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HomeMy WebLinkAbout04-24-15 (5) BUREAU OF INDIVIDUAL TAXESPenns Ivania Inheritance Tax pennsyLvanla PO BOX 280601 Y HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE _ r` ,q �-Ya er Res Or1Se RE�QR�� REV-1543 E^UocE�EL (0 �i �� �y p FILE N0.21 REGIISTH OF WILLS ACN 0129 DATE 04-14-2015 NIS PPR 29 PM 12 11 Type of Account I L E I� OF Estate of MILDRED A JEZ Savings O R P j-j A i4 S' C HtT SSN Checking ,,r. r Date of Death 03-22-2015 Trust LINDA A SMELTZ 'CUMBEi?k-F,''v � '� County CUMBERLAND Certificate 4 WHEATLAND DR MECHANICSBURG PA 17050-1600 MEMBERS IST FCU 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.12629 Remit Payment and Forms to: Date Established 10-20-1971 REGISTER OF WILLS Account Balance $9,458.35 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $4,729.18 Tax Rate X 0.045 Potential Tax Due $ 0.045 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 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. B F-1 The information is The above information is correct, no deductions are being taken,and payment will be sent correct. with my response. Proceed to Step 2 on reverse. Do not check any other boxes. C F�The tax rate is incorrect. F—] 4.5% 1 am a lineal beneficiary(parent,child,grandchild, etc.)of the deceased. (Select correct tax rate at right,and complete Part 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. Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax E 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 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 If you are making_.p correction to the establishment date(Line 1)account balance(Line 2),or percent taxable(Line 3), please 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"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,please state Official Use Only ❑AAF I your relationship to the decedent: PA Department of Revenue 1. Date Established 1 2. Account Balance 2 $ PAD 3. Percent Taxable 3 X 1 4. Amount Subject to Tax 4 $ 3 5. Debts and Deductions 5 - 4 6. Amount Taxable 6 $ 5 7. Tax Rate 7 X 6 8. Tax Due 8 $ 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. Work Q. Home y L 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 BUREAU OF INDIVIDUAL TAXESPenns Ivania Inheritance Tax "? pennsyLVanla PO BOX 280601 Y HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE And Taxpayer Response REV-1563 EX D-EXEC (08-12) 51 RECORDOFFICE OF ACN 1151FILE 21 20130 ECISTEI; nF W111 DATE 04-14-2015 ?015 PPR 29 Pn 12 10 Type of Account LEt,y CFEstate of MILDRED A JEZ Savings C O PC/a a S, SSN Checking C C I,Date of Death 03-22-2015 Trust LINDA A SMELTZ C(Jf, Qt �f t .h County CUMBERLAND Certificate 4 WHEATLAND DR t C`. . MECHANICSBURG PA 17050-1600 MEMBERS 1ST FCU 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.12629 Remit Payment and Forms to: Date Established 10-20-1971 REGISTER OF WILLS Account Balance $4,000.23 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $2,000.12 Tax Rate X 0.045 Potential Tax Due $90.01 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 F�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 F]The information is The above information is correct, no deductions are being taken,and payment will be sent correct. with my response. Proceed to Step 2 on reverse. Do not check any other boxes. C F�The tax rate is incorrect. F—] 4.5% 1 am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased. (Select correct tax rate at 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 NAsset 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 Debts and Deductions Allowable debts and deductions must meet both ofthe following criteria: A. The decedent was legally responsible for payment,and the estate is insufficient topay 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 iorequired,you may attach O1/2^x11^sheets of paper.) Deko Paid Payee Description Amount Paid Total (Enter on Line 5 of Tax Calculation) . $ PA Tax Calculation If you are making a correction tmthe establishment date(Line t)account balance(Line 2).wrpercent taxable(Line 3), please obtain a written correction from the financial institution and attach it to this lorm. 1. Enter the date the account was established ortitled oedexisted otthe date ofdeath. 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 iataxable 0oyou. o. First,determine the percentage owned bythe decedent. L Accounts that are held"intrust for"another or others were 100%owned by the decedent. ii. For established more than one year prior 0othe date ofdeath,the percentagetaxable ia180%divided bythe total number ofowners including the decedent. (For example:2owners=5O%.3owners~33.33%.4owners ~26%.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 oyany debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject totax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. If indicating a different tax rate,please state Official Use Only [3 AAF your relationship to the decedent: PA Department of Revenue 2. Account Balance 2 $ PAD 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 $ 5. Debts and Deductions 5 - 4 Step 2: Sign and d��eba|ovv. Rotuml�VOunm completed nd�goedoo i to the Reg�torufVW||olisted onthe hnntofthis form, a|ong-withooheokhuranyp tyuuammehing. Checks must bemade payable to"Register ofWills,AgenL^ Donot send payment directly oothe 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 belief. BUREAU OF INDIVIDUAL TAXES Penns Ivania Inheritance Tax pennsyLvania PO BOX 280601 Y HARRISBURG PA 17128-0601 Information NoticeDEPARTMENT OF REVENUE i ' -- -- NEV-1543 EX DocE%EC (08-12) And Taxpayer Response FILE NO.21 -- IS- Sa S RECORD' D � �C Q ACN 15120131 F _ DATE 04-14-2015 Z0�5 PJPR Pfl �2 ?O Type of Account .L Estate of MILDRED A JEZ Savings C L 1=R j 0 r� SSN Checking Q R P H A�} , Date of Death 03-22-2015 Trust LINDA A SMELTZ (,)'_1 t=T County CUMBERLAND Certificate 4 WHEATLAND DR 'CUM8EPLfl MECHANICSBURG PA 17050-1600 E l MEMBERS 1sT FCU 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.12629 Remit Payment and Forms to: Date Established 10-04-2006 REGISTER OF WILLS Account Balance $39,060.45 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $ 19,530.23 Tax Rate X 0.045 Potential Tax Due $878.86 45NOTE': 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 Step 1 : Please check the appropriate boxes below. 1 A F-]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 u The information is The above information is correct, no deductions are being taken,and payment will be sent correct. with my response. Proceed to Step 2 on reverse. Do not check any other boxes. C F-]The tax rate is incorrect. F—] 4.5% 1 am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased. (Select correct tax rate at 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. EAsset 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 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 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), please 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"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,please state Official Use Only ❑AAF your relationship to the decedent: PA Department Of Revenue 1. Date Established 1 2. Account Balance 2 $ PAD 3. Percent Taxable 3 X 1 4. Amount Subject to Tax 4 $ 3 5. Debts and Deductions 5 - 4 6. Amount Taxable 6 $ 5 7. Tax Rate 7 X 6 1 7 8. Tax Due 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. Work Home Z 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 RECORDED OFFICE OF REGISTER Jian§e Tax Pennsylvania BUREAU OF INDIVIDUAL TAXES Pennsylvania YnWfl PO BOX 280601 DEPARTMENT OF REVENUE HARRISBURG PA 17128-0601 1015 pip ati I REV-1543 EX D-EXEC 2) A n d VX7 a y MUL.e FILE NO.21 — CLERIK ori ACN 15120132 DATE 04-14-2015 CUMBERL,V:,') , I A. Type of Account Estate of MILDRED A JEZ Savings SSN Checking Date of Death 03-22-2015 Trust LINDA A SMELTZ County CUMBERLAND X Certificate 4 WHEATLAND DR MECHANICSBURG PA 17050-1600 MEMBERS 1ST FCU 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.12629 Remit Payment and Forms to: Date Established 10-12-2013 REGISTER OF WILLS Account Balance $ 112,639.55 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $56,319.78 Tax Rate X 0.045 NOTE*: If tax payments are made within three months of the Potential Tax Due $2,534.39 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 Step 1 : Please check the appropriate boxes below. 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. B n The information is The above information is correct,no deductions are being taken,and payment will be sent correct. with my response. Proceed to Step 2 on reverse. Do not check any other boxes. C F—]The tax rate is incorrect. F-] 4.5% 1 am a lineal beneficiary(parent,child, grandchild,etc.)of the deceased. (Select correct tax rate at right, and complete Part � 12% 1 am a sibling of the deceased. 3 on reverse.) F-] 15% All other relationships(including none). D [—]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 set will be reported on Pt3 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 ofthe following criteria: A. The decedent was legally responsible for payment,and the estate isinsufficient topay the deductible items. B. You paid the debts after the death ofthe decedent and can furnish proof ofpayment ifrequested bythe 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) $ PA Tax Calculation �--�--� If you,are making m mmrmuotimn to the establishment dote(Line 1)account balance(Lime 2),mrpercent taxable(Line 3), please 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 ufthe account that imtaxable bzyou. a. First,determine the percentage owned bythe decedent. i Accounts that are held"intrust for"another nrothers were 100%owned bythe decedent. ii For established more than one year prior tothe date ofdeath,the percentage taxable io10U%divided bythe total number ofowners including the decedent. (For example:2owners=5D%' 3owners=33.33%.4owners =25Y6.etoj 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 nfany debts and deductions claimed from Part 2. G. 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 onyour relationship tothe decedent. If indicating a different tax rate, please state your relationship to the decedent: mw, KIE, 1. Date Established 2. Account Balance 111W -11 3. Percent Taxable 3 X KL 100 4. Amount Subject to Tax 14 WN 01 5. Debts and Deductions 5 6. Amount Taxable 6 $ J§1 ge 1-11W 1011 eo 7. Tax Rate 7 X Step 2: Sign and date below. Return TWO completed andsigned copies to the Register ofWills listed onthe front ofthis form, along with acheck for any payment youaremaking. Checks must bomade payable to"Register ofWills,AganL^ Donot send payment directly tothe 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 belief. r ' O OR O rt no v � o00 " i LL O J o 1 i NNQ �0 0 �I f v7 1 • Cr.a I N O '7 6 1 �t o ` o v A O bti� a I; I r t j C a � , z