HomeMy WebLinkAbout11-18-14 (3) BUREAU INDIVIDUAL TAXES
PO BOX 280601 PennsY Pennsylvania Inheritance Tax ) DennSVlvania
28 1 r J
HARRISBURG PA 17128-0601 Information NoticeDEPARTMENT OF REVENUE
And Taxpayer Response —' REV-1543B EX DocEXEC (08-12)
FILE NO RECORDED OFFICE OF ACN14 77590755
REGIS'! j T Q; 'y j I DATE 11-06-2014
ZGO11 N1 01U 18 PR ? 2 Type of Account
C L E 1 r', O F Estate of KERMIT W HOLLER Security
SSN X SEC Acct
O R P H A¢.a S' (,0 U �j Date of Death 07-18-2014 Stock
NEDRA S MARSHALL EP i :; i_}� County CUMBERLAND Bonds
1912 COLUMBIA AVE
CAMP HILL PA 17011-5420
WELLS FARGO ADVISORS 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.43130643
Remit Payment and Forms to:
Date Established REGISTER OF WILLS
Account Balance $636,570.99 1 COURTHOUSE SQUARE
Percent Taxable X 33.333 CARLISLE PA 17013
Amount Subject to Tax $212,188.21
Tax Rate X 0.150
Potential Tax Due $31,828.23 NOTE*: If tax payments are made within three months of the
decedent's 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
1 Step 1 : Please check the appropriate boxes below.
A F_�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. _
B F—]The information is The above information is correct, no deductions are being taken,and payment will besentcorrect. with my response.
Proceed to Step 2 on reverse. Do not check any other boxes.
C F�The tax rate is incorrect. ❑ 4.5% I 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.)
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.
00
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.)
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 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 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
2
4. Amount Subject to Tax 4 $ 3
5. Debts and Deductions 5 - 4
6. Amount Taxable 6 $ 5 f
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
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Taxpayer Signature Telephone Number Dat6
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