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Home My WebLink About08-04-15 eurzenu or �xomoun� rnxes Pennsylvania lnheritance Tax �j ��- PennS�/LVdilld ro eox �eozoi �w � oeanarmervr or Aevervue �uxx�seuec rn v�zs-aso� IflfOfrtl2[lOf1 NOIiCO pE.�s� �o.o«<0e.,�� And Taxpayer Response Fi�E No.2�is-oaa� ACN 15132475 DATE 06-1�-2015 Type of Account Estate of KEITH L SELTZER Savings Checking Date of Death 04-06-2015 Tms[ LINDA M SHAR2ETT5 CountyCUMBERLAND Certificate 1511 LETCHWORTH RD CAMP HILL PA 17011-7524 c� � a c � � m � m � x� no �i � � _� =o :� � <'o ...� o _ '. r ;' ,._,. _.._ ;�:� ,s . . _ 0 r n � � -, .. . - . .�_ �S � �- m METRO BANK provided ihe department with the information below indicating Ihat aCthe deatFmf ihe � above-named deceden[you were a joint owner or beneficiary of the account identified. Remit Payment and Forms to: Account No.626868038 Da�e Es�ablished 12-11-2006 REGISTEH OF WILLS Account Balance $6,97422 � COUHTHOUSE SOUARE CARLISLE PA 17013 Percent Taxable X 50 Amount Subject to T� $3,489.61 Tax Ra�e X 0.150 NOTE': If tax payments are made within�hree months of lhe Potential Tax Due $523.44 decedenPs date of death.deduct a 5 percent discoun[on the tax With 5% Discoun�(Tax x 0.95) $(see NOTE') due. Any inheritance tax due will become delinquen�nine months afler�he date ofdealh. PART StBP 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 fo Step 2 on Bverse. Do not check any other boxes and disregard the amount shown above as Potential Tar Due. g �The information is The above information is correct, no deductions are being taken,and payment will be sen� correct. with my respanse. Proceed ro Step 2 on reverse. Do not check any other 6oxes. � �The tax rate is incorrect � 4.5% I am a lineal beneficiary(parent,child, grandchild, etc.)of the deceased. (Select correct tax ra[e a� right,and complete Part � �p� I am a sibling of�he deceased. 3 on reverse.) � 15% All other ralafionshlps(induding none). p �Changes or deductions The information above is incorrect and/or debis and deductions were paid. listed. Complete Part 2 and part 3 as appropriate on the back ol Ihis lorm. E �Asset will be reported on The above-identified asset has been or will be reporled and tax paid wi[h Ihe PA Inheritance Tax mheritance�ax form Re�um filed by fhe estate representa[ive. REV4 500. Proceed fo Step 2 on reverse. Do not check any ofher boxes. � �Please sign and date the back of the form when finished. PART Debts and Deductions 2 Allowable debts and deductions mus�meet both of the followinq criteria: A. The decedent was legally responsible for paymem,and�he estate is insuRicient to pay the deductible items. B. You paid[he debts afler Ihe death oi�he decedent and can fumish prwf oi paymen�ii requested by�he department. Qf additional space is required,you may attach 8 V2"x 11"sheets of paper.) Da[e Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculalion $ PART Tax Calculation 3 Ii you are making a correction to the establishment date(Line 1)account balance(Line 2),or percent laxable(Line 3), please obtain a written correction trom ihe tinancial institution antl attach it to this torm. 1. Enter the date the account was established or�itled as i�exis�ed at ihe date of dea�h. 2. Enter the total balance of ihe account including any interest accrued at ihe date of death. 3. Enter the percentage of the account that is taxable to you. a First,determine ihe percentage owned by the decetlent. i. Accounts ihat are held"in tmst for"another or others were 100%ownetl by ihe tlecedent. ii. For joint accounts established more than one year prior to the tlate of tleath,the percentage tauable is 100%divided by the total number of owners including ihe decedent (For example:2 owners=50%,3 owners=33.33%, 4 owners =25%,etc.) b. Next. divide the decedenYs percentage owned by the number of surviving owners or 6eneficianes. 4. The amounl subjecl to�ax is determined by multiplying�he account balance by�he percen�taxable. 5. Enter�he total of any deb�s and deductions claimed from Patl 2. 6. The amount taxable is determined by subtracting the debis and deductions from the amount subject to tax. Z Enter the appropriate tax rate from Step 1 based on your relationship m the decetlent. If indicating a different tax rate, please state ��(;yyl lJS2 OPIY-QHAF.� your rela�ionship�o Ihe decedent HA '� PA Department of Reven�e " 1. Date Es[ablished 1 �.r . 2. Account Baiance 2 $ PA� � 3. Percen�Taxable 3 x �� . 4. Amount Subjecl ro Tax 4 $ 2 3 5. Debts and Deduc[ions 5 - 4 — 6. Amount Taxa6le 6 $ � w 7. Tax Rate 7 k S e. Tax Due e $ � R £ ��,�� _ 9. With 5%Oiscount(Tax x .95) 9 X .SteFI 2: Sign and date below. Return TYVO completed and signed copies to the Re9ister of Wills listed on the imnt of this form. along with a check for any payment yau are making. Checks must be made payable to"Register of Wills,AgenC' �o no[send paymenl direc�ly to the Departmenl of Revenue. Under penalty of perjury, I declare that the facts I have reported above are tme,correct and complete to Ihe best of my knowledge and belief. WOfk J/ 7 / i� t'�3�6 ;�f' � - �7�'/9ui� ��i."r� iik(n, Home %/ i i�d � ini7 �. .17- lv TBxpayer 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