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Home My WebLink About05-26-15 qEV-1162 EXII t561 COMMONWEPLTH OF PENNSVLVANIR �EPAPTMENi OF PEVENUE OVFEAO OF INOIVIol1PL TA%ES �EPi.480801 nnr+a�seoac,Pn n�%eosoi pENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 020717 MCCAULEY KAREN D 52916TH STREET NEW CUMBERLAND, PA 17070 ACN ASSESSMENT AMOUNT CONTROL NUMBER ----- -�-- � ,e1e 101 � 579.22 ESTATE INFORMATION: sSN: I FILE NUMBER: 2� 15-OZ66 I DECEDENTNAME: STRAUSBAUGH RUTH M I DATEOFPAYMENT: 05/26/2015 I POSTMAFK DATE: 05/21/2015 I couNrv: CUMBERLAND � DATE OF DEATH: 12/14/2014 I � TOTAL AMOUNT PAID: S�g•22 REMARKS: RECEIPT TO ATTY CHECK# 4028 INITIALS: CJ sEA� RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS rnxPnvea euueao ov ieorvmun� rw�Es pennsylvania lnheritance Tax f �� Penn5yLV8111d vo eox xeaco� Information Notice • � oevnarnervroF r+eveHue HAkRISB1IRG PA ll12B-0601 � ppvi�n v m� And Taxpayer Response n�e No.2i�� 'G-L�� RECO;�-.C". :. --��JcOF ncNisiisos� „�,�, . _- DATC03-2P2015 ��5 �j�{� 2D �� 1 12 TypeofAccaunt . Estate of RUTH M STRAUSBAUGH �Savings - � SSN 192-14-6537 Checking �H p - � ' Da� TrUst KATELYN M MCCAOLEV . CounryCUMBERLAND X Certi�icate 53] BOSLER AVE ��1'�-� � ' � LEMOYNE PA 17043-L815 LITIZENS BANK OF PENNSYLVANIA 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 Paymenl and Farms[o: AccounlNo.6254724767 Date Establishetl 11-10-2006 REGIS7ER OF WILLS Account Balance $1,05627 1 COUFTHOUSE S�UARE CARLISLE PA 17013 Percent Taxable X 50 Amount Subject�o Tax $528.14 Tax Rale X 0.150 NOTE': If tax paymen�s are made within three mon�hs of�he Potential Tae Due $7922 decedenfs date o(death,deduct a 5 percen[discount on Ihe tax With 5%Discount(Tax x 0.95) $(see NOTE') due. Any inheritance tax due will become delinquent nine monihs after[he date ot death. pqRr $tBP 1 : Please check the appropriate boxes below. t n �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 tlisre9ard the amoun( �,L shnwn above as Potentizl Tar pue. g�he information Is The above information is correcl, no deduclions are being taken, antl paymem will be sen[ correct. with my response. Proceed to Step 2 on reverse. Oo not check any ofher boxes. p �The�ax rate is Incorrec�. � 4.5% I am a lineal beneficiary(paren�,child,grantichild,e�a)o�the deceased. (Select correct tax rate at right,and complete Part � �p/ I am a sibling of ihe deceased. 3 on reverse.) � 15% All other relationships (including none). p �Changes or deductions The information above is inwrrect and/or tlebts and deductions were paid. listed. Complete Part 2 and part 3 as appropriate on the back ol this toim. E ❑Asset will be reported on The above-iden�ified asset has been ar will be reporled and tax paid with the PA Inheri�ance Tax mheri�ance tax form Retum filed by�he esla�e representalive. REV-1500. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the torm when finished. � PART Z Debts and Deductions Allowable deb[s and deductions must meet both of the tollowing criteria: A. The decedent was legally responsible for payment,and the es�ate is insufficient to pay the deductible items. B. Vou paid the debts afler the death of the decedent and can fumish proof of payment if requested by ihe departmen[. (If additional space Is required,you may a�tach 8 U7'x 11"sheets o�paper.J Date Paid Payee Description Amount Paid Totel (Enter on Llne 5 of Ta�c Celculation $ PART Tax Calculation 3 If you are making a correction to the esWblishment date Line 1 account balance Line 2 , or ( ) ( ) percenttazable(Line3), please obtain a written correction irom Ihe financial institution antl attach it to this form. L Enter the date Ihe account was established or titled as it existed at Ihe date of death. 2 Enter(he total balance o�the acwun�including any in�eres�accrued at the date of dea�h. 3. Enter the percentage of the account that is taxable ro you. a. Firet.determine the percentage owned by ihe decedent. i. Accoun�s�hat are held "in�ms�for"another or o�hers were 100%owned by�he tlecedent. ii. Forjoint accounts es[ablished more than one year prior to ihe date of death,the percentage tauable is 100%divided by�he�o�al number of owners including�he decedent. (For example:2 owners=50%,3 owners=33.33%, 4 awneis =25%, etc.) b. Nex�, divitle[he deceden�'s percen�age owned by�he number of surviving owners or beneficiaries. 4. The amount sublect to tax is determined by mul[iplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions daimed fmm Part 2. 6. The amount taxable is determined by subtractin9 the debts and deductions from the amount subject to tax. 7. Enter ihe appmpria�e tax rate from Step 7 based on your relationship to the decedent. If indicating a diflerent�ax ra�e, please s�ate ��u�� % . yourrelationshipto[hedecedent p/{D8P `2lff#AQII" '„Ipf..F'{yyBpUB 1. Date Established 1 r.�„ : z. Account Balance z $ p/�= 3. Percent Taxable 3 x y 4. Amount Subject to Tan 4 $ 3 5. Deb�s and Deductions 5 - q - 6. Amount Taxable 6 $ $ " 7. Tar Ra�e ] X s 8. T� Due e $ � 9. Wi�h 5% �iscount(Tax x .95) 9 % $ Step 2: Sign and date 6elow. ReNrn 7W0 completed and signed copies m the Re9ister o�Wills listed on ihe front of this form, along with a check for any payment you are making. Checks must be made payable to"Register of Wills,Agen�" Do not send paymen�directly b the Department of Revenue. Untler penalry of perjury, I declare that�he facis I have repotled above are true,correct and complete to[he best of my knowledge and belief. ^„ Work � � � Home'l l -I -1 -i � � a a - 5 pay Signature Telephone Number Date IF YOU NEED FURTHER ISTANCE, 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 _ �� ,��y�i ', y � �� _ a = a '— . 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