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Home My WebLink About08-04-14 (2) COMMONWEALTH OF PENNSYLVANIA REV-1162 EXI11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280801 HARRIS8UR6,PA 17128-0801 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 019504 MENGLE MARK R 76 SKYLINE DRIVE MECHANICSBURG, PA 17050 ACN ASSESSMENT AMOUNT CONTROL NUMBER 14504392 j $1,436.99 ESTATE INFORMATION: FILE NUMBER: 2114-0566 DECEDENT NAME: MENGLE PHYLISS C DATE OF PAYMENT: 08/04/2014 POSTMARK DATE: 08/02/2014 COUNTY: CUMBERLAND J DATE OF DEATH: 05/30/2014 TOTAL AMOUNT PAID: $1,436.99 REMARKS: MARK R MENGLE CHECK# 3459 INITIALS: WZ SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES ED BOX 280601 Pennsylvania inheritance Tax 9 , Pennsylvania f� HARRISBURG PA 17128-0601 0 tic (� Infoqmnation Notice DEPARTMENT OF REVENUE n Information d payer Response NLJ'�)r R. (And�'.TOpayer Response U ;.,c FILE NO.2114-0566 11 REVISED NOTICE ACN 14504392 REVISED NOTICE DATE 07-21-2014 P, 49h AUG -4 Pill I Type of Account W Estate of PHYLISS C MENGLE Security C'OURT SEC Acct MARK R MENGLE CUMBERt AJ\1,_ CO3, PA Date of Death 05-30-2014 Stock 76 SKYLINE DR County CUMBERLAND Bonds MECHANICSBURG PA 17050-1750 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. Account No.78192123 Remit Payment and Forms to: Date Established REGISTER OF WILLS Account Balance $33,613.84 1 COURTHOUSE SQUARE Percent Taxable X 100 CARLISLE PA 17013 Amount Subject to tax $33,613.84 Tax Rate X 0.045 Potential Tax Due $1,512.62 NOTE*: If tax payments are made within three months of the With 5%Discount(Tax x 0.95) ${see decedent's date of death,deduct a 5 percent discount on the tax NOTE`} due. Any inheritance tax due will become delinquent nine months after the date of death. PART 1 Step 1: Please check the appropriate boxes below. A 0 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. _14 D-the f@6rrniion 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. C M The tax rate is incorrect. F—] 4.5% 1 am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased, (Select correct tax rate at right, and complete Part 12% 1 am a sibling of the deceased. 3 on reverse.) F-1 15% All other relationships(including none), D Changes or deductions The information above is incorrect and/or debts and deductions were paid listed. Complete Par[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 8112"x 11"sheets of paper,) A9 01 •L Date Paid Payee Description kJ 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 y g { ) { 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 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%,eta) 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 Official Use Only ❑AAF your relationship to the decedent: PA Department of Revenue 1. Date Established 1 2. Account Balance 2 $ PAD 3. Percent Taxable 3 X .1 4. Amount Subject to Tax 4 $ 3 5. Debts and Deductions 5 4 j 6. Amount Taxable 6 $ 5 1 7. Tax Rate 7 x _6 8. Tax Due 8 $ � 8 9. With 5% Discount(Tax x .95) 9 x 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 G�12~3q1 � Q� � O Home?!7 -Cc��' 9 �S-6_ Zj-1�2y/ Taxpayer Signature -- J— 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