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Home My WebLink About03-27-15 a�AE^� �F �"��^� �"'Es Pennsylvania lnheritance Tax �� PennS�/LV8r118 PO BO% 180601 • � OEPPPTMENT OF PEVENOE �uxa�seuec rn v�ze-osm Iniormation Notice And Taxpayer Response ��-�_�� .�"�� •-�_� FILE NO.2114-0914 acti i ssoz2i a DATE 03-24-2015 Type of Account Estpa{te of EUGENE H HERTZ Security R[�ORO.EbdFF�:oCe�Oioeemos�oa-2aia stock�� CVNTHIA A POOLE �,_�ISTE�� F ' �Ca�+tYCUMBERLAND Bonds 4379 GREEN PARK UR MOUNT JOY PA 17552-8890 '.�i5 �Infl �7 °f '_ ` 4 c_� : �; o�r��,r,t:s' c: CLM_":'' .. , " : VAN6UAkU provided the department wi[h the information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identitied. Account No.57788071376455 Remi�Payment and Forms�o: Oa�e Established REGISTER OF WILLS Account Balance $26,536.37 � COURTHOUSE SOUARE CARLISLE PA 17013 Percent Taxable X 100 Amount Subjed b Tax $26,536.37 Tax Ra�e X 0.045 NOTP: I�tax payments are made wi�hin three mon�hs of lhe Polential T� Due $ 1,194.14 decedenYs date of dea�h,deduct a 5 perrent discount on the�ax Wi�h 5% Discoun�(Tax x 0.95) $(see NOTE') due. Any inheri�ance�ax due will become delinquen�nine monihs afler�he date a�death. PARr $tBP 1 : Please check the appropriate boxes below. i 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. Pmceed ro Sfep 2 on reverse. Do not check any other boxes antl disre9ard the amounf �hown 3hovc ae Po!=ntial Tax Oue. g �The informalion is The above information is correc�, no deductions are being taken,and paymenl will be sent correct. with my response. Proceed to Sfep 2 on reverse. Do not check any other boxes. p �The tax rate is incorrecL � 45% I am a lineal beneficiary(parent,child,grandchild, etc.)of the deceased. (Select correct tax rate at riqht, and complete Part � �p/ I am a sibling o�the deceased. 3 on reverse.) � 15/ All other relationships(including none). p �Changes or tleductions The informalion above is incorrect and/or debis and deductions were paid. listed. Complete Part 2 and part 3 as appropriafe on the 6ack ol this lorm. E �Asset will be reported on The above-identified asset has been or will be reported and tau paid with the PA Inheritance Tax nheritance�an form Re�um filed by�he esla�e representa�ive. REV-1500. Proceed m Step 2 on reverse. Do not check any other boxes. � a Please sign and date the back of the form when finished. PART Debts and Deductions 2 Allowable debis and deductions must meet both of ihe following criteria: A. The decedent was legally responsible for payment,and the estate is insufficient ro pay the deductible items. B. Vou paid the debts afler the death of the deceden�and can fumish pmot of payment if requested by the department. Qt additional space is required, you may a[tach 8 V2"x 11"sheets of paper.) Date Paid Payee Descrip�ion Amount Paid Total Enter on Line 5 ot Tax Calculation) $ PART Tax Calculation 3 If you are making a correction�o�he esWblishment date(Line 1)account balance(Line 2),or percent taxable(Line 3), please obtain a written correction from the financial institution antl attach it to this torm. L Enter the date the accoun[was established or titled as it existed at the date of death. 2 Enter ihe total balance of the account induding any in[erest accmed at ihe date of death. 3. Enter Ihe percentage of the account ihal is taxable to you. a. First,de�ermine�he percentage ownetl by�he deceden�. i. Accounts that are held"in�msl for"ano�her or others were 100%owned by the tlecedent. ii. For joint accounts es[ablished more ihan one year prior to the date of death,ihe percentage taxable is 100%divided by the�otal number o�owners includinq the decedenL (For example:2 owners = 50%,3 owners=33.33%, 4 owners =26%.etc.) b. Nex�,divide Ihe decedenYs percen�age owned by the number of surviving owners or beneficiaries. 4. The amount subjec��o tax is tletermined by mul�iplying the accoun�balance by�he percenl taxable. 5. Enter the total of any debts and deduc�ions claimed from Part 2 � 6. The amoun�taxable is de�ermined by subhacting the tlebts and deductions from the amount sublect to tax. Z En�er�he appropriate tax ra�e fmm Slep 1 based on your relationship b�he decedent. If indicating a diffe�ent�ax rate,please s�ate �(��yy� �e�� your relationship to ihe decedent 1� t. Date Established 1 .,�°"� ,� PA DCpartm�J�. .�t�e�e��.` :��, `-, 2 Account 8alance 2 $ QAfl� � � � � � � �a �� . 4�� 3. Percent Taxable 3 X x ,� �,,:4,�, ,. ,,. 2 ^ 4. Amoun�Subjecl to Tax 4 $ .3 ; � �,.,..V . � �. 5. Debts and Deductions 5 - 4 � :�"' x r, �:�" . 6. AmountTaxable 6 $ � �_ t 7. Tax Ra�e 7 X � �, - .,i, 3 { 8. Tax Due g $ $ `: ,�, � �� 4 � 9. With 5%Discount(Tax x .95) 9 X . , „ryn,: „ �.. StBP 2: Sign and da�e below. Return TWO completed and signed copies to Ihe Register of Wills listed on the front ot this form, along with a check for any payment you are making. Checks must be made payable to"Register of Wilis, Agent." Do not send payment directly to the Department of Revenue. Under penalry of perjury, I dedare ihat the facts I have reported above are irue,correct and complete to ihe best of my knowledge and belief. „ �-/ �/ WOrk l.Glr�l./'�Cn . Gt � �� Home �1�- -�G� '�.�5 � Taxpayer Signature Telephone Number Date 3-a J-�5 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 _.. .. ___. . , "`'°�`,� � �; ; i � 3 � �ts RECORCED GrFICE OF' � �� RFf, ^r� Y'LLS. — p , ,f; �,�15 f?cB 27 °f1 12 34 �! � ��' i ��_ :P � ORP;I, . -- _ ,' .� COM9E, ,;� _ z = � �. _ a. J� _ r_, y = u: �� — v a: � " �;, � `- - 'L � < � - 3 j 1n J Q f�r - LT' G _ .t; - L/7 �— "' j � — � 5 � o � � � � 'I f—' � i7:, �n � h � � i (�� ll.— '_ �J .. . i v � ,1 � �� r /Y � T_ .- n =�� -1' � � � :�1 M o �� 5 �