HomeMy WebLinkAbout04-23-15 COMM�MNFALTH OF PENNSYLV4NIA REV-1162 EXI�' S'o.
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RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 020559
POPLASKI HOLLY A
12 MORARI DRIVE
DILLSBURG, PA 17019
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
--- — --
15503154 � 5100.75
ESTATE INFORMATION: ssr�:
FILE NUMBER: 21 7 5-0223 �
DECEDENT NAME: BAHN ROBERT E I
DATEOFPAYMENT: 04/23/2015 I
POSTMARK DATE: O4/Z1/ZO15 �
couNrv: CUMBERLAND I
DATEOFDEATH: 02/14/2015 I
�
TOTAL AMOUNT PAID: 5100.75
REMARKS:
CHECK# 885
INITIALS: CJ
sEq� RECEIVED BY: LISA M. GRAYSON, ESQ.
REGISTER OF WILLS
FEGISTER OF WILLS
a�a�� oF :Ho���ow� *.xEs Pennsylvania lnheritance Tax �� ��� PennS�/LV8�118
ro eox zeoco� �� � oecaarnervroraevervue
xnearseoas w �nae-oso� Information Notice
� - And Taxpayer Response "�""• "'"�"""•"'
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R ,,.,.-� .� DATE04-20-2015
f����S'..._. ,�- '�il �S _ _
Type of Accoun�
'0?$ PPR 23 �?,I 1$s�or aoaeaT E snHN �se����ry
X SECAcct
�i �.� . - Date of Death 02442C15 Srock
HOLLY A POPLASKI pRP�{ � .,�J,�� ��'.' CountyCUMBERLAND Bonds
12 MORARI DR . �.
OILLSBORG PA 17019-1555 ��fh!^;.?' ! '�
JOHN HANCOCK ir+v 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.
Remit Payment and Forms to:
AccountNo.2040266
Date Established REGISTER OF WILLS
AccountBalance $11,783.55 1 WURTHOUSES�UARE
Percent Taxable X 20 CARLISLE PA 17013
Amount Subject to T� $2,356.71
Tax Ra�e X 0.045 NOTP: If tax paymen�s are made within three mon�hs of Ihe
Potential T� Due $106A5 decedenPs date of death,deduct a 5 percent discount on the tax
With 5%Discoun�(Tax x 095) $(see NOTE') �(7(�.'7 5 due. Any inheri[ance�ax due will berome delinquent nine mon�hs
afterthe date ofdeath.
PART St2P 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 nof check any ofher boxes and disregard the amount
�ho�.vn above ac oofentiel ,T.;v Due_
g �The information is The above informa�ion is wrrect, no deduclions are being taken,and payment will be sene
correc�. with my respanse.
Proceed to Step 2 on reverse. Do no(check any ofher 6oxes.
p �The tax rale is incorrecL � 4.5% I am a lineal beneficiary(parent child. grandchild, etc.)of Ihe deceased.
(Select correct tax rate at
right,and complete Part � �p/ I am a sibling of ihe deceased.
3 on reverse.)
� 15% All other rela[ianships(including none).
p �Changes or deductions The informa�ion above is incorred and/or debts and deductions were paid.
listed. Complete Part 2 and part 3 as appropnate on the back o/this lorm.
E �Asset will be reported on The above-identified asse[has been or will be reported and t� paid with the PA Inheritance Tax
inheritance tax form Retum filed by the esta�e representative.
REV-1500. Proreed to Sfep 2 on reverse. Do not check any other boxes.
Please sign and date the back oi the form when finished.
PART Debts and Deductions
2
Allowahle deb�s and deductions must mee�both of[he following cri�eria:
A. The decedent was legalty responsible for payment,and the estate is insufficien�to pay[he deductible items.
B. Vou paid ihe debts after the death of ihe deceden[and can furnish proof of payment if requested by ihe depariment.
Qt additional space is required, you may at�ach 81/2"x 11"shee�s of paper.)
Da�e Paid Payee Description Amounl Paid
To�al (Enler on Line 5 0�Tax Calcula[ion $
P'4RT Tax Calculation
3 If ou are makin a correc[ion to Ihe establishment date Line 1 account balance Line 2 , or
y g ( ) ( ) percenttaxable(Line 3),
please obtain a written correction iram ihe tinancial institution and attach i[to ihis form.
L Enter the date ihe account was estahlished or titled as it existed at the date of death.
2 Enterthetotalbalance ofthe accountincluding anyinterestaccrued atthe date ofdeath.
3. En�er the percentage of�he account iha�is laxable�o you.
a Firs�,de�ermine the percentage ownetl by�he decedent.
'. Accounts�hat are heltl"in[mst for"another or others were�00%owned by ihe decedent.
ii. For joint accounts established more ihan one year prior to�he tlate of death. ihe percentage taxable is 100%divided
by Ihe total number of owners induding the decedent (For example:2 owners =50%, 3 owners=33.33%,4 owners
=25/, etc.)
b. Next, divide ihe decedenPs percentage owned by�he number of surviving owners or beneficiaries.
4. The amount subject ro tax is determined by multiplying ihe account balance by ihe percen[taxable.
5. En�er the total o�any debts and deductions claimetl Gom Pah 2.
6. The amoun�taxable is determined by sub�racting Ihe debts and deductions from the amounl subject to tax.
7. Enter ihe appropriate tax rate irom Step 1 based on your relationship to ihe decedent.
If indicatin9 a diHerent tax ra�e,please state . � (��y� (!�y��ly Q��
your relationship ro ihe decedent pA Department ot�ReYenue :�
1. Date Establishetl 1 r.:,, ,
2. Account 8alance 2 $ P����
3. PercentTaxable 3 x 2 �
4. Amount Subjec�to Tax 4 $ 3 .
S Debts and Deductions 5 - Q
6. Amoun[Taxable 6 S 5
7. Ta. Rate � X 6
8. Tav Due 8 $ �
8
9. WI�h 5%Dlscount(Tax x .95) 9 X �OD •��j .
.St@P 2: Sign and date below. Retum 7W0 completed and signed copies to the Regis[er oi 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,AgenC' Do no�send
payment directly ta the Departmen[of Revenue.
Under penalry of perjury, I declare Iha�[he facts I have reported above are(rue,correct and complete to the best of my knowledge and
belief.
�� �� � �� " �� Work -Ill- 7N1- 1�144
�'%�1 �� ��L�/Lc-c� Home �1r7-�#3'�- ioqy `��a'U /5
Taxpayer 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: i-800-447-3020
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