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Home My WebLink About03-02-15 � , , : pennsylvania BUREAU OF INDIVIDUAL TAXES Pef1C1SyIVallla Illllerlta�lC@ TaX ' DEPARTMENT OF REVENUE P� B�X 2806�1 Information Notice . .... RE�-,543a E%OocEXEC (OB-12> HARRISBURG PA 17128-0601 And Taxpayer Response FILE NO.2115-0076 ACN 15501146 DATE 02-18-2015 Type of Account Estate of MERRILL R BIVENS Security SSN 201-16-6003 X SEC Acct Date of Death 01-10-2015 Stock County CUMBERLAND Bonds ANNA B SCOTT 15 E EPPLEY DR CARLISLE PA 17015-4379 , ..:� C'�� n C�"1 ^"�'� (� lY �� : C? � i,� C,.> -� -�.a :� �� :�.� .,.. ..� _ i ., _ a _ � '. . ,. `,� � . .:7 . NEs rovided the department with the information below indicating thn�fae�the dea#��of the`i, EDWARD JO p above-named decedent you were a joint owner or beneficiary of the account i e ;.,? ��.7 Remit Payment and Forms to: �� Account No.5281386713 REGISTER OF WILLS Date Established 1 COURTHOUSE SGIUARE Account Balance $612,342.02 CARLISLE PA 17013 Percent Taxable X 100 Amount Subject to Tax $612,342.02 Tax Rate X 0.045 NOTE': If tax payments are made within three months of the Potential Tax Due $27,555.39 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 to Step 2 on reverse. Do not check any oiher boxes and disregard the amount Sh.,U�.,a►��.A as Pnfcntl8l T��8- g The information is The above inf n eation is correct, no deductions are being taken,and payment will be sent �correct. with my respo Proceed to Step 2 on reverse. Do no t c h e c k a n y o t h e r b o x e s. 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 de�b�ate o n the back of th's forl m. listed. Complete Part 2 and part 3 as app p E Asset will be reported on The ab f led b the estate epresentat�e ill be reported and tax paid with the PA Inheritance Tax �inheritance tax form Retu Y 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 s Tax Calculation 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 your relationship to the decedent: � °�� ° �. D \\�\��\\�\��\�� F � � O . �� \,,�� \\ � �� ate Established 1 �� `��`��,�� :� � � �� ti��`� � ��\�\�� \ � \ � � c� 2. Account Balance ^a�� \��`��a\��`��\��\�� '•' �u�� 2 $ ��\��\��\��\��\�� `\��u�� \\��\��Q�� d� � A 3. PefCent T1X3bl@ `� ��o��`�a�� . AV��\�s��\ `3 X `��\�\��r��V��A\�V�\�A�� \��:�\�`��`\ 4. ARIOUIIt SUbJBCt t0 T3X 4 ,$ �`'�`A��AV��`��\�\��\\��A�A��\`�\\�V��V ` �� ' �� A��\��\� � �� a� �� `�� 5. D@btS 3fld D@dUCtIOnS 5 - �'\�� c��\�A`��A��`�� ` �� :� 6. AfTI �a�� a�� AV��\\��VA��\��V�� \ . OU�f T8X8fJI8 ��VVA�� \o��V�� A`��`V\�� 6 $ �� A�Ao�� \ � � � z �� \��V�`�� `��V�\V��V��\�A�� 7. Tax Rate �� o�� \ � 7 � �; u��AA�\��:A��A�\�� V�V\� � � �--�c--..,-_„_ A � ��A\ �A�\��\��A��:A �. '�� VAAA o�� 3�� A�� p��: 8. T8x Due 8 $ �� ` �� •��`��\��V � � �� A�A Ao�� \\ �� A��VV��`��Ay��p��`�� \o � �� A�� • With 5% Discount(Tax x .95) 9 X �� ` `� �°��`��`��°` ,�„ �� a��\ �\� ��\., \��\��:�� \��\�\ �� \y� ��VA�V\�V��V�� AA �. ��.�� \\�\�..,�\�� \..��,��Z\�u��\��Y.��\�o\J�a�s�a��:�\�\��...a�.: Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wilis listed on th 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. e front of this form, Under penalty of perjury, I declare that the facts I have reported above are true,correct and complete to the best of my knowled e an belief. 9 d C� %3 W6��c- Home (�l'�� 2�{q-$212 Taxpayer Signature Telephone Number Date 2�-T�t S IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REV DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-7g7_8327. 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