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Home My WebLink About06-15-15 ouxeau oF ixomow� uxes Penns Ivania lnheritance Tax . � pennsylvania vo eox zaosoi Y NPRRISBIIRG PA ll120-0601 �nf��m'a��On NQ��Oe �� OEPAFTMENT OF PEVENUE And Taxpayer Response Fi�E No.2i iGsaaia F��•-,�� ACN 15126632 - - - - .' �.- DATE OS-18-2015 Type of Account (��y uui� 1� Cll %- "�stateofSARAOMGDERMOTT Savinqs X Checking CLE:�.>. 0�' DateofDeath02-21-2075 Tmst CAROLYN SCHEFFER . . ...., ��;�T CountyCUMBERLAND Certificate 134 HOGESTOWN RO �' `'��.. . � MECHANICSBURG PA I7050��6 '� � „ , SANTANUER 9AN[ provided the department with the information below indicating ihat at the death of the - above-named decedent you were a joint owner or beneficiary of the account identified. Remi�Payment and Forms to: AccouniNo.1681720353 Date Established OB-04-1997 REGISTEq OF WILLS Account Balance $12,59L56 1 COUR7HOUSE S(]UARE Percent Taxable X 50 CARLISLE PA 17013 AmountSubjec[IOT� $6,295J8 Tax Ra�e X 0.045 NOTE': If tax paymen�s are made within(hree months of[he Poten[ial Ta�e Due $283.31 tlecedenYs da[e of death. deduct a 5 percent discount on the tax With 5%Discount (Tax x 0.95) $(see NOTP) due. Any inheritance tax due will become delinquent nine monihs afler ihe date of death. PART $t@P 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 fo Sfep 2 on reverse. Do not check any other 6ozes and disregartl the amount shown a6ove as Potenfial7ax Due. g ❑The information is The above information is correct, no deductions are beinq[aken, antl payment will be sent correct. with my response. Proceed fo Step 2 on reverse. Do not check any other boxes. p �The tax rate is incorrect. � 4.5% I am a lineal beneficiary(parent,child,grandchild.etc.)of ihe tleceased. (Selec�correc��ax ra�e a� right, antl 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 incorrect antl/or debts and deductions were paid. listed. Complete Part 2 and part 3 as appropriate on the 6ack ol this lorm. E �(Asse[will be reported on The above-identified asset has been or will be reported and tax paid wi�h ihe PA Inheritance Tax ��inheritance tax�orm Fetum filed by the es�ate represen�ative. REV-1500. Proceed fo Step 2 on reverse. Do not check any ofher 6oxes. :J Please sign and date the back of the form when finished. PART Debts and Deductions 2 Allowable debts and deductions must meet both of ihe following criteria: A The decedent was le9ally responsible for payment, and lhe estate is insufficien�to pay the deductible items. B. Vou paid ihe debts after the death of the decedent and can furnish proof of payment if requested 6y the department. Q(additional space is required, you may atlach 81/2"x 11"shee�s o�paper.) Date Paid Payee Description Amount Paid Tolal En�er on Line 5 of Tax Calculation) $ PART Tax Calculation 3 Ii you are making a correction to the establishment date(Line 1)account balance(Line 2),or percent taxable(Line 3), please obtain a writlen correction irom the tinancial ins�itution and anach it to Ihis torm. 1. Enter the date[he account was established or titled as it exis[ed at the date of death. 2. Enterthetotalbalance ofthe accountincluding anyinterestaccrued atthe tlate ofdeath. 3. Enter the percen[age of the account tha�is taxable ro you. a. FirsL determine the percentage owned by ihe tlecedenL � '. Accounts that are held"in imst for"another or others were 100/owned by the decedent. ii. For joint accounts establishetl more than one year prior b�he date o(death,the percentage taxable is 100%divided by lhe total number of owners including the decedent (For example:2 owners =50%,3 owners=3383%,4 owners. = 25%.etc.) b. Next, divide the decedenfs percentage owned by the number of surviving owners or beneficiaries. 4. The amount su6ject to tax is determined by multiplying the account balance by Ihe percent taxable. 5. Enter the rotal of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by sublrecting the debts and deduc�ions�mm�he amoun�subjec�m tax. Z Enter the appmpriate ta�c rate from Step 1 hased on your relationship to ihe decedent. If indicating a diReren�tax rate,please slate {�fICi21�JSB�fl�Y.{�AA�� ,'�. your relationship to the decedenC PA Df�,18TfRi@13i 01':flCV8X1U@ 1. Date Established 1 "3^� � 2. Account Balance 2 $ PAp � 3. PercenlTaxable 3 X � 4. Amoun[Su�ject[oTax 4 $ � y�.:. � 5. De6ts and Deduc�ions 5 - 4 s. Amount Taxable s S 5 : 7. Tax Fate 7 X 6 8. Tax Due B $ � 8 9. With 5% Dlscount(Tax x .95) 9 X � .SteP 2: Sign and date below. Re�urn TWO completed and signed copies lo lhe Regis�er of Wills lis�ed on the�mnt o�[his form, along with a check tor any payment you are making. Checks must 6e made payable to"Register of Wills.AgenC' Do not send paymen[directly ro[he Department of Revenue. Under penalty ot perjury, I declare that[he facts I have reported above are tme,wrrect and complete to the best of my knowledge and belief. � � �� [ Work - � X �1-� }'"—c'� Home rl �'1— (a��1 - O(Jl � (y 1�� Taxpayer 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 � � � oa a h a a � x y a y � ^ 3 00 � y � - a ; �, � � � o T � � .._ Y' L p) nozn �'i � m c m aa, 3 v; n ,'�, 6 �) m � m � �f) ,o � o m 9 i -�+ a p � n N c _. n v = o o � � � .+ �n y = W C `G � 3 - � � � � �,I - r v�' - C7 _ } _ _ � C _ � G7 - T - � . _ ' M � P J = _ �., ,_ , ��_�awno _ 1'.. „LO ��'� #:! °� _ , � t = S!, Z U� ;i fdll" Si:� f f �`J� � � � �� ; _� �_"_ . ._��,�