HomeMy WebLinkAbout08-04-15 (2) a�aF•� �F ��o���ow� *�E� pennsylvania lnheritance Tax �� � ���� PennSyLV8�11B
PO BOX 880601 ����� OEPNRTMENTOFPEVENIIE
NIRPISBOR6 PF 1]120-0603 �nfQ�mal�On NO1�CQ ¢rv-iem er w.mc eon .o
And Taxpayer Response Fi�E No. ziia-oees
ACN 15138991
DATE 07-2L2015
Type o�Account
Estate of SALVATORE J VALVO �Savings
Checkmg
Date of Death OB-30-2014 Tmst
�r RANDOLPH P VALV❑ CountyCUMBERLAND X Certificate
212 ALLENOALE WAV
CAMP HILL PA 17011-6402
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SANTANOER BANK provided the department with the information below indicating that at:ihe des of�j�h�
above-named decedent you were a joint owner or beneficiary of the account identified. �
Remit Payment and Forms to:
AccouniNo.7680360839
Oate Established 03-27-2014 REGISTER OF WILLS
Account Balance $g7,382.94 � COURTHOUSE SOUARE
CARLISLE PA 17013
Percent Taxable X 100
Amount Subjecl to Tax $97,382.94
Tax Fate X 0.150 NOTE^. If tax paymenis are made within three monihs of the
Potential Tax Due $ 14.607.44 decedenfs date of death,deduct a 5 percent discount on Ihe tax
With 5%Discount(Tax x 0.95) $ (see NOTP) due. Any inheritance tax due will become delinquent nine months
afler ihe date of death.
PART $tEP 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 decedenf who was
21 years old or younger at date of death.
Proceed ro Step 2 on reverse. Do nof check any ofher boxes and tlisregard the amount
shewn 26ove as Pofen!ial T2x Dve.
g �The iniormation is The above information is correc[, no deductions are being taken, and payment will be sent
correcl. wi�h my response.
Proceed to Step 2 on reverse. Do not check any other boxes.
p �The tax rate is incorrect. � 4.5% I am a lineal beneticiary (parent,child,grandchild, etc.)of the deceased.
(Select correct tax rete at
right, and complete Part � �p/ I am a sibling ot ihe deceased.
3 on reverse.)
� 15% All other relationships(including none).
p �Changes or deductions The information above is incorrect and/or debts and deductions were paid.
listed. Complete Part 2 and part 3 as appropnate on the back o/this lorm.
E �Asset will be reported on The above-identitied asset has been or will be reported and tax paid with the PA Inheri�ance Tax
inheritance tax brm Retum filed by ihe estate representalive.
REV4 500. Proceed to Sfep 2 on reverse. Do not check any othei boxes.
I
� Please sign and date the back of[he form when finished. �
PART
2 Debts and Deductions
Allowa6le debts and detluctions must meet both of�he follawing cri�eria:
A. The decedent was legally responsible for payment, and ihe estate is insuflicient[o pay the deductible items.
B. Vou paitl the debts afler the death of the decedent and can furnish proof ot payment if reques[etl by the department.
(If additional space is required. you may attach 8 1/2"x 11"sheets of paper.)
Date Paid Payee Description Amount Paid
Total (En�er on Line 5 ot Tax Calcula�ion $
PApT Tax Calculation
3 Ii you are making a correction to the esWblishment da[e Line 1 account balance Line 2,or
( ) ( ) percent tazable(Line 3),
please obtaln a written correction trom the tinancial institution and attach it b this form.
t En�er the da�e Ihe account was established or�itled as i�existed at the date of death.
2. Enter ihe total balance of the account including any interest accrued at the date of death.
3 Enter the percentage oi the account that is taxable to you.
a. Firs[,tletermine the percentage owned by the tlecedent.
'. Accow[5 tha�are held "in�mst�or"ano�her or others were 100%owned by[he deceden[.
ii. Por joint accounts established more ihan one year prior to the tlate of death, ihe percentage taeable is 700%divided
by the total number of owners indutling the decedent. (For example:2 owners= 50%, 3 owners=33.33%,4 owners
=25%,eta�
b. Next,divide the decedenPs percentage owned by[he number of surviving owners or beneficiaries.
4. The amount subjec�to[ax is determined by multiplying the account balance by the percent taxable.
5. Enter[he total of any debis and deductions claimed irom Pan 2.
6. The amount taxable is tletermined by subhacting the debts antl deductions from Ihe amoun�subject ro tax.
Z Enter the appropriale�ax ra[e from S�ep 1 based on your relationship to Ihe decetlent.
If indicating a dif�erent tax rate, please state ��' {)({CId11JSB�0�
your relationship[o the decedent: y Q�F
1. Date Established 1
PA Department of Revenue : �
2. Account Balance 2 $ PAD �
3. Percent Taxable 3 X �
4. Amount Subject to Tax 4 $ 2
3 `
5. Debis and Deduc[ions 5 - q .
6. Amount Taxable 6 $ $' �
7. Tax Rate 7 X s
8. T� Due 8 $ �
$
9. Wi�h 5% Discoun� (Tax x .95) 9 X
.St@P 2: Sign and date below. Return 7YY0 completed and signed copies�o ihe Register of Wills listetl on the Gont of this form,
along with a check for any payment you are making. Checks must be made payable to"Register of Wilis, AgenU' Do not send
payment directly b the Depariment of Revenue.
Under penal�y of perjury, I declare that the facts I have reported above are true,correc�antl complete to ihe best of my knowledge and
belief.
Work
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Taxpaye 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