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Home My WebLink About10-27-14 BUREAU OF INDIVIDUAL TAXESPenns Ivania Inheritance Tax penns�/LVanla PO BOX 280601 y HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE --"' REV-1543 EX DocEXEC (OB-12) And Taxpayer Response FILE NO.21 i'+-882 ACN 14148653 DATE 09-02-2014 Type of Account Estate of JANET R UTTS Savings SSN X Checking Date of Death 08-08-2014 Trust ** MARTHA L JONES County CUMBERLAND Certificate 1180 HIGHLAND DR MECHANICSBURG PA 17055-6006 � o MEMBERS IST FCU provided the department with the information below indicating tlr-t the doth d tide above-named decedent you were a joint owner or beneficiary of the account identified l Remit Payment and Forms to: �� T" r^r -N.] -- r -1) Account No.565066 _- Cr Date Established 06-16-2014 REGISTER OF WILLS , . : Account Balance $5,636.41 1 COURTHOUSE SQUARE CARLISLE PA 17013 Percent Taxable X 50 '_ Amount Subject to Tax $2,818.21 r-` rrI Tax Rate X 0.045 N v `rt Potential Tax Due $ 126.82 NOTE*: If tax payments are made within three months of the With 5/°Discount Tax x 0.95 decedent's date of death,deduct a 5 percent discount on the tax ° ( ) $(see NOTE*) O,ff 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 taxis 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. B The information 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 The tax rate is incorrect. 4.5% 1 am a lineal beneficiary(parent,child,grandchild, etc.)of the deceased. (Select correct tax rate at right, and complete Part F—] 12% 1 am a sibling of the deceased. 3 on reverse.) 15% All other relationships (including none). D ❑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 frog 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 indicatinga different tax rate, lease state 1110 P \ \ 1tr� S8�Qt1y\ your relationship to the decedent: 1. Date Established 1 2. Account Balance 2 $ \\`\�� \ \ \�\\ 14110 \ \\��` 3. Percent Taxable 3 X100 �\\ 4. Amount Subject to Tax 4 $ \\\ \ \\\\\\\ \ \ ` `NA \o , 5. Debts and Deductions 5 - � � \��\\\\ \�\\ `�y`�\��\\\\\\\\�\ ' ..........�`��y\ 6. Amount Taxable 6 $ \ � � 1\\\�\`\\\\`�\\\��\\. \\\\\ �\ 7. Tax Rate 7 XkeR \� 8. Tax Due 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 11'7 YIA -077,2 Home - ?01 /0 -.93- Taxpayer Signatu 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