HomeMy WebLinkAbout05-11-15 (2) COMMONWEALTH OF PENNSYLVANIA - REV-1162 EX01-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG,PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 020648
MATTER LEROY R
3 BOXWOOD LANE
CAMP HILL, PA 1 701 1-7501
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
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__________ --------
101 $926.11
ESTATE INFORMATION: SSN:
FILE NUMBER: 2115-0339
DECEDENT NAME: MATTER CECILE G
DATE OF PAYMENT: 05/12/2015
POSTMARK DATE: 05/11/2015
COUNTY: CUMBERLAND
DATE OF DEATH: 02/12/2015
TOTAL AMOUNT PAID: $926.11
REMARKS:
CHECK# 5532
INITIALS: DB1
SEAL RECEIVED BY: LISA M. GRAYSON, ESQ.
REGISTER OF WILLS
REGISTER OF WILLS
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
crn
� � n
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)gbr percent taxebIMLine 3),
please obtain a written correction from the financial institution and attach it to this form. o
1. Enter the date the account was established or titled as it existed at the date of death. `'
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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 indicating a different tax rate,pleas state Official Use Only [IAAF
your relationship to the decedent: ,AV PA Department of Revenue
1. Date Established 1
2. Account Balance 2 $ ,Z/. 6-7 5'v PAD
3. Percent Taxable 3 X
4. Amount Subject to Tax 4 $ 2
�6
3
5. Debts and Deductions 5 - 4 t
6. Amount Taxable 6 $ l 440"3• f> 5f
7. Tax Rate 7 X O, 6 j
8. Tax Due 8 $ �"7 r
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 of my knowledge and
belief.
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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