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Home My WebLink About07-20-15 (2) BUREAU OF INDIVIDUAL TAXES Pennsylvania Inheritance Tax pennsyLvania PO BOX 280601 DEPARTMENT OF REVENUE HARRISBURG PA 1712B-0601 Information Notice I REV-1543 EX DocEXEC (08-12) REG STER OF WILLS ACN 15137803 1 DATE 07-13-2015 ?015 JUL 20 PM I bO T�e��u�n CLERK OF Esta�ufLET[Fh4JVVA[TE Savings ORPHANS' �0�RTS� Checking C U M B E R L A N D CD'` K��eofDeath U5-O3'2O15 Trust ARBUTUS BABg ' County CUMBERLAND |-�Certificate APT 201 7 ALLIANCE DR CARLISLE PA 17013-4143 ^ ' METRO 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. Account No.537167355 Remit Payment and Forms to: Date Established 01-30-2006 REGISTER OF WILLS Account Balance $8,293.09 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $4,146.55 Tax Rate X 0.150 NOTE Utm ammo��* mo�h othe Potana|Tax�ue ' --,-' '-- - - decedent's date ofdeath,deduct a 5 percent discount on the tax With 5%Discount(Tax xO.Q5) due. Any inheritance tax due will become delinquent nine months —S-fd - -5-91.0 g2p after the date of death. PART Step 1: Please check the appropriate boxes below. � � A L�N«»tax is due' Nammthe spouse 0fthe deceased orUamthe_parent of a decedent who was 21 years old or younger atdate of death' Proceed tnStep 2onreverse. Donot check any other boxes and disregard the amount shown above aaPotential Tax Due. ,-�. � N�\Thei�orma�nn\e The above i�onnahoni000rne�.nodedu� taken,�—^cornoo1. with my response. Proceed/nStep 2nnreverse. Dnnot check any other boxes. C F-�The tax rate isincorrect. F—1 4.5Y6 |amoUneo|beneDuiary(parontchild, grandchild, etcjofthe deceased. -�(Select correct tax nate at -- right,and complete Part F—1 12% \amasibling ofthe deceased. 3onrevoruo.) F—1 15% All other relationships(including none). D �-1Changes ordeductions The inhann��ionabove ioinoornao and��rdeb�and doduubonmwempu�. �-�Ua1ed. Complete Part,2and part 3auappropriate onthe back o/this form. E F �-�Aa�twU|bemepn�edun The above'idanhUedem�thas been orwU|beropu�edand�xpaid with the PA|nhehtanoeTax �- inheritanootaxbrm Return filed bythe estate representative. REV'1500. Proceed boStep 2onreverse. Donot check any other boxes.M_ 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 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 8 1/2"x 11"sheets of paper.) i 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 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. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. If indicating a different tax rate,please state ��° ' OflCtag "( p) AAS , �� v your relationship to the decedent: nt 1. Date Established 1v 2. Account Balance 2 $ PPADD, JOy a" ` T ll- ` \„ \ s 3. Percent Taxable 3 X \ s 0 E 4. Amount Subject to Tax 4 $ 0k, yNv .� & 5. Debts and Deductions 5 - 4 3 110 \ 01 6. Amount Taxable 6 $ v z. 7. Tax Rate 7 X 0 \1; Aw �y $ 1 8. Tax Due 8 ` 9. With 5% Discount(Tax x .95) 9 X ` ......... ..—ki._.. ti ... _.. __ 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 Home �I�7. 2q 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 t REc REOJ� � V'Pr PL of i ORPHA cu co IMBERLxv ja tit - ti .q.� � �ly•g.Mf a j/