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Home My WebLink About05-11-15 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX�11-96) DEPARTMENT OFREVENUE BUREAU OF INDIVIDUALTAXES DEPT.280601 HARRISBURG,PA 1 7 1 28-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 020642 FORAN DAVID M 317 ERDMAN DRIVE DAUPHIN, PA 17018 ACN ASSESSMENT AMOUNT CONTROL NUMBER ""__" fald """___' _____"' 15502370 � 5440.05 ESTATE INFORMATION: ssN: � � FILE NUMBER: 211 5-0246 � DECEDENT NAME: FORAN NORMAN F � DATE OF PAYMENT: 05/1 1/201 5 � POSTMARK DATE: 05/07/201 5 � courvTY: CUMBERLAND � DATE OF DEATH: 02/20/2015 � � TOTAL AMOUNT PAID: 5440.05 REMARKS: CHECK# 118 INITIALS: HMW SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS ��rin�_,_i,i .T�.�, , �:��?�� pennsylvania BUREAU oF INDIVIDUAL TAXES Pennsylvania �nheritance Tax , �� PO BOX 280601 ``�� DEPARTMENT OF REVENUE HARRISBURG PA 17128-0601 Information Notiee �� REV-15438 ex m�exee eos-iz� And Taxpayer Response FILE NO.2115-0246 ACN 15502370 DATE 03-27-2015 Type of Account Estate of NORMAN F FORAN Security SSN 168-24-9041 X SEC Acct Date of 2015 Stock DAVID M FORAN County CUMBERLAND Bonds 317 ERDMAN DR DAUPHIN PA 17018-9360 r-� �� G'> u"�—� � tZl c � rb"� n WELLS FARGO ADVISORS provided the department with the information below indicatin�tt�+t at the�eat�� of the above-named decedent you were a joint owner or beneficiary of the account idera��fi�i.c� � ��' �� Remit Payment and Forms to: " `' � ``" Account No.3344 ` '- . Date Established REGISTER OF WILLS �a, ' 1 COURTHOUSE SGIUARE - � � . Account Balance $20,586.96 CARLISLE PA 17013 �`-' Percent Taxable X 50 t� t t`", a_ c Amount Subject to Tax $ 10,293.48 . t'� � Tax Rate X 0.045 NOTE"`: If tax payments are made within three months of the Potential Tax Due $46321 decedenYs 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 other boxes and disregard the amount shown above as Potential Tax Due. g u i ne infiormation is ' The above information is correct, no c�eductions are being taken,and paymeni will be sent correct. with my response. Proceed fo Step 2 on reverse. Do not check any other boxes. C �The tax rate is incorrect. d 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 debts and deductions were paid. listed. Comp/ete 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 tvc 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 c�ate the back of the form when finished. \ �� .F�,,�,,,��. _,�-,�, 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 Tax Calculation 3 If you are making a correction to the establishment date Line 1 account balance Line 2 or ( ) ( ), percent taxable(Line 3), __ �rlQase 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 � ;�� \��\\� � � \� \��p�\ �� \�\\��\\��\��\\��\� your relationship to the decedent: \\ \� �� \ � �� ,,, �� \�\�� \�� o�� a 1. Date Established 1 �� \ ��\ �A� �� , � � \ �� A�� A V\VA \�\�� `° ��p��A�� V\�A�� V��\��\�� 2. ACCOUnt BalanCe 2 $ �� y\�yv\\vy�yv�\��A��y��\y��\V��y��y��y�� \�o �� A\� �o��A�V��A��` ��A�A�A��o�V�\\��V�. 3. Percent Taxable 3 X „��V�� \A�\ A�V�V�V\�� \ ��V�. ��`��\�VAV��AV��AV��A\��\\V�\V��\V`\\\\\�� o�� V A ��A��`V��\V`�\\��A�u�o��A 4. Amount Subject to Tax 4 $ �� `��`��"° �� " � �� A��AV �� o��A\\\V��\\��AA��A��V`��V��A\��A\��ti` �o�\�� 5. D2btS 1f1C.� �@CrUCtIOnS 5 - ��A�\ \\� � � �� \V\ \��AVA`��\�`A�A��AV��A\� ��AV��A�`��A\\��\\��\�� V� �A�� 6. AI'T10Uflt TaX8fJI8 6 $ \�� `A�"� � `� °�� A�� A� ��A��\�V`\��\��\��\��`��A��`V��A\��\��A\�� \ �`��` V �\\ \\��\VA�A�\\� ��\��\V��V�� 7. Tax Rate X � �� \� � �\`\��`��`�`��A��A \\\��\\\�A��`��O �A�� `,` � A\�\�� o\��A�A�A� ��O\��\��\��A��A\�� V\� � 8. T� Due g $ �� A\� \A��AAV��\`�\��\VA�A\V �\\ �\\��\\\�Ay\V��\\� ��` ��\��\��\��o��\\�� o �� A�� A\\\�� \� A�� 9. W Itfl �J/o �I SCOU flt�T1X X .9 rJ� 9 X ��Am��V ��yV� �`��o��\�p�`\��A\\OVcAV\ti`\��AA��A\��5\\�Ah0�� V AV\\V� 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 fo y payment you are making. Checks must be made payable to"Register of Wills,Agent." Do not send payment d' c y to e epartment of Revenue. Under enalt per' ry, I declare that the facts I have reported above are true,correct and complete to the best of my knowledge and belief Work 'Ir7�7v?!gL•OU "��f�1J f�l� �1�1� �►r Home �i�� /-�� `l S�b �ol� a ignature 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 �� '�� . ��. {�� _ ��r.l .,j �i�y - �, .«c F � � `- � � � :.�; 4"4 � � •'"'.-� �� •�- '� '�� ,,,'.� � i �,F. :..+ A r �� P iv;� � ..r �G Cal w\,^\ '"=- �� h�y� � \ r .� / . f ~+ � �� #;} ^ �f � J :� �:; ��. 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