HomeMy WebLinkAbout11-19-14 � .,,,,
BUREAIJ oF INOIVIDUAL TAXES Pennsylvania inheritance Tax � � � pennsylvania
PO BOX 280601
HARRISBURG PA 17128-0601 I11fOrlllat1011 NOtIC2 DEPARTMENT OF REVENUE
And Taxpayer Response RE�-15`3 EX oa`EXE` `oe-`Z�
FILE NO.2114-0751
ACN 14155748
DATE 10-09-2014
Type of Account
Estate of ELAINE J KAUFMANSCHILLER Savings
Checking
Date of Death 07-18-2014 X Trust
DAVID KAUFMAN County CUMBERLAND Certificate
465 GRANDON WAY
MECHANICSBUR6 PA 17050-9171
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CITIZENS BANK oF PENNSYLVANIA provided the department with the informatipr�:bel- indi�a#i�g that at
the death of the above-named decedent you were a joint owner or beneficiary�f ttie a�ount-id�ntified.
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Remit Payment and Forms to: r– ��'�
Account No.6214400521 �--� cn c�
Date Established 07-05-2006 REGISTER OF WILLS � �
Account Balance $3,749.24 1 COURTHOUSE SQUARE
CARLISLE PA 17013
Percent Taxable X 100
Amount Subject to Tax $3,749.24
Tax Rate X 0.150
Potential Tax Due $562.39 NOTE`: If tax payments are made within three months of the
decedenYs 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 fo Step 2 on reverse. Do not check any other boxes and disregard the amounf
shown above as Potential Tax Due.
g �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% I am a lineal beneficiary{parent,child,grandchild, etc.)of the deceased.
(Select correct tax rate at
right, and complete Part � 12% I am a sibling of the deceased.
3 on reverse.)
� 15% All other relationships (including none).
p �Changes or deductions The information above is incorrect and/or debts and deductions were paid.
listed. Comp/ete 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. y
PART Debts and Deductions
2
Aliowable debts and deductions must meet both of the foliowing 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 tf�e fiinancial 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 estabiished more than one year prior to the date of death,the percentage taxable is 100%divided
by the total number of owners inciuding the decedent. (For example:2 owners=50°/a, 3 owners=33.33%,4 owners
=25%,etc.)
b. Next, divide the decedenYs 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.
� - ��;� � ���"� �� ,,�. .�;�..,� z ��;_
If indicating a different tax rate, please state ��,� �� �;�
your relationship to the decedent: � ��� ,;
1. Date Established 1 ��� ��
� <� _ �
2. Account Balance 2 $ ��,�� �� �- `
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3_ Percent Taxable 3 X
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4. Amount Subject to Tax 4 $ ` � � ��a� � ��
�����v ry����. �,
5. Debts and Deductions 5 - ��� � �� �' � " �� �����
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6. Amount Taxable 6 $ � �� �`��" �'""
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7. Tax Ra.te 7 X �� . ��.:
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8. Tax Due 8 $ � �, �� � � ���
�z�� �,` �^��-,* � � . ��;.�
9. With 5%Discount(Tax x .95) 9 X <������,��,�,����,� ,�x� ���� ��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.
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Taxpayer Si 'ature 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
BOR�,o oF INDIVIDUAL TAXES Pennsylvania lnheritance Tax � pennsylvania
PO BOX 280601 DEPARTMENT OFREVENUE
HARRISBURG PA 17128-0601 Information Notice
And Taxpayer Response ` REV4543 EX DocE%EC �oa-�z�
FILE NO.2114-0751
ACN 14156101
DATE 10-13-2014
Type of Account
Estate of ELAINE J KAUFMANSCHILLE Savings
X Checking
Date of Death 07-18-2014 Trust
** DAVID KAUFMAN County CUMBERLAND Certificate
965 GRANDON WAY
MECHANICSBURG PA 17050-9171 c7 c�
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CITIZENS BANK oF PENNSYLVANIA 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.
Remit Payment and Forms to:
Account No.6239705474
Date Established 08-14-2013 REGISTER OF WILLS
Account Balance $23,522.69 1 COURTHOUSE S(�UARE
Percent Taxable X 100 CARLISLE PA 17013
Amount Subject to Tax $23,522.69
Tax Rate X 0.150
Potential Tax Due $3,528.40 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 I am the parent of a decedent who was
21 years old or younger at date of death.
Proceed fo Step 2 on reverse. Do not check any other boxes and disregard the amounf
shown above as Potentia/Tax Due.
g �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% I am a lineal beneficiary(parent,child, grandchild,etc.) of the deceased.
(Select correct tax rate at
right, and complete Part � 12% I am a sibling of the deceased.
3 on reverse.)
� 15% All other relationships (including none).
p �Changes or deductions The information above is incorrect and/or debts and deductions were paid.
listed. Comp/ete 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 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 decedenYs 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.
�` ���� ��� ��� ������ �A��� �
If indicating a different tax rate, please state �V" \\ � �� � � �� ��� �\��\
��\� �' ��
your relationship to the decedent: ������� �`� � � �� ������ �� � ����
1. Date Established 1 ������ \ \
2. Account Balance 2 $ \�
������\�\ �
���������� . � .
����\
3. Percent Taxable 3 X ������� �
����
��� �_ .
������� . �
4. Amount Subject to Tax 4 $ �A���� � � ���� ���„ „ � �
5. Debts and Deductions 5 - `�`���'\���`�`�\ \�� \ ����\\\��\\ . \�
���A\��� �� � ��fi�
��`\\�\�\ �� ����.�'�� �� � :. O��
6. Amount Taxable 6 $ �A����a� � � S `\�`
\�\\� ��� � �. � \���
7. Tax Rate 7 X \��\� � \\\ �\
����\�\�\�\ ������ ��\��, ��
8. Tax Due 8 $ ��\�\������ �
� ��
���\� ����\�\\��� \\\ � ���\
� ��A���� ��� � �� \v
9. With 5% Uiscount(Tax x .95) 9 �`�`�`�:��������������o�������u������������o��������� �������������.������u�� ��� ���a���;
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.
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Taxpayer 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
_ __ __
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BUREAU OF INDIVIDUAL TAXES � � � enns Lvania
Po Box Z8o6o� Pennsylvania inheritance Tax � , p y
HARRISBURG PA 17128-0601 IIIfOCIllc�t1011 NOtICe ` DEPARTMENT OF REVENUE
And Taxpayer Response RE�-15`3 EX oo`EXE` `08-12�
FILE NO.2114-0751
ACN 14156102
DATE 10-13-2014
Type of Account
Estate of ELAINE J KAUFMANSCHILLE Savings
Checking
Date of Death 07-18-2014 Trust
DAVID KAUFMAN County CUMBERLAND Certificate
965 GRANDON WAY �'�
MECHANICSBURG PA 17050-9171 n ���
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CITIZENS BANK aF PENNSYLVANIA 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.
Remit Payment and Forms to:
Account No.6261791437
Date Established 08-14-2013 REGISTER OF WILLS
Account Balance $5,000.78 1 COURTHOUSE S�UARE
Percent Taxable X 100 CARLISLE PA 17013
Amount Subject to Tax $5,000.78
Tax Rate X 0.150
Potential Tax Due NOTE*: If tax payments are made within three months of the
$750.12 decedenYs 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 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.
g �The information is The above information is correct, no deductions are being taken,and payment will be sent
correct. with my response.
Proceed to Srep 2 on reverse. Da not check any other boxes.
C �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 � �2qo I am a sibling of the deceased.
3 on reverse.)
� 15% All other relationships (including none).
p �Changes or deductions The information above is incorrect and/or debts and deductions were paid.
listed. Comp/ete 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. ( ,
_,j�
(
Please sign and date the back of the form when finished. �J
PART Debts and Deductions
2
Ailowable 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 t�rate, piease state �' � �r"� ����� ''� �`��
your relationship to the decedent: ���'_., �
1. Date Established 1 ,�` :
2. Account Balance 2 $
3. Percent Taxable 3 X
4. Amount Subject to Tax 4 $ � "
5. Debts and Deductions 5 - ��y c�
6. Amount Taxable 6 � -
7. Tax Rate 7 X � � �`���� '�
�� �� �r�� �,���- ���, 4'
8. Tax Due 8 $ �������� ..�� �..;"
.:- s
9. With 5% Discount(Tax x .95) 9 X e ;��� '�� ��� �� �� ,
.,.. .., .;� ��.a��r,x .:���'... '�.. �. .,:�� .,.,.,,., :.F:�
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 directiy 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.
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Ta�cpayer Si nature 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: 1-8Q0-447-3020
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