HomeMy WebLinkAbout05-26-15 (6) BUREAUt2F INDIVIDUAL TAXES Penns Ivania Inheritance Tax pennSytvanla
PO BOX 280601 y DEPARTMENT OF REVENUE
HARRISBURG PA 17128-0601 Information Notice
'----""` REV-1543 E%DocE%EC (08-12)
And Taxpayer Response FILE N0.21 — 1
ACN 15115035.
DATE 03-20-2015
Type of Account
Estate of RUTH M STRAUSBAUGH Savings
SSN Checking
Date of Death 12-14-2014 Trust
BAILEY A DEVORE County CUMBERLAND X Certificate
537 BOSLER AVE
LEMOYNE PA 17043-1815
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CITIZENS BANK OF PENNSYLVANIA provided the department with the information below;
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;inanclal institution and a.tach 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 Official Use Only ❑AAF
your relationship to the decedent: PA Department of Revenue
1. Date Established 1
2. Account Balance 2 $ PAD
3. Percent Taxable 3 X 1
2
4. Amount Subject to Tax 4 $ 3
5. Debts and Deductions 5 - 4
6. Amount Taxable 6 $ 5
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—7. Tax Rate 7 X 6
8. Tax Due 8 $ 7 .
$ ti
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
Home Z- - -2152
Taxpayer Signature Telephone Number Dak'
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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