HomeMy WebLinkAbout04-24-15 BUREAU INDIVIDUAL TAXES
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PO BOX 280601 Pennsylvania Inheritance TaxI
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HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE
REV-1543 EX OocE%EC (08-12)
And Taxpayer Response FILE NO.2115-0043
RECORDEI OFFICE OF ACN 15121653
REGISTEi, C-7 WILLS DATE 04-23-2015
MIS APR 24 PM 12 14.
Type of Account
C L F I,K OF Estate of CARLO G BROCCOLO Savings
R R R � �J. l�r T SSN Checking
Date of Death 01-06-2015 Trust
** MARIA G BROCCOLO CUMBEi,CL '; (`lA County CUMBERLAND X Certificate
139 BRINDLE RD
MECHANICSBURG PA 17055-9515
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.7700183365 Remit Payment and Forms to:
Date Established 07-12-2014 REGISTER OF WILLS
Account Balance $ 107,033.54 1 COURTHOUSE SQUARE
Percent Taxable X100
CARLISLE PA 17013
Amount Subject to Tax $107,033.54
Tax Rate X 0.150
Potential Tax Due $ 0.150 .03 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
1 Step 1 : Please check the appropriate boxes below.
A r-]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.
B F1The information is The above information is correct, no deductions are being taken,and payment will be sent
correct. with my response.
Proce 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 V`—'
right, and complete Part F-] 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 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|arequired,you may attach 81/2^x11^sheets ofpapor.)
Date Paid Payee Description Amount Paid
Total(Enter on Line 5 of Tax Calculation) $
PART Tax Calculation
�--�—� If you are making correction to the establishment account balance(Line 2)'orpercent taxable(Line 3).
please obtain awritten correction from the financial institution and attach ittothis form.
1. Enter the date the account was established or titled as it existed at the date of death.
2. Enter the total balance ofthe account including any interest accrued et the date ofdeath.
3. Enter the percentage m4the account that iutaxable toyou.
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 Vothe date nfdeath,the percentagetaxable io1OD%divided
bythe total number o/owners including the decedent. (For example:2owners=5O%, 3owners=3333%'4owners
=25%.eto.)
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 ofany debts and deductions claimed from Part 2.
8. The amount taxable iadetermined bysubtracting the debts and deductions from the amount subject totax.
7. Enter the appropriate tax rate from Step 1 based onyour relationship 0othe decedent.
If indicating a different tax rate,please state 4
your relationship to the decedent:
nu
2. Account Balance 2 $
ISE-
3. Percent Taxable 3 X 4" v-
4. Amount Subject to Tax 4 $
41
5. Debts and Deductions
6. Amount/ - -
Step 2: Sign and date below. Return TWO completed signed copies to the Register cdWills listed onthe front ufthis form,
along with acheck for any payment you are making. Checks must be made payable to"Register of Wills,AgenL^ Donot send
payment directly hothe 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
bo||n/.
Work
Taxpayer Signature 8ign[turG Te|ephone Number Date