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Home My WebLink About09-18-14 COMMONWEALTH OF PENNSYLVANIA REV-1162 EXI11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 019694 SANGREY JO ANN B 17 SEBASTIAN WAY CARLISLE, PA 17015 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold __________ -------- 14138677 $5,513.07 ESTATE INFORMATION: SSN: FILE NUMBER: 2114-0659 DECEDENT NAME: INGALLS MARILYN R DATE OF PAYMENT: 09/18/2014 POSTMARK DATE: 09/18/2014 COUNTY: CUMBERLAND DATE OF DEATH: 06/21/2014 TOTAL AMOUNT PAID: $5,513.07 REMARKS: CHECK# 1734 INITIALS: DMB SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES Pennsylvania Inheritance Tax pennsytvania PO BOX 280601 HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE And Taxpayer Response REV-1543 EX D-EXEC(08-12) FILE NO.21 RECORDED OFFICE OF ACN 14138677 REPISTER OF 'IVILLS DATE 07-07-2014 Z.014 "" ^" / / ' 4 ' / Type ofAccount E��MAR�YNR \NGA�S �F Savings SSN213- Checking 0 RpHA�f � � �' �U��onfDeathO6-21'8D14 Trust ** JOANN SANGREY CUMBER[A��Dr - County CUMBERLAND |-|Ce��c�o 17 SEBASTIAN WAY CARLISLE PA 17015-7677 ^ MID PENN BK 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. ~ Account No.18049239 Remit Payment and Forms to: Date Established 0G'1S'2013 REGISTER OF WILLS Account Balance $38,888.18 1 COURTHOUSE SQUARE Percent Taxable X 100 CARLISLE PA 17013 Amount Subject toTax Tax Rate XO.15U NOTE*: \f�xpo`��-n- 1 are made vvithinthree months odthe Pctonda\Tax Due � decedent's date ofdeath,deduct a5percent discount onthe tax With 5%Discount(Tax xU.9S) due. Any inheritance tax due will become delinquent nine months after the date n/death. PART Step 1: Please check the appropriate boxes below. A )��|No tax is due' Uam the spouse of the deceased or amthe parent of a decedent who was 21 years old or younger at date of death' Proceed AnStep 2onreverse. Donot check any other boxes and disregard the amount shown above asPotential Tax Due. 8 �-7The infnrmudonis The above information iucorrect, 6odeductions are being taken,and payment wiUbesent L� oorrect� with my response. Proceed tnStep 2unreverse. Donot check any other boxes. C �-lTho�xrate iuinoormut F-]� 4.5% /amolineal bano8oi�y (parert.child,-gnunduhi|d^�o.)of the deceased. (Select^_^ correct tax rate at right, and complete Part �-1 12% |amasibling ofthe deceased. 3onrevoroej �-� F-1 16% All other relationships(including none). �^�Changes ordadm�innm The i�ormadnnabove ieinoonoo and/or de�oand deductions were pa�. » L/-"J listed. Complete Part 2and part 3aaappropriate onthe back o/this form. E [-��-lAmoetw0bemportedmn The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax inheritance tax form Return filed bythe estate representative. REV'1500. | Proceed koStep 2onreverse. Donot check any other boxes. | Please sign and date the back of the form when finished. PART 2 Debts and Deductions 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.) 8 e,4-c or• 6`a 0 y D ai Payee Description Amount Paid b layl 11 132 kre_l( ckte l3 ( 9'1�a-jlq Total (Enter on Line 5 of Tax Calculation $ 2 0 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), piease.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 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: r \ partmeh bf,Revenue I 1. Date Established 1 E a F 2. Account Balance 2 $ 1?, 6R, l te \� 3. Percent Taxable 3 X 00 \\\ \ 2\�\ \�\ 4. Amount Subject to Tax 4 $ 3$. 8&g,L00 ,w�� 5. Debts and Deductions 5 ,\ \ \\ \\ 6. Amount Taxable 6 $ Je � �8►�g � � n \\` \ `14 o �\ \W 7. Tax Rate 7 _X IS �U 15�� \o\ °` �0 6 ` z ENE 77, 8. Tax Due 8 $ 52 03 ;v 9. With 5% Discount(Tax x 95) 9 X'0 SS 13,0 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. Wokn In-asY-13U3 Home 3-3 qSS lbefig Ta ayer 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