HomeMy WebLinkAbout11-18-14 (6) BUREAU OF INDIVIDUAL TAXESPenns Ivania Inheritance TaxQV
pennsytvanla
PO BOX 280601 Y
HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE
REV-1543B EX D..EXEC (08-12)
And Taxpayer Response FILE NO.2114-0755
RECORDED CF ICE OF ACN 14507763
RECISTFiZ Jr- "V"JUS DATE 11-06-2014
0191 NOU 18 r11 2 21 Type of Account
C I F^ ; OF Estate of KERMIT W HOLLER Security
SSN X SEC Acct
0 R P H A�:S' C O'1*,T Date of Death 07-18-2014 Stock
NEDRA S MARSHALL I F n I = o, r -) �A County CUMBERLAND Bonds
1912 COLUMBIA AVE C.�MB_""' J'1
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.73109459 Remit Payment and Forms to:
Date Established REGISTER OF WILLS
Account Balance $329,267.91 1 COURTHOUSE SQUARE
Percent Taxable X 33.333
CARLISLE PA 17013
Amount Subject to Tax $109,754.87
Tax Rate X 0.150
Potential Tax Due $ 0.150 .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 Step 1 : Please check the appropriate boxes below.
1
A No tax is due. I am the spouse of the deceased or 1 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.
B0 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. 74.5% 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.)
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
Lf"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'
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 isinsufficient 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 indicatinga different tax rate, lease state �� \° o°� '' \� �� •
p
your relationship to the decedent:
1. Date Established 1
2. Account Balance 2 $ A\ �� s\�y��
3. Percent Taxable 3 x \ �
\�® m\
4. Amount Subject to Tax 4 $
5. Debts and Deductions 5
6. Amount Taxable .6 $
7. Tax Rate .7 x
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
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Taxpayer Signature Telephone Number D to
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
BANW LAM(OFICE, LLC
429 SOUTH 18'"STREET PHONE: 717-730-7310
CAMP HILL,PA 17011 FAX: 717-730-7374
E-mail: mikebangs(a�verizon.net
MICHAEL L. BANGS,Attorney-at-Law WILLIAM E.MILLER,JR.
WENDY K.STRAUB,Paralegal Of Counsel
November 17, 2014
Lisa M. Grayson, Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
RE: Estate of Kermit W. Holler
File No. 21-14-0755
Dear Ms. Grayson:
Enclosed you will find Pennsylvania Inheritance Tax Information Notice and Taxpayer Response
documents that I file on behalf of Oneida Small, Selinda Homsey and Nedra Marshall.
Very truly yours,
Michael L. Bangs
wks
Enclosures
cc: Mr. Michael Homsey