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HomeMy WebLinkAbout04-24-15 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 NO. CD 020569 KILEY MARY ELLEN 104 LITTLE RUN ROAD CAMP HILL, PA 17011 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold __________ -------- 15120842 $104.16 ESTATE INFORMATION: SSN: 15120843 5976.29 FILE NUMBER: 2115-0180 DECEDENT NAME: BROSNAN MAVIS DATE OF PAYMENT: 04/24/2015 POSTMARK DATE: 04/24/2015 COUNTY: CUMBERLAND DATE OF DEATH: 01/18/2015 TOTAL AMOUNT PAID: $1 ,080.45 REMARKS: CHECK# 295 INITIALS: DB1 SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXESPenns Ivania Inheritance TaxI ` pennsytvania PO BOX 280601 y HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE REV-"I E%.-ETEC M-121 And Taxpayer Response FILE NO.2115-0180 RECOR LED OFFICE OF ACN 15120843 REGISTER C c VVILILS I DATE 04-17-2015 M5 PH 29 Type of Account C!f: K OF Estate of MAVIS C BROSNAN Savings O R P H A I`�ISSN Checking �' U�l� Date of Death 01-18-2015 Trust MARY E K I L EYC O M D IE_ i_r,;�R; County CUMBERLAND Certificate 104 LITTLE RUN RD CAMP HILL PA 17011-2000 METRO BANK 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.7760432695 Remit Payment and Forms to: Date Established 08-06-2009 REGISTER OF WILLS Account Balance $45,674.49 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $22,837.25 Tax Rate X 0.150 Potential Tax Due $ 0.150 59 NOTE*: If tax payments are made within three months of the 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 F�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 Dde. BE]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 FV The tax rate is incorrect. 94.5% 1 am a lineal beneficiary (parent,child,grandchild, etc.)of the deceased. (Select correct tax rate at right, and complete Part F—I 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 2 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 11,account balance(Line2),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"intrust 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 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 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 indicatinga different tax rate lease s ate. P I�ov y � .l� S your relationship to the decedent: —i 1 � \� \ 0 v. 1. Date Established 1 92 e 2. Account Balance 2 $ 4 66 7 4 I —� 11 A 3. Percent Taxable 3 X 5 d o� � 6�w� o �� 4. Amount Subject to Tax 4 $ 2 g 3 : 5. Debts and Deductions 5 t; � "yv 20, 6. Amount Taxable 6 $ Z Z g 37 A A �A\ a R �_�� A 7. Tax Rate 7 X .©` 8. Tax Due 8 $ 10 -7 &g �� u 11, \ \ �� @�. o V V o ` o f 9. With 5%Discount(Tax x .95) 9 X cJ 7fo.��I :. �� .. ..o:..d o �....:.: o..._ 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 Home Taxpay6 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 BUREAU INDIVIDUAL TAXES 28 PO BOX 260601 7 Pennsylvania Inheritance Tax DennSJ lvania e r HARRISBURG PA' 17128-0601 Information Notice i DEPARTMENT OF REVENUE And Taxpayer Response REV-1543 Ex D..EXE`(08-12) RECORDED OFFICE OF FILE NO.2115-0180 ACN 15120842 REGISTER C F WILLS DATE 04-17-2015 HIS PPR 29 FM 11 57 Type of Account C LE `y O F Estate of MAVIS C BROSNAN Savings ,r �, •- SSN X Checking C `c,'"H ti'�is I Date of Death 01-18-2015 Trust MARY E KIC&4bEtl'_r',fd,i r' 3, County CUMBERLAND Certificate 104 LITTLE RUN RD CAMP HILL PA 17011-2000 METRO BANK 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.537855033 Remit Payment and Forms to: Date Established 06-01-2009 REGISTER OF WILLS Account Balance $4,873.12 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $2,436.56 Tax Rate X 0.150 Potential Tax Due $365.48 NOTE': If tax payments are made within three months of the 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 F-]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. B0 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 ®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 12% 1 am a sibling of the deceased. 3 on reverse.) 15% All other relationships (including none). D F�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 ����� � ����m�� ���� ���~ �������ns Allowable debts and deductions must meet both ofthe following criteria: A. The decedent was legally responsible for payment,and the estate ioinsufficient kupay the deductible items. B. You ai�dlhedebts after the death of the decedent and can furnish proof ofpayment ifrequested by the department. (If additional space^' —isrequircd�youmay attach 81/2^x11^sheets ofpaper.) ` Date Paid Payee ' DescriptionAmount Paid Total (Enter on Line 5 of Tax Calculation) $ Tax Calculation If or percent taxable(Un3)` please obtain=written correction from the financial institution and attach ummthis form. 1. Enter the date the account was established or titled asdexisted at the date of death. 2. Enter the total balance ufthe account including any interest accrued o1 the date of death. 3. Enter the percentage odthe account that iotaxable 0oyou. a. First,determine the percentage owned bythe decedent. i Accounts that are held"intrust for"another or others were 100%owned by the decedent. ii. For established more than one year prior 0mthe date ofdeath,the percentagetaxable ia1U0%divided bythe total number ofowners including the decedent. (For example:2owners=5U%.3owners~33.33%.4owners ~25%.eto.) b. Next, divide the decedent's percentage wmnadbythenumbarofourvivingownenoorbeneKoimies. . 4. The amount subject!otax iodetermined bymultiplying the account balance bythe-percent taxable. . 5. Enter the total ofany debts and deductions claimed from Part 2: G. The amount taxable iodetermined bysubtracting the debts and deductions from the amount outj ` ' ax. 7. Enter the appropriate tax rate from Step 1 based onyour relationship 0othe dooedor�� If indicating a different tax rate,please state your relationship to the decedent: Official Use Only 0 AAF PA Department of Revenue 1. Date Established 2. Account Balance 2 $ 17, PAD" 5. Debts and Deductions 5 4 7. Tax Rate 7 X Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Willslisted onthe front ofthis form, along with ucheck for any payment you are making. Checks must bemade payable 0o"Register ofWills,Agent^ Donot send payment directly to the Department ofRevenue. 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 ob «� TaxpayMBignature 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 ti 1 rn C'> F... CO r"3 ri F.�. _r: -;C� Q E ta? -- •:r1 Crs y� A itZ 'iS�M M