HomeMy WebLinkAbout06-01-15 (2) BUREAU OF INDIVIDUAL TAXES _ Penns Ivania Inheritance Tax pennsyLvania
PO BOX 280601 n jj r+ Y
HARRISBURG PA 17128-0601]L V 61�DED l(j I E Information Notice DEPARTMENT OF REVENUE
r�L REV-1543 EX D-EXEC(08-12)
r ,,, L �_Fnd Taxpayer Response
REGI.,�T}:_ `. 1 FILE NO.21- 1h-0IP0V
ACN 15122620
1 2 08
U DATE 04-28-2015
�`i-U r Type of Account
'ORHHO,,` r
Estate of LEONARD L BIXLER Savings
,C U M 31 '•` SSN Checking
Date of Death 04-12-2015 Trust
** KENITH E WINGERT County CUMBERLAND Certificate
7761 HANOVERDALE DR
HARRISBURG PA 17112-9770
MEMBERS IST FCU 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 Payment and Forms to:
Account.No.255885
Date Established 05-02-2014 REGISTER OF WILLS
Account Balance $48,225.26 Y COURTHOUSE SQUARE
Percent Taxable X 100
CARLISLE PA 17013
Amount Subject to Tax $48,225.26
Tax Rate X 0.150
NOTE*: If tax payments are made within three months of the
Potential Tax Due $7,233.79... decedent's date of death,deduct a 5 percent discount on the tax
With'5%Discount(.Tax xl<0:95) $:( 4NOtE*) due. Any inheritance tax due will become delinquent nine months
after the;date of death.
PART
1
Stepl' Please check the appropriate boxes below.
A No tax is duet 1 am the s ouse of the deceased or l am the parent of a decedent who was
'i year's o tl br younger at date of death.
F� rocee'do Step 2 on reverse. `DO not check any other boxes and disregard the amount
shown above as"Potential Tax Due.
B The informtitiorrr,q�' 'I he.above ih'fdrrhation 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 F]The tax rate is incorrect. 4.5% 1 am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased.
(Select correct tax rate at
right, and complete Part F� 12% 1 am a sibling of the deceased.
3 on reverse.)
15% All other relationships (including none).
D ®Changes or deductions The information above is incorrect and/or debts and deductions were paid.
listed. Complete Part 2 and part 3 as appropriate on the back of this form.
E. F—]Asset will be reported on The above-identlfie'd'asset hes:been or.will be reported and tax paid with the PA Inheritance Tax
inheritance tax form Return filed by the=e'state' representative.
REV-1500: Proc'eed`td Step'2 on reverse. Do not check any other boxes.
Please sign and date the back of the form when finished.
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`tfie 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;ike- decedent.
i. Accounts that are held"in trust for"another or others were 100%owned by true 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 deterniinecl tby 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 indicatin a different tax rate, lease state e L �
9 P
your`reiatioriship to the decedent: h
1. Date Established 1
2. Account Balance 2 $JAI dIw ..
��
3. Percent Taxable 3 X \
4. Amount Subject to Tax 4 $ .11r, 1 • �- v
u
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7 X . 1 k t
8. Tax Due 8 $
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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E. `� G' AGI Home
Taxpayer Signature Telephone Number Date'"
IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA .DEPARTMENT- OF R VENUI4
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