HomeMy WebLinkAbout04-23-15 (2) qEV-`-62E%f1� PPi
COMMOA W EALTH 0=PENNSYLVANIA
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RECEIVED FROM: INHERITANCE AND ESTATE TAX
oFFicin� aeceiPr NO. CD 020559
POPLASKI HOLLY A
12 MORARI DRIVE
DILLSBURG, PA 17019
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
----- -
a 15503154 � S100J5
ESTATE INFORMATION: 55N�. 19&24-155�
FILE NUMBER: 2115-0223 I
oeCeoervT NnmE: BAHN ROBERT E I
DATEOFPAYMENT: 04/23/Z015 I
POSTMARK DATE: 04/21/2015 �
cauNTv: CUMBERLAND I
DATEOFDEATH: 02��4�ZO'IS I
�
TOTAL AMOUNT PAID: S 100.75
REMARKS:
CHECKti 885
INITIALS: CJ
sEA� RECEIVED BY: LISA M. GRAYSON, ESQ.
REGISTER OF WILLS
REGISTER OF WILLS
auuv,u oF �Hvmoun� *<xcs Pennsylvania lnheritanceTax �`.j �(-�N pennSy�Van�a
ao eax zaosm 1.�
INRftISBIIR6 V< V120-0601 �nfQ�ma��n �y�t�(Je � �EVPfi1ME�NTOFflEVENOE
� � And Taxpayer Response "
RLE NO. 2115-0223
ACN 15503154
R .,._� �_-, onreoa-zo-zois
R[GI�� _ ,= ,��:LLS
rYPe oi Account
?01$ PPR 23 R(I 1$s�`�oraoeeaTeaaHN �se���ay
SSN 93-24d557 SECAcct
�! �_�.� . ���� Date of Death 02-142015 Stock
HOLLV A POPLASKI ORP�� ,,i�,,,� �� CountyCUMBERLAND Bonds
12 MORARI OR . .
DILLSBURG PA 17019-1555 ������C' ; �� -
JOHN xnNcocc inv provided the department with the information below indicating that at the death of the
above-named deceden[you were a joint owner or beneficiary of the account identified.
Remit Payment and Forms to:
Account No.2040266
Date Es�ablished REGISTER OF WILLS
Account Balance $ 11 J83.55 1 COURTHOUSE SOUARE
CARLISLE PA 17013
Percent Taxable X 20
Amount Subject b Tax $2,356.71
Tax Ra�e X 0.045 NOTE': If�ax paymen[s are made wi[hin Ihree months of�he
Potential Ta< Due $106.05 tlecedenCs date of dea[h, deduct a 5 percent discount on the tac
With 5% Discount(Tax x 0.95) $(see NOTE') �(�.Z 5 due. Any inheritance tax due will become delinquent nine months
after ihe da[e of death.
PART S1EP 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.
Pmceed to Step 2 on reverse. Do not check any other boxes antl disregartl the amount
eho:v.^ateve as Pore^tial T:r Due.
g �The informa�ion is The above inbrmation is mrrect, no deduc[ions are being taken, antl payment will be sent
rorrect. wi�h my response.
Proceed ro Step 2 on reverse. Do not check any other boxes.
p �The taz rete is incorrec[. � 4.5% I am a lineal beneficiary (parent,child,grandchild,etc.)of�he deceased.
(Seled correct lax rate at
righ�,and comple�e Part � �p� I am a sibling of Ihe deceased.
3 on reverse.)
� 15% All other relationshlps (ncluding none).
p �Chanqes or deductions The informa[ion above is incorrect and/or debts and deductions were paid.
listed. Complefe Part 2 and part 3 as appropriate on the back of this lonn.
E �Asset will be repotled on The above-identified asset has been or will be reported and tax paid wi[h Ihe PA Inheritance Tax
inheritance tax form ReWm tiled by ihe estate represen[ative.
REV4 500. Proceed to Sfep 2 on reverse. Do nof check any other boxes.
Please sign and date the back of the form when finished.
PART Debts and Deductions
2
Allowable debts and deductions mus� mee�both o�the following criteria:
A The decedent was legally responsible for payment, and the estate is insuNicient to pay the deductible items.
6. You paid the debts after the death of the decedent and can furnish pmof of payment if requested by the department.
(If additional space is required,you may attach 8 V2"x 11"sheets of paper.)
Date Paid Payee Description Amount Paid
Total (Enter on Line 5 of Tax Calculation $
PART Tax Calculation
3 If ou are makin a correction to ihe esWblishment date Line 1 account balance Line 2 ,or
y g ( ) ( ) percent taxable(Line 3),
please obtain a writlen correction from the financial institution and attach it to this torm.
1. En�er the tlate the accouN was established or titled as i�exis�ed al�he date of dea�h.
2 Enter ihe total balance of the account including any interest accrued at ihe date of death.
3. Enter�he percentage o�the account that is�axable to you.
a First,determine�he percen�age owned by the decedent.
i. Accounis ihat are held"in imst for"another or others were 100%owned by the decedent.
ii. For joint accoun�s established more[han one year prior[o Ihe da�e of death,the percentage taxable is 100%divided
6y�he total number of owners including the decedenL (For example:2 owners=50%,3 owners=33.33%, 4 owners
=25 0,etc.)
b. Next,divide the tlecedenCs percentage owned by the number of surviving owners or beneficiaries.
4. The amoun[subject to tax is determined by mWtiplying the account balance by the percent taxable.
5. Enter[he total of any debis and deductions claimed from Part 2.
6. The amount taxable is determined by subiracting ihe debis and deductions irom ihe amount subject to tax.
Z Enter the appmpria�e tax ra�e from Step 1 based on your relationship to the tlecetlent.
It indicating a tlifferent tax rate, please sta�e OfflCi3(Use Ck11�:[[JA/1F
your relationship to the decedenY. P� pe
1. DateEstablished 1 PaKmet�flf�CY2ItUB .�.
2. Account Balance 2 $ PAD
3. PercentTaxable 3 X 2
4. Amount Subject to 7ax a $ 3 :
5. Debts and Deductions 5 - q �
6. Amoun(Tauable 6 $ 5 —��
�. Tax Fate Y 6
8. Tax Due 8 $ � �
$
s. wan s% olscount(rzx x .ss) s X I 00��(S � � �
$t2p 2: Sign and date below. ReWm TYJO completed and signed copies ro the Feqister of Wills lis�ed on ihe front of this form..
along with a check for any payment you are making. Checks must be made payable to"Regis�er of Wills, AgenL" Do not send
payment direcity to ihe Deparlment of Revenue.
Under penalry of perjury. I declare that the facts I have reporled above are tme, correc[and complete co the best of my knowledge and
belief.
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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: 1-800-447-3020
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