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Home My WebLink About05-26-15 (2) REV-1162 EX111-96) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 1 7 1 28-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 020725 KEVIN & KAREN MCCAULEY 529 16TH ST NEW CUMBERLAND, PA 17070 ACN ASSESSMENT AMOUNT CONTROL NUMBER ---'—' fold 15115033 � $�9•22 ESTATE INFORMATION: sstv: �s2-�4-653� � FILE NUMBER: 211 5-0266 I DECEDENT NAME: STRAUSBAUGH RUTH M � DATE OF PAYMENT: 05/26/2015 I POSTMARK DATE: 05/21/201 5 I courvrv: CUMBERLAND � DATE OF DEATH: 1 2/1 4/2014 I � TOTAL AMOUNT PAID: $�9•22 REMARKS: CHECK# 4027 INITIALS: HMW SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS � -�� •o-n..�i�u-rllfl ' � ��;� fi� pennsylvania BUREAU OF INDIVIDUAL TAXES Pennsylvania lnheritance Tax }� DEPARTMENT OF REVENUE Po BOX zao6o� Information Notice REV-1543 E%DocEXEC (OB-12) HARRISBURG PA 17128-0601 � ��! ^/ � And Taxpayer Response FILE NO.21 r�`V ACN 15115033 DATE 03-20-2015 Type of Account Estate of RUTH M STRAUSBAUGH Savings SSN 192-14-6537 Checking Date X Certificate 537 BOSLER AVE LEMOYNE PA 17043-1815 , -.a c-� f7 ��a � c_ `1-' '�:7 t"1 .� � -+—� �T� C-� . __ .... •�-�. .....:.1 .:'.� 4�;.�� [.M1,'.i _ �J ,..._ 1.,,1 ,_.� � --G .r�> .. � . . , ; � ___ � _ N ' �.' Cn { CITIZENS BANK OF PENNSYLVANIA provide�te e a oa t ow eVrloh benefi�ary o�he aQcoun�t idengfiedt at the death of the above-named decedent you 1 _, ,!�., � ... i,, Remit Payment and;Forms� ; -- Account No.6254722241 ��' `�� REGISTER OF WtLLS � '� Date Established 11-10-2008 1 COURTHOUSE S�UARE Account Balance $1,056.27 CARLISLE PA 17013 Percent Taxable X 50 Amount Subject to Tax $528.14 Tax Rate X 0.150 NOTE*: If tax payments are made within three months of the Potential Tax Due $�9•22 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 ahove as Potenfial T�x Due. g �he 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 �The tax rate is incorrect. � 4.5% I am a lineal beneficiary (parent,child, grandchild, etc.)of the deceased. (Select correct tax rate at right,and complete Part � 12% �am a sibling of the deceased. 3 on reverse.) �15% All other relationships(including none). � �Changes or deductions The information above is incorrect and/or dOb�ate o at ae back of th s form. l i s ted. Complete Part 2 and part 3 as app p E �Asset 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�ro eed to Step 2 onpeverse.tl Do not check any other boxes. REV-1500. Please sign and date the back of the form when finished. �� ,�n��„��,�� 1 11 I II tl��l\I 1 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 "in trust 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 ��y\ � �� ;�� o�� \�� \�� \ ��\\ � ��\\�� your relationship to the decedent: ��\� �� p� ` �� \\�� ,�� \ \��\��"C ��\ ��\\� �\ 1. �8te EStdf�l ISh2C1 1 ��AA\�A�` � � ��\�\�AV�\��A��V`V�\�A��A\\V�V��V� �� V��.A�� V�� \ � � ��A�A�� `Z. ACCO U flt B8I311 C8 2 $ Oi��A\ \ � ��A �A�\�\�V�A�AA�\\��\\��V��\�`��j �� \ � A��\\��V��A�\��V��V�� \ ��A��. �� A�A�� \��A� �� 3. Percent Taxable 3 X �"�� ` �� \��\��A��\�� o �� A\��A�� V� �� \�� 4. Amount Subject to Tax 4 $ �� \\��\��\��``\\��\� �\��\ � o \\\��,�� \\\\o\\� ��\. � ,� � ��' � A � ��t � `�� J. �2btS 311Cj �BC�UCtI0t1S �J " �� V �`��VAA��V`��\�V�� \\�\\�� 6. Af110Uf1t T3X31�I8 6 $ �� V O � A��o\\\�� \��`��\��\A`\��\�A�� \O\\�� \`\\�\��\��\\\\��\\\� ��\\�\\\\��. x ��\�` 7. Tax Rate 7 �� O\ �O�\ti\�� \�� @ � �� \ \ � � ��\��\��\��\��a\\\��\� �. � 8. Tax Due 8 �� \ �p ��\ � � \��\\��\\o\ti�\�\��\��\p��\�� \\�' c� v \�� \ � ��\��`\�\��\��\\�� Y�\�� \ �\�\��\� 9. With 5��0 Discount(Tax x .95) J ^ a�\��\�\\�. �a> :_\\,. �\\\\��\\��o.a'..\:�.��.v\ �.\\��.�� ...�.o��\\\\�' \00\\�\ 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 Wilis,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 -� � � � � S Taxp yer 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 z � � � � n cn C x r --3 � � trJ `< ['r7 2 7J �-3 9 � Z .n C� � ^[7 � 9 a r� v O J O ,,� --] `.."'.. T7 ��l , � � �f'i C 7 (.,• <:) C7 _. � �� '� �i _-t:. t)} iJ r. _ c`.' N � �_ , � . U� . , , +�� : -� '�� . • �• � ;. .. _ �.? , c:; �'1 9 n � c.� a �c. t�� ._; �c,; �,.� �'.t r � v, c.� i tU rN-� •�-3 tT] � x � -tioo 9 C � � � � �p N ;�� _ 9 ,a,, � ,� �`; - rn ;�.� � :=� �� — '�_ _ ;�� _ ;� ��LY�i4x��;�� . �il .�`� r � � � ' P��i�f ,. i' � � �� ..4 i � �Y';x ...J�. $i T .� ° P,r v.. '�. �4 �$. }�5 oii i ��; r �, p . � ;�� I�� 1g l.� v, , �31�r 4 �•� • � Ii�IlrHli �� ,.