etc.) of the deceasec r�� ti � rSht and com tlete Part t o q�„ �+ O 9 P � 12/o I am a sibling of the deceased. 0� O 3 on reverse.) �� 15% All other relationships (including none). v U 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 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), please obtain a written correction from the financial institution and attach it to this form. �. Enter the date the ac�ount was establisheu�r tt�ed as it ex�sted at the clat2 af 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 owr�ed 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 multipiying 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 t�rate, please state �"�� `�� " �� `�� `� � ` �� your relationship to the decedent: � �\ . � ``` � ,� 1. Date Established 1 � �� ,, � 2. Account Balance 2 $ � �a��.� \ 3. Percent Taxable 3 X ��. � � � �� .. � .: ��. . 4. Amount Subject to Tax 4 $ � � � \ � \\ ,,. \ 5. Debts and Deductions 5 - �� ;� � �. �� 6. Amount Taxable 6 $ � �� X \ � 7. Tax Rate 7 � : � . �� ` . �� _ � . � . � 8. i�x Due 8 $ :�: �, _ s . ;; , � � � .,. � � � A �. 9. With 5%Discount(Tax x .95) 9 X ��`�' � �� _ A� �� a� �ti� �� ' ��\ � �ti� 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 7/7` �o y� o'�i�� Ho►�e 717-3yy— ��19' �02 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 B�R�,o oF INDIVIDUAL TAXES Pennsylvania lnheritance Tax � pennS�/LVat118 PO BOX 280601 HARRISBURG PA 17128-0601 IllfOrCTIatI011 NOtICe ' DEPARTMENT OF REVENUE �� REV-1543B EX DocE%EC (08-12) And Taxpayer Response FILE NO.2114-0535 ACN 14504559 DATE 07-10-2014 Type of Account Estate of DAVID D SHANK Security X SEC Acct Date of Death 05-12-2014 Stock JASON S SHANK County CUMBERLAND Bonds 18588 PATH VALLEY RD DRY RUN PA 17220-9730 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.58386568 Date Established REGISTER OF WILLS Account Balance $15,800.20 1 COURTHOUSE SQUARE Percent Taxable X 33.333 CARLISLE PA 17013 Amount Subject to Tax $5,266.68 Tax Rate X 0.045 Potential Tax Due $237.00 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°/a 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 the� shown above as Potential Tax Due. g �The in#ormation is The above information is correc?, no deductiens are b2ing taker, and payment�rviil be st correct. with my response. F-- Proceed to Step 2 on reverse. Do not check any other boxes. w �"' O� O U C �The tax rate is incorrect. � 4.5% I am a lineal beneficiary(parent, child,grandchild,etc.)of the decease U� � �O (Select correct tax rate at � rig h t, an d comp le te Pa rt � 12% I am a sibling of the deceased. �O 3 on reverse.) �� '—'� o � 15% All other relationships(including none). �' ,�,r, `�" O� � O� � +N �U p �Changes or deductions The information above is incorrect and/or debts and deductions were paid. v 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 Inheritanc inheritance tax form Return filed by the estate representative. REV-1500. Proceed to Step 2 on reverse. Do not check any ofher 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), please obtain a written correction from the financial institution and attach it to this form. 1. Enter tne date the account was established or titied as it existed at the tiat2�f 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 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. \ ':•\:','�:�� :' � �� ,..:. � \ ::, ,c� ��`��.�:�� \ If indicating a different tax rate, please state � s� �� , � your relationship to the decedent: o� , �� \�� `� "`� �� V � � � � �, � � � 1. Date Established 1 ��,,,` ��` � �� "� �� ... � �� : � 2. ACCOUfIt B3I3f1C@ 2 $ � � � �� \,�`� .�� 3. Percent Taxable 3 X �� ` �� ' � 4. Amount Subject to Tax 4 $ � � " " �\\\ :�� \. :�� ..\\ � \ �.. ` 5. Debts and Deductions 5 - �� .�� 6. Amount Taxable 6 $ �� " � ' �� ` �` �� . �.. 7. Tax Rate 7 � � � • � X �� . '; ��o� �� .��. � � 8. Tax Due 8 $ . , .. � � ��\ �s `� \` � .�� \ .� �� 9. With 5% Discount(Tax x .95) 9 X ��. \�\�� a��'��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 717- (o yf'0�(087 Home 7��- 3y9-�� / axpayer 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 lnheritance Tax � pennsylvania PO BOX 280601 DEPARTMENT OFREVENUE HARRISBURG PA 17128-0601 Information Notice REV-15438 EX DocEXEL (OB-12) And Taxpayer Response FILE NO.2114-0535 ACN 14504562 DATE 07-10-2014 Type of Account Estate of DAVID D SHANK Security X SEC Acct Date of Death 05-12-2014 Stock JASON S SHANK County CUMBERLAND Bonds 18588 PATH VALLEY RD DRY RUN PA 17220-9730 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.7913837 Date Established REGISTER OF WILLS Account Balance $243,114.43 1 COURTHOUSE SQUARE Percent Taxable X 33.333 CARLISLE PA 17013 Amount Subject to Tax $81,037.33 Tax Rate X 0.045 Potential Tax Due $3,646.68 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 wr � 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the ar shown above as Potential Tax Due. F g �The information is The above information is correct, �o deductions are being taken, and payrner�t wili be se w ,� correct. with my response. � � O� Proceed to Step 2 on reverse. Do not check any other boxes. �� w � U C �The tax rate is incorrect. � 4.5% I am a lineal beneficiary(parent, child, grandchild, etc.)of the deceas� �O (Select correct tax rate at �r`� � a right, and complete Part � 12% I am a sibling of the deceased. �� O 3 o n r e v e r s e.) v� � O � 15% All other relationships (including none). � �l �� U 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 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), please obtain a written correction from the financial institution and attach it to this form. 1. Enter the date the account was established cr 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 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 �� \ your relationship to the decedent: o � ' ��,.� � ��-�� - � 1. Date Established 1 �\��\� `� \� � �� A.r� . � ��. �� ,�_. A . ��_ A. ` 2. Account Balance 2 $ '�� , �� 3. Percent Taxable 3 X � ��' � �� ' � �� \ . . � � ,. � � „ 4. Amount Subject to Tax 4 $ ;\O� � \, � \�. \ � 5. Debts and Deductions 5 - � � � �� 6. Amount Taxable 6 $ � 7. Tax Rate 7 X �.��\ \ � \�� .� .�\� � . � �� z"s. Tax Due 8 $ � � � �� . , ;. . �\�s . � ��_� 9. With 5% Discount(Tax x .95) 9 X ��` �� s�a�� A\\ �A\�� 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 7/7- .l�y8 �o��£� Home 7�7-3�1`�- 7p� 7�� axpayer 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 r _> . �:. .. . � �,.,,�,� �. �.��. ��.�� .�..�,..�.��. ,� � �.r __,�.,....,._,�,,..�,�. BUREAU oF INDIVIDUAL TAXES Penns Ivania lnheritance Tax � pennsylvania PO BOX 280601 Y HARRISBURG PA 17128-0601 IllfOr171atI011 NOtICe DEPARTMENT OF REVENUE REV-15438 E%DocEXEC (OB-12) And Taxpayer Response FILE NO.2114-0535 ACN 14504562 DATE 07-10-2014 Type of Account Estate of DAVID D SHANK Security X SEC Acct Date of Death 05-12-2014 Stock JASON S SHANK County CUMBERLAND Bonds 18588 PATH VALLEY RD DRY RUN PA 17220-9730 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.7913837 Date Established REGISTER OF WILLS Account Balance $243,114.43 1 COURTHOUSE SGIUARE Percent Taxable X 33.333 CARLISLE PA 17013 Amount Subject to Tax $81,037.33 Tax Rate X 0.045 Potential Tax Due $3,646.68 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`�r 21 years old or younger at date of death. �� Proceed to Step 2 on reverse. Do not check any other boxes and disregard the s shown above as Potenfial Tax Due. g �The information is The above information is correct, no deductions are being taken,and payrrient will be sE correct. with my response. � Proceed fo Step 2 on reverse. Do not check any other boxes. O � O C The tax rate is incorrect. 4.5% I am a lineal beneficiary(parent, child,grandchild,etc.) of the deceas� v � �� (Select correct tax rate at � �� ''� U ri ht,and com lete Part o �O � � 9 P � 12/o I am a sibling of the deceased. 3 on reverse.) �� O � 15% All other relationships (including none). p� O p � � �� p �C h a n g e s o r d e d u c t i o n s T h e i n f o r m a t i o n a b o v e i s i n c o r r e c t a n d/o r d e b t s a n d d e d u c t i o n s w e r e p a i d. c� listed. Comp/ete Part 2 and part 3 as appropriate on the back of fhis form. E Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inherita�� a� 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 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. Enter the date the account was established or titied 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 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 °� �� ; �"� � �� your relationship to the decedent: ��\�\ �� \�� ` � � ` �� . \ 1. Date Established 1 � �� . � ..\ \ \ 2. Account Balance 2 $ � � � � � � � 3. Percent Taxable 3 X ��.. �.,. .� 4. Amount Subject to Tax 4 $ :��, ,� �� \��: \ �� s v � �. Debts and Deductions 5 - ; �`�� _ ��\ 6. Amount Taxable 6 � ,,, 7. T� Rate 7 X �� \\ � �� 8. T� Due 8 $ '�� A. �� \� � � ��.:��. � �� \ . .. . . \ � .9. Wltfl �J°�O �I$COUIIt�Tc1X X ..9�J� .9 X \��\�\\� A�� \�� A� ��V�� A\\� A�\� �\V \��i Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wilis 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'7/7- �yg°��°� Home ��7�.�c/- �� 7 aa i axpayer Signature Telephone Number ate 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 BURFAU OF INDIVIDUAL TAXES Penns Ivania lnheritance Tax � � pennsylvania PO BOX 280601 y HARRISBURG PA 17128-0601 (CIfOCCT1atIO11 NOtIC@ DEPARTMENT OF REVENUE '� � REV-1543B EX DocEXEC (OB-12) And Taxpayer Response FILE NO.2114-0535 ACN 14504565 DATE 07-10-2014 Type of Account Estate of DAVID D SHANK Security X SEC Acct Date of Death 05-12-2014 Stock JASON S SHANK County CUMBERLAND Bonds 18588 PATH VALLEY RD DRY RUN PA 17220-9730 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 SGtUARE Percent Taxable X 33.333 CARLISLE PA 17013 Amount Subject to Tax $ 1,221.51 Tax Rate X 0.045 Potential Tax Due $54.97 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 ofher boxes and disregard the ar � shown above as Potential Tax Due. g �The information is The above information is correct, no d�ductions are being taken, and payment wiil be ser � correct. with my response. w � O� Proceed to Step 2 on reverse. Do not check any other boxes. O U� � � O C �The tax rate is incorrect. � 4.5% I am a lineal beneficiary(parent,child,grandchild, etc.) of the deceased ��,., U (Select correct tax rate at O p � right,and complete Part � 12% I am a sibling of the deceased. �� p 3 on reverse.) �� , � 15% All other relationships (including none). �� U U p �Changes or deductions The information above is incorrect and/or debts and deductions were paid. listed. Comp/ete 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 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. i. tnier ihe date the account was estabiished or tit{ed as �t exisied at thE date of�eath. 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. ��,��.s.., � . �:� a;" � �. ° ;�- . ' � �� If indicating a different tax rate, please state � ' � � � your relationship to the decedent: � ` � � � �� ` .� �� 1. Date Established 1 \r�� ,��. 2. Account Balance 2 $ �` �\` �� ' � 3. Percent Taxable 3 X � � � .�,�. . ,�.,__ �. . . .. . ..� ., 4. Amount Subject to Tax 4 $ � ��' �� `�"� � �� \ � A� � \�_ ` \ �� 5. Debts and Deductions 5 - :,\ �\ � � `� � \��'�� F>. AmOUntTBXabI2 6 $ : ��°:� � � ' � � �a �� .� �� 7. T� Rate � X �0� �\�� A A�� 8. T� Due � 8 $ "`� '". ' .� .. , \ � � �� .� � � �� 9. With 5%Discount(Tax x .95) 9 X �� \��`s�� O� ��\ �� e�� o �� 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 7/7— 6y�—�687 i�---_"_. Home - 3y9- 70 xpayer 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 BURFAU OF INDIVIDUAL TAXES Pennsylvania lnheritance Tax � pennsylvania PO BOX 280601 DEPARTMENT OF REVENUE HARRISBUR6 PA 17128-0601 Information Notice REV-1543B EX DocEXEC (OB-12) And Taxpayer Response FILE NO.2114-0535 ACN 14504565 DATE 07-10-2014 Type of Account Estate of DAVID D SHANK Security X SEC Acct Date of Death 05-12-2014 Stock .IASON S SHANK County CUMBERLAND Bonds 18588 PATH VALLEY RD DRY RUN PA 17220-9730 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 SGIUARE Percent Taxable X 33.333 CARLISLE PA 17013 Amount Subject to Tax $1,221.51 Tax Rate X 0.045 Potential Tax Due $54.97 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 Sfep 2 on reverse. Do not check any other boxes and disregard the am� � shown above as Potential Tax Due. g �The information is The above i^formatior is corre�t, �o deductions a�e being taken,ar�d Nayrent wili te sent correct. with my response. � Proceed fo Step 2 on reverse. Do not check any other boxes. � O �' O� C �The tax rate is incorrect. � 4.5% I am a lineal beneficiary (parent,child, grandchild, etc.)of the deceased. v� � � (Select correct tax rate at Z� right, and complete Part � 12% I am a sibling of the deceased. O p � q 3 on reverse.) �� ,-� � � 15% All other relationships(including none). �� d"' � OC� O O� �Changes or deductions The information above is incorrect and/or debts and deductions were paid. � � � �v � 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 Inheritanc 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 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. i. E�te�the date the account was esta�lished or titleu�is ii 8xls:ed 8t:he 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: � � �� s� � , ; 1. Date Established 1 � � �� .� � � 2. Account Balance 2 $ 3. Percent Taxable 3 X � . � , 4. Amount Subject to Tax 4 $ ��"� �� . 5. Debts and Deductions 5 - �� ` � �� 6. Amount Taxable 6 � ;�� 7. T� Rate 7 X �, . � �� ,� � '.. �... 8. i az vue 8 $ ' � ��.. . �. ... ` � , ti�� 9. With 5% Discount(Tax x .95) 9 X ��o��o��'�� o�� :�� a��.� �� 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 ?/�' (�LIg �-o�l�� _ Home ��7- 3�l y- 7oy o� r xpayer 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