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Home My WebLink About02-26-15 REV-1162 EX(11-96) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 17128-0601 PENNSYLVAN�A RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 020290 PATRICIA MATTHEWS 1316 FENWICK DR HARRISBURG, PA 17110 ACN ASSESSMENT AMOUNT CONTROL NUMBER ---------- -------- fald 15107075 � $1 1 ,000.00 ESTATE INFORMATION: ssN: 20�- -ss3s I FILE NUMBER: 211 5-021 8 � DECEDENT NAME: FULK PAUL F I DATE OF PAYMENT: 02/26/201 5 � POSTMARK DATE: 02/26/201 5 � CouNTY: CUMBERLAND � DATE OF DEATH: 05/28/2014 � � TOTAL AMOUNT PAID: 511 ,000.00 REMARKS: RECEIPT TO ATTY CHECK# 542 INITIALS: HMW SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS �� , -, �� BUREAU OF INDIVIDUAL TAXES �� P��✓ �� Pennsylvania lnheritance Tax �� PO BOX 280601 Information Notice DEPARTMENT OF REVENUE HARRTSBURG PA 17128-0601 REY-1543 EX UocE%EC coe-iz� And Taxpayer Response FILE NO.21 - /�- !�2/� ACN 15107075 DATE 02-09-2015 Type of Account Estate of PAUL F FULK Savings SSN 207-07-8838 X Checking Date of Death 05-28-2014 Trust PATRICIA A MATTHEWS County CUMBERLAND Certificate 1316 FENWICK DR HARRISBURG PA 17110 � .:> C"'� `"=A �7 c:- � �--� ;:�`�� t-r� ' -� r7 i'� �� r,.� ..a c�� .,,.3 .. Q7 '-,7 _ , ,., » P�:..'_' f`� r o ,., �,,, �, 1 _ : :� i} � i � ..�:3 ��: PNc BANK NA provided the department with the information below indicating that at the death of ths� : = �;� above-named decedent you were a joint owner or beneficiary of the account identified. y , Remit Payment and Forms to: � �, Account No.5003548445 Date Established 06-17-2003 REGISTER OF WILLS Account Balance $22,083.54 1 COURTHOUSE SGIUARE CARLISLE PA 17013 Percent Taxable X 50 Amount Subject to Tax $11,041.77 Tax Ra[e X 0.045 NOTE`: If tax payments are made within three months of the Potential Tax Due $496•88 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. y 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 drsregard fhe amount shown above as Potential Tax Due. g �The information is The above information is correct,no deductions are being taken,and payment wiil be sent correct. with my response. Proceed to Step 2 on reverse. Do not check any afher 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 � y 2% 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 fhe back of fhis 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 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 Caiculation $ 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 firom the firianciai institution and attach it to this form. 1. Enter the date the account was estabiished 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 flffiCiai Use Ot�ly ❑AAF your relationship to the decedent: PA DepaYtmet3t Of RBveCwe 1. Date Established 1 2. Account Balance 2 � P�D 3. Percent Taxable 3 X 2 4. Amount Subject to Tax 4 $ � 5. Debts and Deductions 5 - 4 6. Amount Taxable 6 $ � ? Tax Rate 7 X 6 8. Tax Due 8 $ 7 8 9. With 5%Discount(Tax x .95) 9 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 ot my knowledge and belief. � - Work �I �- ��3��-(�S'7 t� � �� .�C-c�–_-�— Home �x�135 �-��(v-I 5 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