HomeMy WebLinkAbout07-06-15 a�a�� �F ��o����w� *a=Es Pennsylvania lnheritance Tax ���� Pennsylvania
PO BOX Peosol � DEP�FTMENTOFFEVENUE
HPRRIS90RG PA IlIIO-0601 Information Notice
And Tazpayer Response Fi�E No. 2ns�oiso
ACN 15505377
DATE 06-17-2015
Type o�Account
Estate of KAROL S DANOWIR Securiry
SEC Acct
Date of Death 01-0&2015 Stock
SHARON F GOLDBERG CauntyCUMBERLAND Bontls
1422 IRODUOIS PL
ANN ARBOR MI 48104-4638
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F[ne�irv INVESTMENTS provided the department with the information below indicating that at t�ie death
of the above-named decedent you were a joint owner or beneficiary of the account identified.
Remit Payment and Forms to:
Account No.0
Date ESWblished HEGISTER OF WILLS
Account Balance $ 190,47970 1 COURTHOUSE SQUARE
CAHLISLE PA 170�3
Percent Tauable X 50
Amount Sublec��o Tax $95,239.85
Tac Rate X 0.045
Potentiai T� Due $4,28579 NOTE': Ii tax payments are made within ihree months of the
decedenYs date of death, tletluct 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
aflerthe da�e ofdea�h.
PAAT $teP 1 : Please check the appropriate boxes below.
1
A Q No tax is due. I am the spouse of the deceased or I am the parent ot a decedent who was
21 years old or younger at date of death.
Pmceed to Sfep 2 on reverse. Do not check any other boxes antl disregard Ihe amount
shav.r.abm�e a Pofentlal`c`x Ouz.
g �The information is The above information is wrrect, no deduMions are being taken,antl paymentwill be sent
correc�. wi�h my respanse.
Proceed to Sfep 2 on reverse. Do not check any other boxes.
p �The tax ra�e is incorrecL � 4.5% I am a lineal bene�iciary(parent,child, grandchild, etc.)of�he deceased.
(Select correct ta�c rate at
right,and complete Patl � �p� I am a sibling of ihe tleceased.
3 on reverse.)
� 15% All other relationships(including none).
p ❑Chanqes or deduaions The information above is inwrrect and/or debis and deductions were paid.
listed. Complete Part 2 and part 3 as appropria[e on the back ol this torm.
E Asset will be repotled on The above-identified asset has been or will be reporled and tau paid with ihe PA Inheritance Tax
inheritance tax form Retum filed by lhe estate representa�ive.
REV-1 W0. Proceed to Step 2 on rererse. Do not check any other boxes.
� �Please sign and date the back of the form when finished.
PART Debts and Deductions
2
Allowable debis and deductions must meet both of the following criteria:
A. The tlecedent was le9alty responsible for payment,and the estate is insufficient[o pay the deductible items.
8. Vou paid ihe debts after[he death of the decedent and can fumish proof of payment if requested by the depanment.
Qf additional space is required, you may attach 8 V7'x 11'shee�s of paper.)
Date Paid Payee Description Amount Paid
Total En�er on Line 5 of Tax Calculation $
PART Tax Calculation
3 � If you are making a correction to the establishment tlate(Llne 1)account balance(Line 2),or percent taxable(Line 31,
please obtain a written cortection from the financial insti[ution antl attach it to ihis torm.
L Enter the date ihe account was established or titled as it existed at ihe date of death.
2 Enter lhe total balance ot lhe account indudinq any interest accrued at ihe tlate of death.
3. Enter Ihe percentage of the account�ha�is taxable to you.
a First, determine the percentage owned by the decedent.
i. Accounts that are held"In imst 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%dividetl
by[he total number of owners induding Ihe decedenL (For example:2 owners=50%, 3 owners=33.33%,4 owners
= 25%,etc.)
b. Next, tlivide ihe decedenCs percentage owned by the number of surviving owners or beneficiaries.
4. The amount subject lo tac is de�ermined by mul[iplying Ihe account balance by the percen�taxable.
5. En[er the total ot any debts and deduc�ions claimed from Part 2.
6. The amount taxable is determined by subtracting the debts and deductions irom the amount subject ro tax.
Z En�er the appropriate t� ra�e from Step 1 based on your rela�ionship to the tlecetlent.
I(indica�ing a dif�erent tax ra�e, please s�ate � j �,tr
your relationshlp�o�he decedent "�z�'�' � 4 � i� .
t DateEstablished 1 '�` �,�� '��
2. Account Balance 2 $ PA� „ �� �
�t 4E�n, �.. :y.
3. Percent Taxable 3 x
+�`s�,.,�"'�' kk
4. Amount Subjec�to Tax 4 $ �'� �
3 �,� � � rt5t� '�ae � Wp �L� ��;`
5. Debis and Deductions 5 -
a ' x` .tT:'n ti -.,� 7,"A� . .'#
6. Amount Taxable 6 $ � '.�'�"fl"E""",�� R ��
7. T� Rate 7 X � -� ,� ia ,m� „Y.:. $4
8. T� Due 8 $ 7 ,...� } F
-, i
$ .e; ,� i
9. W[h 5%Dlscaunt(Tar x .95) 9 X wsi?'T�'a.ty�+ur
St@p 2: Sign and date below. Return TWO completed and signed copies to[he Register of Wills listed on the iront 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 ihe Department of Revenue.
Under penalry of perjury, I declare that the facts I have reported above are true,corred and complete b the best of my knowledge and
bellet yyor �3���y / S�p
� � Home
Taxpayer Signature Telephone Number Date � q�
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: 1-800-4473020
RECOP,C�D CFFICE OF
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