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Home My WebLink About05-13-15 COMMOMNEaLirv OF FCNNSVLVANIA PEV-1162 EH111-B61 FrME NL OF P[V ENUE dUPEAU OFINONI�IIPLTiXES i 280fi01 HPPP152lIFG,�P1]128 Ofi�1 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFlCIAL RECEIPT NO. CD 020659 FOUST BUDD 506 WEST MAIN STREET MECHANICSBURG, PA 17055 ACN ASSESSMENT AMOUNT CONTROL NUMBER ---- --- 15125123 � $244.71 ESTATE INFORMATION: SSN: � FILE NUMBER: 211 5-�534 � oeCEDErvr NaMe: LAIRD CHRISTOPHER P I DATEOFPAYMENT: 05/13/2015 � POSTMARK DATE: OB/13/2015 � courvrv: CUMBERLAND I DATE OFDEATH: 02/05/2013 � TOTAL AMOUNT PAID: 5244.71 REMARKS: CHECK# 1202 INITIALS: CJ sEA� RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS a��^� �F ��^� �^xEs Pennsylvania lnheritance Tax 6:�j ��':' PennSY�Vdflla YOB�% 000601 ji� oEPAPTMENTOFPEVENOE HARRISBOR6 PA 1]130�0601 Information Notice And Taxpa er Response - � RECO ¢C-''; �. � !:��OF Fi�eNo.zi -iS-C',�'� �`„I„__'. ACN 15125123 � � 'U_� DATE o5-0&2015 2015 l�flY 13 F�I 1 54 rypeO�q a � � �� Esta�e of CHFISTOPH P LAIRD Savings Qn� �� -.�- Checking � � Date of Death 02-05-2013 Tmst BU�D A FOUST �� COun�yCUMBERLAN� CehifiCa�e APT H 310 VAIRO BLVD STATE COLLEGE PA 16803-2838 n s T BANK provided Ihe 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. Remit Payment and Forms to: ACCounINo.9846602358 Date Establishetl 07-01-2008 REGISTER OF WILLS AccountBalance $3,262.73 � COURTHOUSES�IIARE Percent Taeable X 50 CARLISLE PA 17013 Amoun[Sublect�oTax $1,631.37 Tax Rate X 0.150 Po�en�ial Tax Due $pqq,7� NOTE': If tax paymen�s are made within three months of the decedent's date of death,deduct a 5 percent discount on Ihe tax With 5%DiscouM(Taa x 0.95) $(see NOTE') due. Any inheri[ance tax due will become delinquent nine months afterthe date ofdeath. PART StEP 1 : Please check the appropriate boxes below. 1 A �No tax is due. I am the spouse ot the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceetl to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. g �The information is The above information is correct, no deduc[ions are being taken,and payment will be sen� carrect. with my respanse. Proceed to Step 2 on reverse. Do nof check any other boxes. p �The�ax rale is inCorrecL � 0.5% I am a lineal beneficiary (parent, Child,9randChild, etC.)Of the deCeased. (Selecicorrecttax ra�e at right,and complete Pah � �p/ I am a sibling of the tleceasetl. 3 on reverse.) � 15% All other relationships (Including none). p �Changes or deduclions The inbrmation ahove is incorrec�and/or de6ts and deductions were paid. listed. Complete Part 2 and part 3 as appropriate on the back ol this lorm. E �Asse[will be reported on The above-iden�ified asset has been ar will be repotled and�a<paid with the PA Inheritance Tax inheri[ance tax brm Re�um�iled by the estate representa�ive. FEV-1500. Proceetl ro 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�he estale is insWficien�to pay the deduc�ible i[ems. B. You paitl the debts after ihe death of ihe decedent and can fumish proof of payment if requested hy the department. Q(additional space is required, you may attach 8 V2"x 11'sheets of paper.) Da[e Paid Payee Descrip�ion Amount Paid To[al (Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 tl ou are makin a correction to the establishment date Line 1 account baiance Line 2 ,or y g ( ) ( � percent�axable(Line 3), please ob�ain a written correction irom ihe financial instilution antl attacn it to�hls form. L Enter lhe da�e�he account was eslablished or titled as it existed at�he date of death. 2. Enter Ihe�o�al balance of the accoun[including any interest acemed at the date of tleath. 3. Emer the percentage of Ihe accoun�tha� is taxable to you. a. First,determine ihe percentage owned by ihe decedent. '. Accounts that are heltl"in imst for"another or others were 100%owned by ihe decedent. ii. For joint accounts eslablished more than one year prior to the date ot death,the percentage tacable is 100%divided by the mtal number of owners including the decedent (For example:2 owners=50%,3 owners=33.33%,4 owners =25%,etc.) b. Next,divide the decedenfs percentage owned by ihe number of surviving owners or beneficiaries. 4. The amount subject to tau is delermined by mWtiplying ihe account balance by the percent taxable. 5. Enter the�otal of any dehts and deductions claimed Gom Patl 2. 6. The amount�axable is determined by subimcting Ihe deb�s antl deductions�rom the amount subject to tax. 7. Enter ihe appropriate tax rate irom Step 1 based on your relationship to the decedent. It indicating a di�ferent�ax rate,please state �� (��ja��(�� . . your rela�ionship m the decedent . ,;.� •„;,�,��,��QE..��e ` 7�.�,y: 1. Date Established 1 � ' z Account Balance 2 S PAfl�� r '�� 3. PercentTaxable 3 X ��, , � �. � # `�.. 4sM�9 a. Amount Subjec�m 7ax 4 S 3 � ' �s�r�� 5. Debis and Deductions 5 - ,� �x � „ ,�, � 6. AmountTaxable 6 $ 5� �, �.,s�'� ]. Tax Rate 7 � �'r�'' ; �� s �� e. Tax Due g $ ? � �� t �� $ _-; r . .-�.s x �=<. �y�. � 9. With 5%Discount(Tax x .95) 9 X St@P 2: Sign and date below. ReNrn TWO comple[ed and signed copies�o Ihe Register of Wilis 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,AgenC' Do no[send paymentdirectlytothe Depatlmento�Revenue. Under penalty of perjury, I declare ihat the facts I have reported abave are hue,correct and complete[o the best of my knowledge and belief. Work "3"'� d�"/� Home F,/�i 3�-6�7� Taxpayer Signature Telephone Number Date g f_��_� �� 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 . . � �; � � � � - ; � � � � _a ., T � � T � � � G � 1+ , �� Y' ^ µ' >' � 1 �II � s IJ " S � T �- � � r � � c � r � C M = G s'� `� -� � = r ., -x �, = � � '� -� � e i - � t = r � _ .� P t,� _ � j�; = . _' .. . . :`:':9Pi�� _ --. �_.. .;?;7ilda0 � Y � 1 _ .�:;� .-�:�� 3) _ hS i Wd £T h8W SiCi � R�� / ( _ �ir: _.;,;;�a � .3 •;� _ �o �oia� .:�;aoo3a � •� : . � o� ��