HomeMy WebLinkAbout06-29-15 (2)COMMONNiEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 28PE01
HARRISBURG, PA 1/1 I8-0601
RECEIVED FROM:
DEVLIN FLORENCE
210 CUMBERLAND DRIVE
CAMP HILL, PA 17011-6672
EYE
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ESTATE INFORMATION:
SSN:
FILE NUMBER:
2115-0515
DECEDENT NAME:
DEVLIN RAYMOND A
DATE OF PAYMENT:
06/29/2015
POSTMARK DATE:
06/26/2015
COUNTY:
CUMBERLAND
DATE OF DEATH:
03/03/2015
REV1162EX(- 96)
NO. CD 020907
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
15132477 $37.80
TOTAL AMOUNT PAID: $37.80
REMARKS: RECEIPT TO ATTY
CHECK#154
INITIALS: CHI
SEAL RECEIVED BY: LISA M. GRAYSON, ESQ.
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES Pennsylvania Inheritance Tax
PMBOX 280601
R BUPG PA 11128-0601 Information Notice
And Taxpayer Response
FLORENCE K DEVLIN
210 CUMBERLAND OR
CAMP HILL PA 17011-6672
i pennsylvania
DEPARTMENT xOF REVENUE
N
FILE NO. 2115-0515
ACN 15132477
DATE 06-17-2015
Estate of RAYMOND A DEVLIN
Date of Death 03-03-2015
County CUMBERLAND
Type of Account
Savings
Checking
Trust
X Certificate
o
F\1
CJ
l
3
rV 1
M s T BANK provided the department with the information below indicating that at the death pt the _
shove -named decedent you were a ioint owner or beneticiary of the account identified. c>
PART Step 1 : Please check the appropriate boxes below.
1
AE] No tax is due.
gThe information is
correct.
C The lax rate is incorrect.
(Select correct tax rate at
right, and complete Part
3 on reverse.)
D [—] Changes or deductions
listed.
E F-] Asset will be reported on
inheritance tax form
REV -1500.
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 to Step 2 on reverse. Do not check any other boxes and disregard the amount
shown above as Potential Tax Due.
The above information is correct, no deductions are being taken, and payment will be sent
with my response.
Proceed to Step 2 on reverse. Do not check any other boxes.
F5%
Remit Payment and Forms to:
Account No. 25004920674395
12%
1 am a sibling of the deceased.
Date Established 02-02-2004
15%
REGISTER OF WILLS
Account Balance
$ 630.03
1 COURTHOUSE SQUARE
CARLISLE PA 17013
Percent Taxable
X 50
Amount Subject to Tax
$ 315.02
Tax Rate
X 0.120
NOTEIf tax payments are made within three months of the
Potential Tax Due
$ 37.80
decedent's date of death, deduct 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
atter the date of death.
PART Step 1 : Please check the appropriate boxes below.
1
AE] No tax is due.
gThe information is
correct.
C The lax rate is incorrect.
(Select correct tax rate at
right, and complete Part
3 on reverse.)
D [—] Changes or deductions
listed.
E F-] Asset will be reported on
inheritance tax form
REV -1500.
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 to Step 2 on reverse. Do not check any other boxes and disregard the amount
shown above as Potential Tax Due.
The above information is correct, no deductions are being taken, and payment will be sent
with my response.
Proceed to Step 2 on reverse. Do not check any other boxes.
The information above is incorrect and/or debts and deductions were paid.
Complete Part 2 and part 3 as appropriate on the back o/ this form.
The above -identified asset has been or will be reported and tax paid with the PA Inheritance Tax
Return filed by the estate representative.
Proceed to Step 2 on reverse. Do not check any other boxes.
Please sign and date the back of the form when finished.
F5%
1 am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased.
12%
1 am a sibling of the deceased.
15%
All other relationships (including none).
The information above is incorrect and/or debts and deductions were paid.
Complete Part 2 and part 3 as appropriate on the back o/ this form.
The above -identified asset has been or will be reported and tax paid with the PA Inheritance Tax
Return filed by the estate representative.
Proceed to 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
t
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 81/2" 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 dale (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 the decedent.
i. Accounts that are held "in trust 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.
T Enter the appropriate tax rate from Step 1 based on your relationship to the decedent.
If indicating a different tax rate, please state u3 Official Use Orgy ❑ AAF.„
your relationship to the decedent:
nPA Department of fi@YCnU@"
1. Date Established 1 ¢ <
2. Account Balance 2 $ PAu°r
3. Percent Taxable 3 X f `
2 w ,
4. Amount Subject to Tax 4 $
5. Debts and Deductions 5 - ¢°'
6. Amount Taxable 6 $
7 Tax Rate 7 X
S. Tax Due 8 $ 7 „
18 7
7
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 penalj�yy of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and
belief. /1
Taxpayer
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
W
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