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Home My WebLink About01-13-15 COMMONWEALTH OF PENNSYWANIA REV-1162 EX�11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEP7.280601 HARRISBURG,PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 020122 GINGRICH WENDY 1 GREEN MEADOW DR CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold """""' ________ 14154792 � 543.75 ESTATE INFORMATION: ssN: I FILE NUMBER: 2115-0038 I DECEDENT NAME: SWARTZ ROBERT E I DATE OF PAYMENT: 01/1 3/201 5 I POSTMARK DATE: 01/1 O/201 5 � CouNTY: CUMBERLAND � DATE OF DEATH: 09/21/201 4 I � TOTAL AMOUNT PAID: 543.75 REMARKS: CHECK# 2252 INITIALS: HMW SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES Penns Ivania lnheritance Tax � s pennsylvania PO BOX 280601 Y HARRISBURG PA 17128-0601 IIIfOCCTI$t1011 NOtICe ? DEPARTMENT OF REVENUE �- -� � REV-1543 EX UocEXEt (OB-12) And Taxpayer Response FILE NO.21 ---J�•d� .3� ACN 14154792 DATE 10-03-2014 Type of Account Estate of ROBERT E SWARTZ Savings Checking Date of Death 09-21-2014 Trust WESTLY GINGRICH County CUMBERLAND X Certificate 1 GREEN MEADOW DRIVE CARLISLE PA 17013 ,� C `� � i'�r'i MEMBERS isr Fcu provided the department with the information below indica�g`�at at#�e d�tt�f the above-named decedent you were a joint owner or beneficiary of the account i�n�i . � �n �, �� ' t � w�, t�ra Remit Payment and Form�'fo : ��a N Account No. 199414 - ? �"� a . Date Established 04-30-2012 REGISTER OF WILLS , � ' ' —,� ' ��'q Account Balance $5,833.06 1 COURTHOUSE SQUAR�.-, ; ��,t � � -;y Percent Taxable X 16.667 CARLISLE PA 17013 : .°" '"" Amount Subject to Tax $972,20 ' N r= � --, i-•- Tax Rate X 0.045 '"�"� .,.� '�� Potential Tax Due $43.75 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 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 ofher boxes and disregard the amount 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 res�anse. 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. 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. -`�,Z 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 ob#ain a written corre�tion frar.a the financial institution ar�d attach it to this farrn, 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. If indicating a dif.ferent tax rate, please state \\ \\\\�\\�� `�� our relationshi to the decedent: � �� \\� �� `� Y P ��\� ��C�l�'��t�F�`��\\��\� 1. Date Established 1 � �� ,��;°��` ��\�� "� ��\�o��`��o��`�� \� �A\V� �� \��VA�\A�A VA\�v ��v v � �� Vv�A �A��V� ��V��V � `Z. ACCOUfIt B8I8f1C2 `Z $ ��A �AA � ��\� ��\\\��\\��V�V��V V�� '� ��\�� \O\��\ ��\ �Y��\��\\�\\\��\�� \�� \��\� ^ �� A A ��V AA� A�� A� �A��V��A��A�A�� 3. Percent Taxable 3 X �� \ �\\��\��\��\\�� \�\��::�� 4. Amount Sub'ect to Tax 4 $ �� J �� ... �� A �� a"�..�\\� ��\\\.., �.. :�� . .\o\\ .��„\��.��\\\.,\ 5. Debts and Deductions 5 - � �� . ��`�� \�� ,�\\\��\\\� \\\\ �7. AI'f10Utlt T8X8bI2 Fi $ ��o"" � ��` �� ' � ` � �� o �O :yi �� V��\��A�VA�� VA� AAAV�AVA�� V� ��\�� V��VA��A\ 1� X �� \ �A�A \�VA�� VA��VAV A� �� A A 7. TGIX R1te 7 �� v�\v �vvyvvy�vv ' v Vv� ��v� �� v� Vv �vyV��y��\v�� \� �\\\�� \� �`�0�� ` ��\�� \� � �� . � �� A�� 8. Tax Due 8 $ � ��`� ��\\�\\�\ OO\\�� \�\\��\��\ \��\\�\\�� 9. Wlt�'1 'rJ% �I$COl.11lt�I c1X X ..7J� 9 X �.��dA_..:��vo�ao�.�..;��A�a ._m� __....�. ��...:�.aoA� .AA��AA��Ay�oOoJvv��: 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 , � �,� Home I ��'- �-K"�S4 1 `� 1 S 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