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Home My WebLink About01-23-15 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 020152 DUPLICATE SCHAEFER LUCILLE 325 WESLEY DR APT 3108 MECHANICSBURG, PA 17055 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- told __________ -------- 15003182 $387.25 ESTATE INFORMATION: SSN: FILE NUMBER: 2115-0077 DECEDENT NAME: SCHAEFER BARTON T DATE OF PAYMENT: 01/23/2015 POSTMARK DATE: 01/20/2015 COUNTY: CUMBERLAND DATE OF DEATH: 11/20/2014 TOTAL AMOUNT PAID: $387.25 REMARKS: CHECK# 1476 INITIALS: DMB SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL�jfS�rj r1 LOFFICE y I pennsylvania PO Box 280601 I- enn$ Ivania Inheritance Tax �I DEPARTMENT OF REVENUE-12) HARRISBURG PA 17128-0fft GI S-�'E�� OF Vy I�. Information Notice QtICe 1 And Taxpayer Response REV-1543 EX OocE%EC (U8-12) FILE NO.21 -- 15 - -77 3 �y ACN 15003182 DATE 01-19-2015 CLER`t: U 1 0 R p H A tf C,0 ,YRT Type of Account CUMBEF' - ` " Estate of BARTON T SCHAEFER Savings SSN X Checking Date of Death 11-20-2014 Trust LUCILLE K SCHAEFER County CUMBERLAND Certificate APT 3108 325 WESLEY DR MECHANICSBURG PA 17055-3501 PNC BANK NA 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.5000978829 Remit Payment and Forms to: Date Established 03-06-2008 REGISTER OF WILLS Account Balance $18,116.71 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $9,058.36 Tax Rate X 0.045 Potential Tax Due $ 0.045 NOTE': If tax payments are mad ' ' onths of the decedent's date of death,deduct a 5 percent ount on the tax With 5% Discount(Tax x 0.95) $(see NOTE') due. Any inheritance tax due will eco a inquent nine months after the date of death. PART Step 1 : Please check the appropriate boxes below. 1 AF-]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 0 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 F-]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 F�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 Allowable debts and deductions must meet both ofthe 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 iarequired,you may attach 81/2^x11''sheets ofpaporj Date Paid Payee Description Amount Paid Total (Enter on Line 5 of Tax Calculation) $ PA 7-ax Calculation If you are making ocorrection bothe 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 ofthe account that iutaxable toyou. u. First,determine the percentage owned bythe decedent. L Accounts that are held"intrust for"another or others were 100%owned by the decedent. ii. For established more than one year prior iothe date ofdeath,the percentagetaxable|o10O%divided bythe total number ofowners including the decedent. (For example:2owners~5O%,3owners=33.33%. 4owners =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 cfany 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 1based onyour relationship 8othe decedent. If indicating a different tax rate,please state Cl your relationship to the decedent: en 2. Account Balance 2 $ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 $ or N 6. Amount Taxable 6 $ Ar wa Step 2: Sign and date below. Return TWO completed andsigned copies to the Register ofWills|\oiod onthe front ofthis form, along with acheck for any payment you are making. Checks must bnmade payable tu"Register ofWills, AQenC^ Donot send payment directly Vothe 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 Taxpayer Signature uD �JL� ,/ 0 Jl Telephone Number � Date ' E325CI ille Schaefer esley Dr.,Apt.3108 H�f�R �€3U G ' A 3_l� �""""�w �i 1 T fhanicsburg,PA 17055 711 USA LL C.'QA.S'o� Iia.. o tJ t 3 ,.�.•........ 4�ll,tlllll#€lIlli.'11�'}��:ltf�f��i�tIII'lillll'Illitiipsi�is't,�t,�