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Home My WebLink About01-30-15 BUREAU OF INDIVIDUAL TAXES Pennsylvania lnheritance Tax � pennS�/LVll11d PO BOX 280601 DEPARTMENT OF REVENUE HARRISBUR6 PA 17126-0601 Information Notice - -- -� REV-1543 EX DocE%EL (DB-12) And Taxpayer Response FILE NO.2114-1134 ACN 14168447 DATE 12-25-2014 Type of Account Estate of VIVIAN M KEENER Savings X Checking Date of Death 09-27-2014 Trust NANCY L PUGLISSE CountyCUMBERLAND Certificate 4029 CAISSONS CT ENOLA PA 17025-1492 ,�� C� ,-� , ... � c+-- �;,,,,Q.s..__....t r.J. Q � ;.> C� "• -�3 � � '"�j .a.-- °`� �� ,;'? � ', 1�+'1 �.'1 -- , _ �_- ,_1 METRO BANK provided the department with the information below indicating th�at�t�.tfie c�th of t�i.e above-named decedent you were a joint owner or beneficiary of the account identified. ..,--, -, :'.:�! Remit Payment and Forms ta ��1 � •. `�� Account No.536847643 ~ �� Date Established 01-27-2005 REGISTER OF WILLS , �. �� Account Balance $5,746.39 1 COURTHOUSE SGIUARE :: � CARLISLE PA 17013 Percent Taxable X 50 Amount Subject to Tax $2,873.20 Tax Rate X 0.150 Potential Tax Due $430.98 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 other 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 response. Proceed to Step 2 on reverse. Do not check any other boxes. � �he 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. \ 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 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. If indicating a different tax rate, please state �� \ � ��\�� c\��' � � \�� your relationship to the decedent: � \ �� `\��`�� \��s��; �� \�� 1. Date Established 1 \\��,�\��\��\\��\\��,�� ;��,: 2. Account Balance 2 $ �3��\��`\\�\� ��\�� `��S��o��0\��h �� \��`�\��\��\��\��o\�\`�\�� \ \��a 3. Percent Taxable 3 X �� „� �\ �� \` �� \ �.�� \ � \ �� :<.. ��\\\� � �\\\��o� ��\ \��\\��\,��\y� \c\�� \��`�� \\��\��oy\�\\��\\\.:: �\��\��\��o� Z�\��\`� 4. Amount Subject to Tax 4 $ ��`��;��"� ��` `�` "`� �� u �`°\�\�\��\��\�\��\`�\\�\\�\��\��\��z�`�\�\� �� \ ��\�� \ � \\�\\��\��\�\\O\\��\��\��\ J�. �EbtS df1C� �@C�UCtI011S �'J ' �u �AV��VA��A�o��V��VA��A� \\ \\��A � �y�� A�� \V��*��V��\�� `�V�V��`�� 6. Amount Taxable 6 $ �� ` � ��` "' �� o��\��VA�,��A\, � ��V�V�V�\\�A��\\\�� ` � � 7. Tax Rate 7 X �� V��yv�� `��o��`��y��O��o��y��°��y�V\��y�� , � �� A A��@\VA�\��\��A�� A � ��\ �� - ��V� � \�� O� �� s�V��\\�\�� $. TBJC �U@ 8 $ �� .�A V� A��A��.�A\��o��V�A��\�� - ��\o�AAAAA\��VA��V��A� ��A� � "��VA A�A VA� ��A�A\�� \\\\\ ��\\�� a\\��\� ��\�\�\��\�\\\��\ ��\\�� 9. With 5% Discount Tax x .95 9 �� X �\\\\�oo��.�a.��\��a��:��O�\��\\v.�.:..o��o..:a�o�\�� ..�,.:� a�\�\�..,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. � _ Work � _ Hom ?/� `737-3/�3/ �l-D - 2D/ Taxpay Signat 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 JAN L. BROWN BL ASSOCIATES ATTORNEYS AND COUNSELORS AT LAW JAN L. BROWN,ESQUIRE BRENDA F. KEPHART,LEGAL ASSISTANT JACQUELINE A. KELLY,ESQUIRE .TUDITH A. EBERSOLE,ADMINISTRATNE ASSISTANT CHRISTA M. APLIN,ESQUIRE MELISSA L. SMITH,LEGAL ASSISTANT January 28, 2015 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Vivian M. Keener, deceased State File No. 2114-1134 SSN: 181-14-6708 To Whom It May Concern: Enclosed please find for filing two (2) Pennsylvania lnheritance Tax Information Notice and Taxpayer Responses for the Estate of Vivian M. Keener for Metro Bank Account No. 536847643. Please time stamp and return our file copy of this document. If you have any questions, feel free to contact this office. Sincerely, ,, �,__ _ � ,, ��;�� 1 ;� � Christa M. Aplin CMA/mis Enclosures �.� c.� c;; � rc.t ....,� _ .. c� .`::° � � _ :: d�,_ ._,. r`� (, � �'^, ;, � ...�_ , ..� .. 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