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~ aovsxv OF ,wnmzoUAL TAXES Pennsylvania Inheritance Tax pennsytvania
PO BOX 280601 DEPARTMENT OF REVENUE
HARRISBURG PA 17128-0601 Information Notice REV-1543 EX D..EXfX,(08 12)
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TAYLOR B LAIRD 'County CUMBERLAND F|Certificate
92I WALNUT ST
LEMVYNE PA 17043'I444
METRO BANK provided the department vith the information below indicating that at the death of the
above-named decedent you were a joint owner or beneficiary of the account identified.
Account No.537855538 Remit Payment and Forms to:
Date Established 09-02-2009 REGISTER OF WILLS
Account Balance $6,432.10 1 COURTHOUSE SQUARE
Percent Taxable X 50 CARLISLE PA 17013
Amount Subject to Tax $3,216.05
Tax Rate X 0.150
NOTE^' |�hm tsare made vv�hinthree months ofthe
P�enha|Tax Due ' ,-'��-�
decedent's date of death,deduct a5 percent discount on the tax
With 5%Discount(Tax x 095) due. Any inheritance tax due will become delinquent nine months
after the date of death.
PARTI Step 1 : Please check the appropriate boxes below.
AF-]N«� %�� U� d��' Uammthe spouse mYthe deceased K�rUa0Nthe ��arent of a decedent�m0»«»vmas
-- 21 years old or younger at date of death.
Proceed toStep 2onreverse. Donot check any other boxes and disregard the amount
shown above osPotential Tax Due.
' - . �
B i |Thei�ormatonin The above inhormabonionnrne�. nudeducbnnoaeb� taken,`-�oonoot. with my response.
Proceed 8nStep 2onreverse. Dnnot check any other boxes.
C'-1,Q IThe tax rate iaincorrect. 4.5% |amolineal beneficiary (pamnt' child, grandchild, eto.)ofthe deceased.
L�
(Select correct tax rate ut
right,and complete Part �-1 12% |omusibling ofthe deceased. '
3onmveroej �-�
F-] 15% All other relationships(including none).
D / |Changesordnducbonu The i�orm�ionabove iainonnecand�rdeb�and dedu�ionowere pe�.
�-'Uotod. Complete Part 2and part 3aoappropriate onthe back o/this form.
E �-�AaaotwiU 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 filed bythe estate representative.
REV'1500. \ Proceed b/Step 2onreverse. Donot check any other boxes.
|
Please S' nandd81��heb�ok��1hefonnxVh�n �niSh�d.
= � ��
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 frorn the iinanciai 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"intrust 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 ,W, 3GIi $et�}l ,�
your relationship to the decedent: &UANI bLc
P� epart
1 len 1 e�r�nt e
1. Date Established 1 2. O �a �� �a 401*'
�
O°
lJ� o A �o
a-t 3 2 1 _� �� ��
2. Account Balance 2 $ ��. - � �
\.. oma3V`
3. Percent Taxable 3 �� �
X �7 5d
c
4. Amount Subject to Tax 4 $ i 2 (O. (�
5. Debts and Deductions 5 - _ 4
inki
6. Amount Taxable 6 $ lot (>5 5 �W— ,� � �
j \ ` ��\ j
7. Tax Rate 7 X 04 6
8. Tax Due 8 $ I �,t-(. ') 2,
A. g*
9. With 5% Discount(Tax x .95) 9 X
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 Wills,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
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Taxpaye 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