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Home My WebLink About08-06-15 euxEeu or �xomow� uxes Pennsylvania lnheritanceTax �� Pennsylvania PO BOX ]80601 ��i OEPAPTMENTOFqEVENUE XIRRISBIIPG PA V10B-0601 Information Notice AndTaxpayerResponse Fi�EN0.2iia-oea3 '�•-��, RECORCE^ �',"�� .� Or ncN isissasa DATE 07-23-2015 ��]S ,fj;j� 6 C� 12 SZ Type of Account Estate of ANN M BERG Savings C;_�_, , �Checkmg QRp�,Q,!, . � DateofDeatho9-142o1a Tmst KAREN A GROVES � CounryCUMBERLAN� Certifiwte 14144 FLAGSTOf��;;;.,"� '� SAINT PAIIL MN 55124-5017 SANTANOER BANK provided the department with [he information below indicating that at the dea[h of the above-named decedent you were a joint owner or beneficiary of[he account identified. Account No.1687071798 F1emi[Payment and Forms to: Date Established 12-07-2011 REGISTER OF WILLS Account 8alance $84,176.30 � COURTHOUSE SQUARE Percen[Taxable X 16.667 CARLISLE PA 17013 Amount Subject to Tax $14,029.66 Tax Rate X 0.150 Potential Tax Due g p,�pq_q5 NOTE': If[ax payments are made within three moNhs of the decedenPs date of dea[h, tleduct a 5 percent discount on the tax With 5%Discount(Tax x 0.95) $(see NOTE') due. Any inheritance tax due will become delinquen�nine months afler the date o�death. PART St2P 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 2verse. Do not check any other boxes antl tlisregard the amounf shown above as Potenrial7ax Due. g �The information is The above information is correct, no deductions are being taken,and paymen[will be sent correct. wi�h my response. Pioceed ro Sfep 2 on reverse. Do not check any other boxes. � ❑The tax ra�e is inwrred. � 4.5% I am a lineal beneficiary (parent,child,grandchild,etc.)o�the deceased. (Select correc�lex re�e et right, and Comple�e Part � �p/ I am a Sibling o�the tleCeased. 3 on reverse.) � 15% All other relationships (including none). p �Changes or deductions The information above is incorrect and/or debis and deductions were paid. lis[ed. Complete Part 2 and part 3 as appmpriafe on the 6ack o!this lorm. E �Asset will be reponed on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax inheritance tax form Retum filed by ihe estate representative. ftEV-1500. Proceed to Step 2 on reverse. Do not check any other boxes. � � . Please sign and date the back of ihe form when finished. PART Debts and Deductions 2 Allowable debts and deduc�ions must meet both o��he following criteria: A. The decedent was legally responsible for payment,and ihe estate is insufficient to pay the deductible items. B. Vou paid ihe debts after the death of the decedent and can furnish prooi of payment it requested by ihe department. (tl additional space is required, you may a�tach e V2"x 11"sheets of paper.) Date Paid Payee Descrip�ion Amount Paid Total Enter on Line 5 of Tax Calculation) $ PART Tax Calculation 3 If you are making a wrrection to the establishment tlate(Line 1)accoun�balance(Line 2),or percen�taxable(Line 3), please obtain a written correction hom the financlal Institulion and atlach it to this form. L Enter the date ihe account was established or titled as it existed at the date of death. 2 Enter ihe total balance of the account including any interest accmed at the date of death. 3. Enter ihe percentage of the account�hat is[axable to you. a First,determine the percemage owned by Ihe deceden�. i. Accounts�hat are held"in Ims�for"another or others were 100 0 owned by�he deceden�. ii. For joint accounis established more than one year prior to ihe date of death, the percentage tauable is 100%tlivided by the total number of owners including the tlecetlent. (For example:2 owners=50%, 3 owners=33.33%,4 owners =25%, e�c) b. Next,divide the decedenYs percentage owned by ihe number of surviving owners or beneficiaries. 4. The amount subjec��o�ae is determined by mul[iplying[he account balance by the percen�taxable. 5. Enter the�otal of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subhacting[he deb[s and dedudions fmm the amoun[subject�o�ax. 7. Enter[he appropriate�ax rate�rom S�ep 1 based on your rela�ionship to the decedent. If indica�ing a diflerent lax rate,please sta�e ,:�ffIC�2� �JSE�'.Q ApF your relationship to the decedenC 2' i. oa�e Escabnsned � PA Departmer�t�f Revenue z Account Baiance 2 $ ?AD 3. Percent Taxable 3 X � 4. Amount Subjen to Tau 4 $ Z 3 5. Debts and Deductions 5 - q 6. AmountTaxable 6 $ $ � � 7. Tax Ra�e 7 X 6 8. T� Due 8 8 � � 8 9. With 5% Discount(Tax x .95) 9 X �. , . St2P 2: Sign and date below. ReWm TWO completed and signed copies to the Register of Wilis listed on ihe fmnt of ihis form, along with a check for any payment you are making. Checks must be matle payable to"Register of Wills,Agent" Do not sentl payment directty to the Depatlment of Revenue. Under penalty of perjury, I declare that the facts I have reported above are ime,correct and complete ro ihe best of my knowledqe and belief. S l�`�^� "`�'"� Work njS�- � a'� 7 � �-6J1 Home �l �� 1S Taxpayer Signatur 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 �� a��^� �� ^xEs Pennsylvania lnheritance Tax �� pennsylvania Po eox �90601 ��` OEPAFTMENiOFREVENUE HRRRISBORG PA V138-0601 Information Notice And Taxpayer Response "�-""=""�p"` `•"'� RECORDc� .. -^ICE 0± Fi�eNo.2iia-osaa ACN t5139436 �t�"';'-�.�� - ��";I_!j DATE07-23-2�15 ?015 AUG 6 Pf� 12 52 Type ot Account �� EState of ANN M BERG Savings �I�P�IAi - X Checking Date of Dea[h 09-14-2014 Tmst KA2EN A GHOVES CUMB �. , , Coun�yCUMBERLAND Certi�iCa�e 14144 FLAGSTONE TRL � SAINT PAUL MN 55124-5017 SANTRNOE2 BANK provided the department with the information below indicating [hat at the death o([he above-named decedent you were a joint owner or beneficiary of the account identified. Remit Payment and Forms to: Account No.1561044431 Date Established 11-2&2011 REGISTER OF WILLS Account Balance $65,695.19 � COURTHOUSE S(]UARE Percent Taxable X 16.667 CARLISLE PA 17013 Amoun[Subject to Ta�c $10,949.42 Tax Rate X 0.150 Potential Tac Due $L.642.41 NOTE': It tax payments are made within ihree months of[he decedenYs date of death,deduct a 5 percent discount on[he tax With 5%Discount(Tax x 0.95) $(see NOTP) due. Any inheritance�ax due will become delinquent nine mon�hs afler�he da�e o�death. PApT St2P 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 ot death. Proceetl to Sfep 2 on�everse. Do nof check any other boxes and disregard the amount shown above as Potenfial Tax Due. g �The information is The above information is correct, no deductions are being taken, antl payment will be sent correct. wi�h my response. Proceed fo Step 2 on reverse. Do nof check any other boxes. p �The tax rate is incorrecL � 45% I am a lineal beneficiary(parent,child, grandchild.etc.)of the deceased. (Selectcorrecttax rate at right, and comple�e Part � �p� I am a sibling o�the deceased. 3 on revarse.) � 15% All o�her rela�ionshlps(including none). p ❑Changes or deduc�ions The informa�ion above is incorrect and/or deb�s and deductions were paid. listed. Complete Part 2 and part 3 as appmpriafe on the back o/this lorm. E Asse�will be repatled on The above-identified asset has been or will be reported and tae paid with ihe PA Inheritance Tax inheritance tax form Retum filed by�he esta�e represenlative. REV-1500. Proceed to Sfep 2 on reverse. Do not check any other boxes. � �Please sign and date the back of ihe form when finished. PART Debts and Deductions 2 Allowable debis and deductions must meet both of the following criteria: A. The decedent was legally responsible br payment,and the esta�e is insuRicient to pay the deductible items. B. Vou paid the debts after�he death oi the deceden�and can fumish proof oi paymen�i�requested by[he tlepahment. Qf additional space is required,you may attach 8 V7'x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 0�Tax Calcula�ion $ PART Tax Calculation 3 If you are making a correc[ion to ihe esWblishment date Line 1 account balance Line 2 ,or ( ) ( ) percent taxable(Line 3), please obtain a wntlen cortection from the financial instflution antl attach it to this form. L Enter the date the account was establishetl or titled as it existed at the date of death. 2. Emer the to�al balance of the accoun�including any interest accmed a�the da�e o�death. 3. Enter the percentage of the account that is taxable to you. a. First,determine lhe percentage owned by the decedent. '. Accoun�s Ihat are held"in Imst for"another or others were 100%owned by[he decedent. ii. For joint accounis established more than one year prior to the date of death,the percenta9e tanable is 100%divided by ihe rotal number of owners inclutling the decedent (For example:2 owners=50%, 3 owners=3333%,4 owners =25%, etcJ 6. Nex[,divide the decedenYs percenta9e owned by the number of surviving owners or beneficiaries. 4. The amount subjed to tax is determined by multiplying ihe accoun[balance by the percent taxable. 5. Enter the�o�al of any debts and deductions claimed irom Parl 2. 6. The amount taxable is determined 6y suhtrac�ing the deb�s and deduc�ions fmm Ihe amount subject to tax. 7. Emer the appmpria�e tax ra�e fmm Step 1 based on your relationship to the deceden�. If indicating a diflerent tax rate, please state .�:�(fiq31 U38 Only�O ppK , your relationship to�he decedent � �� P/{�@P3rjmgp�Of.flBV8IRl9 :�. 1. Date Established 1 � � 2 Account Balance 2 8 QA� 3. PerceniTaxable 3 X 2 4. Amount Sublect to Tax 4 $ 3 �. 5. Debts and Deductions 5 - 4 fi. Amount Taxahle 6 $ 5 - 7. Tae Rate 7 x 8 8. Tax Due 8 $ � a 9. With 5% Discounl(Tax x .95) 9 X . .St2F7 2: Sign and date below. Retum TWO completed and signed wpies to the Register o�Wills listed on(he front of[his form, along with a check for any payment you are making. Checks must be made payable to"Register of Wilis,Agent" Do not send payment directly to Ihe Department of Revenue. Under penalty of perjury, I declare that the facts I have repotled above are true,correct and complete to the best of my knowledge and belief. �� Work �5 � - �-�7 � ��37 Home Tazpayer Sign tu Telephone Number Date � 3 l�r- 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 : � � d s RECORD:•"� �`.,-�I�E OF o � � iiEGi._",_ �-� P,'�,_�_S �- za d z � � � ;015 FlUG 6 F(� 12 �2 � a � ^ T CLc Nn p ORPHd'.,F.' �_�:�� . . � n n CUMBEi;,. 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