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Home My WebLink About08-17-15 (4) BUREAU OF INDIVIDUAL TAXES PO BOX 2BO601 Pennsylvania Inheritance Tax pennsylvania HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE REGORDED 9FIA- FILE NO.2115-0730 MIS RUG 17 1 DATE 07-14-2015 T�e��o�n �i��,.' �/� ' ` Estate odLULU QCHAMBERS ORpHAN�' ',� '� r SSN Checking --- CUMBE��/ .� ,� ' . Da�ofDea�05-28-2015 Trust nQw&LD A CHAMBERS ` � County CUMBERLAND Certificate 2632 noCuLxwD no --- mC ALzSTsRYILLE PA 17049-8243 - ` - - S & T 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.200000185 Remit Payment and Forms to: Date Established 05-07-2015 REGISTER OF WILLS Account Balance $3,235.17 1 COURTHOUSE SQUARE Percent Taxable '`50 CARLISLE PA 17013 Amount Subject to Tax Tax Rate A'0.045 NOTE*: �~^� �a��v�in��emo�o��e P�enti�Tax Due � ~~'^~ decedent's date ofdeath,deduct a 5 percent discount on the tax With 5% Discount(Tax xO.95) due. Any inheritancedue will become delinquent nine months after the date o/death. PART Step 1: Please check the appropriate boxes below. A F-}No tax is due. I arnthe spouse ofthe deceased or U mmuthe parent ofa decedent m/hovxas --' 21 years old oryounger atdate aYdeath. Proceed*rStep 2ooreverse. Dnnot check any other boxes and disregard the amount shown above aoPox*noa/TaxDue. B | |The information is The above information is correct,no deductions are being taken,and payment will be sent correct with my response. Proceed(oStep 2onreverse. Donot check any other boxes. C �-lThe tax rate iaincormect �-1 4�� |omaUne�beno�c|ary(pamnt.chUd.grandchild,�o.)ofMhedeuoasad. L_| � �-/ (So|e�oo��m��at right,and complete.Part 12% |omasibling ofthe deceased. 3nnemoreoj �-� 15% All other relationships(including nune). D | |Ohangeao,deduo�ono The i�ormadonabove�incuneo and/or debts and deduohonowere pu�. �-'listed. Complete Part 2and part Ooaappropriate onthe back o/this form. E Asset will bereported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax inheritance tax form Return filed bythe estate representative. REV'1500. Proceed(oStep 2onreverse. Dunot check any other boxes, .t ----- Please sign and date the back Qfthe form when finished. Ot r 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.) 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. H. 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 taxis 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 your relationship to the decedent: = � �• �� : 1. Date Established 1 2. Account Balance 2 $ 3. Percent Taxable 3 X u 4. Amount Subject to Tax 4 $ 5. Debts and Deductions 5 6. Amount Taxable 6 $ 7. Tax Rate 7 X 8. Tax Due 8 $ 9. With 5% Discount(Tax x.95) 9 X 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 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