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Home My WebLink About07-22-15 coMmorvweun�oF vervrvsr�vnNin 4Ev-"az exi i i-ee1 YPPiMENT OF FEVENOE BUflFAp OF�.N�IVI�VAL TP%ES T IBOfi01 �naAaiseoa,.va nize-osm pENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 021000 HARDER DIANE L 775 LEE LANE ENOLA, PA 17025-1503 ACN ASSESSMENT AMOUNT CONTROL NUMBER 15137545 51 ,932.87 ESTATE INFOFMATION: ssN: FILE NUMBER: 2'I 15-OSHF) I DECEDENT NAME: BROWN VIRGINIA G I DATEOFPAVMENT: 07/22/2015 I POSTMARKDATE: 07/2Z/ZO15 I couN7v: CUMBERLAND I DATE OF DEATH: 04/25/2015 I � TOTAL AMOUNT PAID: 51 ,932.87 REMARKS: CHECK# 2293 INITIALS: CJ sEA� RECENED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILIS FEGISTER OF WIlLS e�RE•� oF ��o��^� T^xE� Pennsylvania lnheritance Tax ��mj �,� PennSY�Vdllld PO BO% �00601 pEPAPTMENT OF PEVENOE NRPRISB11R6 PP V120-0601 �nf�rma��On NOt�Ce . a��_ssaa¢mmc. �oenn And Taxpayer Response • Fi�e No.ziis-oses RECORC=f, :i-r!r;E OF ACN isis�sas ��_.. . DATE 07-10-2015 70j5 J�� 22 G�� 2 y3 TypeofAccount �,,' ,,. , EstateofVIRGINIAGBF2OWN Savings Checking �RP;i;... DateofDealh04-2S20�5 Tmst uinNE L HABOER � . �T CountyCUMBERLAND Certificate 30 0%FOHO DR ��i`��f�.� . I,� �^�1� LEBANON PA P042-]515 SANTANDER BANK 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: AccouniNo.921717245 Date Established 09-27-2012 REGISTER OF WILLS Account Balance $27,128.01 � COURTHOUSE SOUARE CAHLISLE PA 17013 Percent Taxable X 50 Amount Subjed to T� $ 13,Sfi4.01 Tax Rate X 0.150 NOTP: If tax paymenls are made within[hree months of the Potential Ta�c Due $2,034.60 decedenPs date of death,dedud a 5 percent discount on the tax ✓VJith 5%Discount(Tax x 0.95) $ (see NOTE') due. Any inheritance�ax due will become delinquent nine months � 9�a 8� after the da�e of death. PART SteP 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 to Step 2 on reverse. Oo not check any other boxes antl tlisregard the amounf shown above as PotentialTaz Due. g �T e inrormation is � l'he above information is corzect,nc aaduciions are ceing[arten, ar�d paymen;will be sent carrect. with my response. Proceed ro Sfep 2 on reverse. Do not check any other boxes. p �The tax rate is incorrec�. � 4.5% I am a lineal beneficiary(parent,child,grandchild,elc.)ot�he deceased. (Selecl correc�tax ra�e at right, and complete Part � �z% I am a sibling of the deceased. 3 on reverse.) � 15% All o�her rela�ionships (including none�. p �Changes or deductions The information above is inwrrect antl/or debts and deductions were paid. listed. Complefe Part 2 and part 3 as appropnate on the back ol this lorm. E Asset will be reported on The above-identified asset has been or will he reported and tax paid with the PA Inheritance Tax inheri�ance tax form ReWm filed by the es�ate represen�ative. REV-i 500. Pmceed 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 Allowable debls and deductions mus�meet both of the following cri�eria: A. The decedent was legally responsible for payment, and the estate is insuflicient to pay the deductible items. B. You paid ihe debis after ihe death of ihe decedent and can fumish proof of payment if requested 6y the departmen[. (If adtlitional space is required,you may atlach 81/2"x 11"sheets of paper.) Date Paid Payee Description Amount Paid Tolal En�er on Line 5 of Tax Calculation) $ Pp'RT Tax Calculation 3 If ou are makin a correction to ihe establishment Cate Line 1 account balance Line 2 ,or Y 9 ( ) ( ) percent�axable(Line 3), please oblain a writlen correction from the tinancial instNu�ion and attach i�to this torm. 1. Enter Ihe date the account was es�ablished or titletl as it exis[ed at the tlate of deaih. 2 Enter the rotal balance of Ihe account including any interest accrued at the date ot death. 3. Enter the percentage of Ihe account ihat is taxable to you. a. Firs�,determine�he percentage owned by the decedent. i. Accounts that are heltl"in tms[for"ano�her or others were 100%owned by Ihe decedent. ii. For join[accounis established more than one year prior to the date ot death,the perce.^.tage 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. NeM, divide the decedenPs percentage owned by the number ot surviving owners or beneficiaries. 4. The amoun�subject�o lax is delermined by mul�iplying the account 6alance by Ihe percent�axable. 5. Enter�he tolal ot any deb[s antl deductions claimed irom Part 2. 6. The amount taxable is determined by subtrac�ing the deb�s and deductions from[he amount subjec�[o tax. 7. Enter the appropriate[ax rate fmm Step 1 based on your relationship to ihe decetlent. If indicatin9 a diNerent lax rate, please state (�$C;�al UsB(7n1Y{}qqF your relationship�o the decedent �'�°" ,deP21'IfllE�t O�,�E.w� 1. DateEstablished 1 �a� �F�*4 „ 2 AccountBalance 2 $ P�� ' ^"� � 3. PercentTaxable 3 X � �"' ��. � 4. Amoun�Subjec�to Tax 4 $ 2�"� �� ry � 3'.. 5. Debts and Deductions 5 - 4�; .. {Y ry 6. AmountTaxable 6 $ �"-"�'-� . ��... � .z;F 'n� 7. Tax Rate 7 x � ' a : n TaxDue 9 $ � ?'� 9. With 6% Disrount(Tax x .95) 9 X . . StBP 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on Ihe iront of ihis form, along with a check for any payment you are making. Checks must be made payable to"Register of Wills,AgenL" Do not send payment directly to ihe Department of Revenue. Under penalry of perjury. I declare ihat the facts I have reported above are irue, correc�and complete to ihe best of my knowledge and belief. ,�� / WOfk /%i'u �/VCLICE.%�— Home 7/7— �S'S�- ��/G-5 7��a�ZG✓� Taupayer 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 ;�, �,: _ w - � m _ � � � = � �` _ � �� _ U � _ � ,� � � I� � �in �, �� v J � � • � r�.i �7 ii' ,� i'� i:h �s.; ,., I,' y3ewn� � Haao _ � � ��, ZZ Wd ZZ lpC S�Oi w -� �,.�3U � '_ � S'(1iif� :.: '`:;;�2:00311 i o `' �0 3�1��0 Z ° � ¢ '_ � p s' _ �