HomeMy WebLinkAbout04-14-15 eoxewu or �xomow� rnaes Pennsylvania lnheritance Tax � pennsylvania
o eox zaoaoi '��'J OEPAPTMENTOFPEVENOE
NRRRISBORG PA lll3B-0601 Information Notice
And TaxPayer Response •���u"u�.����••-�_�
RECO DFD OF�ICE Of Fi�ENo.ziis-ons
ACN 15113391
REGI . . - S'lILLS onreo�-is-zois
2015 APR 14 q(� 10 32
Type of Accaunt
C L J( Estate of CHAFLES J MITCHELL Savings
ORPHd'� ( � "'�"r Checking
' ' Date of Deeth 02-07-2015 Tmst
CHARLES J MITCHELL CUMBEF� . �QounlyCUMBERLAND % Cetlificate
335 4TH 5T
NEW CUMBERLN� PA 17070-2120
MEM8ER5 isr 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.
Hemit Payment antl Forms to:
AccountNo.207629
Date Eslablished 10-1&2011 REGISTER OF WILLS
Accoun�Balance $3,277.06 � COURTHOUSE SQUARE
Percent Taxable X 50
CARLISLE PA 17013
Amount Sublect lo Tan $ 1,638.53
Tax Ra�e X 0.045
Potential Tax Due $73.73 NOTP: If�ax payments are made within three mon[hs of�he
decedenfs date of death,deduc�a 5 percen�discount on�he[aa
With 5%Discount(T�x 0.95) $(see NOTE') tlue. Any inheritance tax tlue will become delinquent nine months
afterthe date ofdeath.
PApT StBP 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 Po Sfep 2 on reverse. Do nof check any other boxes and disregard the amounf
5hown above as POfentiai Tar DUe.
g �7he information is The above information is correcL. no deduc[ions are being taken, antl payment will be sent
correc�. with my respanse.
Proceed to Step 2 on reverse. Do not check any other boxes.
� �The tax rate is incorrect � 4.5% I am a lineal bene�iciary(parent,child, grandchild, e�c.)of�he deceased.
(Select corred tax rate at
right, antl complete Pan � �p� i am a sihling of ihe deceased.
3 on reverse.)
� 15% All other relationships (including nane).
p �Changes or deductions The information above is incorrect and/or deb�s and deductions were paid.
listed. Complete Part 2 and part 3 as appropnate on the 6ack ol this lorm.
E �X Asset will be reported on The above-identified asset has been or will 6e reported and t� paid with ihe PA Inheritance Tax
inheritance tax torm Return filed 6y the esta[e 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 debis and deductions must meet both of the following criteria:
A. The deceden[was legally responsible for payment,and the estate is insufficient ro pay the tletluctible items.
B. Vou paid ihe debts after the death of ihe decedent and can furnish proof of payment if requesled by Ihe department.
(If adtlitional 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 Ii you are making a correction to the esWblishme�rt date(Line 1)account balance(Line 2),or percent taxable(Line 3),
please obtain a written correc�ion irom the financial institution and aHach it to ihis torm.
1. Enter the date the account was established or titled as it ezisted at the date of death.
2 Enter the btal balance of ihe account including any interest accrued at ihe date of death.
3. Enter the percentage of the account that is taxable to you.
a. First,de�ermine�he percen�age owned by lhe decedent.
i. Accounts Ihat are held"in hust for"another or others were 100%owned by ihe decedent.
ii. For joint accounts established more than one year prior to the tlate of tleath,ihe percentage tv�able is 100%divided
by ihe total number of owners includin9 ihe decedenL (For example:2 owners=50%, 3 owners=33.33%,4 owners
=25%,etc.)
b. Next,divide the decedenPs percentage owned by the num6er of survivin9 owners or beneficiaries.
4. The amount subject to tax is determined by multiplying ihe aceount balance by the percent taxable.
5. Enter the total of any debis antl deductions claimed fmm Part 2.
6. The amount taxable is delermined by suhtracting the debis and deduc�ions fmm the amoun�subject to tax.
Z Enter the appropria�e[ax ra�e fmm Step 1 based on your rela�ionship to�he deceden�.
I�indicating a diHeren�tax ra�e, please state �py� �gg� qpp
your relationship ro the decedent: ��PaIlme�t O�p2Y2��¢����.,
1. Date Established 1
2. Accouniealance 2 S �Afl���
3. Percent Taxable 3 X j
4. Amount Subject to Tax 4 $ 3
5. Deb�s and Deduc�ions 5 - ¢ �$�,.;
fi. Amount Taxable 6 $ �.
7. Tae flate 7 X � —
e. TaY Due 8 $ � i-
9. With5%Discount(Taxx .95) 9 x . . . ..
St2P 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on ihe front of ihis form,
along with a check for any payment you are making. Checks must be made payable�o"Register of Wills,Agent" Do not sentl
payment directly to the Depatlment of Revenue.
Under penalry of perjury, I declare that the facts I have repohed above are irue,correct and complete to the best of my knowledge and
belief.
/ � Wo� 717-779-7435
�G��)�,��.q6S$f� Home ��rJ/��
Taxpayer Signature d J. Shekletski, asc�elephone 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