HomeMy WebLinkAbout05-08-15 °°"�"° °° '"°'°'°'"� �^'ES Penns Ivania lnheritance Tax � � pennsylvania
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INkRISBIINGP> 1i126-0601 InformationNotice �EPAPTMENTOFFEVENOE
And Taxpayer Response •"."" `. °°"•" '°• "'
RECC � _-, . ,- ; „� CF Fi�eNo.zna-ozas
ACN i 5119958
�E� °�� �I'_I.j DATE0413-2015
�Ol� ��y $ �r � 20 TypeofAccount
�� Estate of ALBERT A WATTS Savings
�RPfi� -.r Checking
�� � Da�e of Death 02-2L2015 Tms�
ROBERT WAiTSSH �U�[�•[i ' � C,oun�yCUMBERLAN� CertifiCate
1610 ENOLA RD �
CARLISLE PA 1]013-6723
ORRSTOWN 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 ihe account identified.
Remit Payment and Forms to:
AccouniNo. 143000479
Date Establishetl 06-294004 REGISTER OF WILLS
Acrount Balance $9,888.09 1 COURTHOUSE SOUARE
PerceniTaxable %50 CARLISLE PA 77013
Amoun[Subjec��o Tax $4,944.05
Tax Rate X O.Oa5 NOTP: If tax payments are made within three monihs of the
Potential Tax Due $222.48 decedenfs date of death, deduct a 5 percent discoun�on the�ax
Wi�h 5%Discount(Tax x 0.95) $(see NOTE') due. Any inheritance�az due will become delinquen�nine monihs
aflerihe date otdeath.
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 ihe parent of a decedent who was
21 years old or younger at date of death.
Proceed to Sfep 2 on reverse. Oo not check any other boxes antl tlisregard the amount
shown above as Potential Tax Oue.
8 �The informa�ion is The above inlormation is correct, no deductions are being taken,and paymem will be sent
correc�. with myresponse.
P�oceed fo Sfep 2 on reverse. Do no(check any other boxes.
p �The tax rate is incorrecL � 4.5% I am a lineal beneficiary(parent,child,grantichild, etc.)of ihe deceased.
(Select correc�tax rate at
right,and complete Parl � 7 p� I am a sibling of Ihe deceased.
3 on reverse.)
� 15% All o�her rela�ionships (including none).
p �Changes or deductions The information above is incorrect antl/or debts and deductions were paitl.
listed. Complete Part 2 and part 3 as appropriafe on the back ol this lorm.
E �Asse�will be reported on The above-identified asset has been or will be reported and t�paid with ihe PA Inheritance Tax
inheri�ance tae form ReNm filed by�he esta�e representa�ive.
REV4 500. Proceed fo Step 2 on reveise. Do not check any other boxes. ^,
\X Please sign and date ihe back of the torm when finished. ,J
1, �r `
PART Debts and Deductions
2
Allowable tlebts and deductions must meet both of the following criteria:
A. The decedent was legally responsihle for payment,and ihe estate is insutticient to pay the deducti6le items.
B. Vou paid the debts aker the death of the decedent and can Wmish proof of payment it requested by the department.
Qf additional space is required,you may attach 8 1/2"x 11'sheets of paper.)
Date Paid Payee Description Amount Paid
Total En�er on Line 5 of Tax Calcula�ion $
PART Tax Calculation
3 Ii you are making a correction to ihe establishment date(Line 1)account balance(Line 2),or percent taxable(Line 3),
please obfain a wrinen correctlon from the financlal institution and attaz�it to this Porm.
L Enter the tlate the account was established or titled as it existed at the date of death.
2. En�er the total balance of�he accoun�inclutling any interest acemed a�the date of death.
3. Enter the percentage of the account�hat is taxable m you.
a. First.de�ermine�he percentage owned by�he deceden�.
i. Accoun(s(ha[are held"in trust for"another or athers were 100%owned by Ihe decedenl.
ii. Por joint accounts established more than one year prior ro the tlate of death,[he percentage tacable is 100%divided
by�he total number of owners including�he tlecedent (For example:2 owners=5�%, 3 owners=33.33%,4 owners
=25%.etc.)
b. Ne�R,divide the decedenPs percentage owned by ihe number of surviving owners or beneficiaries.
4. The amount subject to ta�c is determined by multiplyinq ihe account balance by ihe percent taxable.
5. En�er�he total o�any debts and deduc�ions daimed from Part 2.
6. The amount ta�cable is determined by subtracting the debts and deductions imm ihe amount subject to tax.
7. Enter the appropriate tax rate irom Step 1 based on your relationship�o�he decedent.
If intllcating a dlfterent tax rate,please s�ate �j�(Jgg����.�. ke;., 1�n �
your relationshlp to tha decedent: � _ {�k Bf1t � � BYBflIIf,��yv;`F�'"�� '
1. Date Establlshed 1 �' �. � ��„�' ,��f�s �'� '�. ,� ;�
2. Account Balance 2 $ ���.- ��', "—"'"�' a G
�` *��r.�r � . `��,.
3. Percent Taxable 3 X 2 �4��,�.w'-'"�`i"'"'v"���.ty;K` _ ,.,i t3,;,°,
4. Amoun�Subject to T� 4 $ 3 ' ?,,:� a,� �.�;�.An � r;y
5. Debts and Deductions 5 - 4 z�.��ry.an� q �t�� b;, �. tW -�""���' "
6. Amount7axable 6 $ �, ,.�_"'�
8�,�a �� � ,�*s
�. ra� aate � x 7..�.a .� ":..
8. TaxDue 8 $ �� A �� 4
�;'•"` ,�y#.#� � r- stae'&,a. � x,�
9. WithS%Discount(Taxx .95) 9 X . ,�.�_ --
.SteF1 2: Sign and date below. Return TY✓O completed antl signed copies to the Register of Wills listed on ihe imnt of this form,
along with a check for any payment you are making. Checks must be made payable to"Register of Wills,AgenC Do not send
payment directly to ihe Department of Revenue.
Under penalty of perjury, I declare tha[ihe facts I have reported above are true,correct and complete to the besl 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 777-787-8327. SERVICES FOR
TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-500-4473020