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Home My WebLink About08-07-15 . TN oF aemmsnvarvin qEv-t t82 Exlt v98� oEvnrrrmervrornevervue eoaeno or irvomio�n�-a�s HAPPI50LPG�PADI29-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AN� ESTATE TAX OFRCIAL RECEIPT NO. CD 021082 FREEDMAN DENNIS R 321 HILLSIDE ROAD NEW CUMBERLAND, PA 1 7070-7 842 ACN ASSESSMENT AMOUNT CONTROL NUMBER 75506485 � 5157.01 ESTATE INFORMATION: 55N: FILE NUMBER: 2115-0669 oECEOENr NannE: FREEDMAN RUTH C � DATEOFPAYMENT: OS/O7/2015 POSTMARK DATE: OH/OC/2015 I COUN7v: CUMBERLAND DATE OF DEATH: �6/�9/2015 � TOTAL AMOUNT PAID: $157.01 REMARKS: CHECK# 3810 INITIALS: CJ sen� RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS �:�� eUREPU �� ,��w� *^•« Pennsylvania lnheritance Tax � � - pennsylvania P� BOX 300601 DEPAPTMENTOFFEVENOE H4RRISBUR6 PR 1]1PB-�601 Information Notice �� And Taxpayer Response Fi�E No.2i i 5,osse� ACN 15506485 DATE 07-28-2015 RE�^.Icr,.".. .., � .'I '.:_S Type of Account ?p15 ql�� 7 p(� p yRstate oi auTH c FaEEOMqrv �security SEC Acct Date of Death O6-W-20�5 Stock OENNIS R FREEUMAN COuntyCUMBERLAND Bonds 321 HILLSIOE RO 11GP�{Qi��' �w�� NEW CUMBERLANU PA 17070-18'92 CUM6EFl.'.-:' " - „ PA EATON VANLE INVESTMENT 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. Remit Payment and Forms to: AccounlNo.5004090022 Date Established REGISTER OF WILLS Account Balance $ 78,363.11 1 COURTHOUSE S�UARE Percent Tacable X 20 CAflLISLE PA 17013 Amount Sublect to Tax $3,672.62 Tax Rate X 0.045 Potential T� Due $16527 NOTE': If tax payments are matle within three months of the decedenYs da�e of death, deduc�a 5 percent discount on the tax With 5% Discount(Tax x 0.95) $(see NOTE') due. Any inM1eri�ance tax due will become delinquent nine months afler�he date o�death. 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. Pruceed to SYep 2 on reverse. Do not check any other boxes and disregard the amounf shown above as Potential Tax Due. g �The informa�ion is The above information is correct, no deductions are being taken, antl payment will be sent correct. with my response. Proceed ro Step 2 on reverse. Do not check any ofher boxes. � ❑The tax rate is inwrrect � 4.5% I am a lineal beneficiary(parent,chiltl, grandchild, eta)of the deceased. (Select correct tax rate at right, and complete Part � �p� I am a sibling of�he deceased. 3 an reverse.) � 15% All other relaYionships (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 appmpriate on the back ol fhis lorm. E �Asset will be reported on The above-identified asset has been or will be repotletl and tzc paid with the PA Inheri[ance Tax inheritance tau form ReWrn filed by the estate representative. REV-1500. Proceed to Sfep 2 on reverse. Do not check any other boxes. � Please sign and date the back of the form when finished. PART Debts and Deductions 2 Allowable debts and deductions must mee�both of the following cri�eria: A The tlecetlent was legally responsible tor payment, and the estate is insuHicient to pay ihe deduc[ible items. B. Vou paid the debts after the death of the decedent and can furnish proof oi payment if requested by the department. Qf additional space is required, you may attach 8 V2"x 11"sheets of paper.) Date Paitl Payee Description Amount Paid Total Enter on Line 5 of 7ax Calculation $ PART Tax Calculation 3 It you are making a correction to the establishment tlate(Line 1)account balance(Line 2),or percent taxable(Line 3�, please oblain a written correction from the tinancial mstitution 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 ihe account including any interest accmed at the tlate of death. 3 Enter the percentage of Ihe account that is taxable to you. a First,determine�he percentage owned by the decedenl. i. Accounts that are held"in hust for"another or others were 100%owned by ihe decedent. ii. For joint accounts established more than one year prior ro the date of death,the percentage tanable is 100%divided by lhe to[al number of owners including[he tlecetlenL (For example:2 owners=50%,3 owners=33.33%,4 owners =25%, etc.) b. Next, divide the decedenPs percentage owned by ihe number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying ihe account balance by the percent taxable. 5. Enter ihe total o�any deb�s and tletluc�ions claimed irom Part 2. 6. The amounl taxable is de�ermined by sub[racting the debts and deduc�ions from�he amount sublect�o tax. 7. Enter�he appropria�e tax rate irom Step 1 based on your relationship to�he decedent. If indicating a different tau rate, please state {�((q�(f�Q�u.(�qqF your relationship to the decedenc pA Uepartt71er1t 9f RSvenUe„`y y 1. Date Established 1 2. Account Balance z S �p� - 3. Percent Taxable 3 X � - ,2 � 4. Amount Subject to Tax 4 S 3 ,,,a» .�� 5. Debls and Deductions 5 - .Y � 6. Amount Taxable 6 $ � 7. Tax Ra�e 7 x � e. Tax Due 8 $ � � 9. Wi�hS%Dlscaunt(Taxx .95) 9 X St2P 2: Sign and date below. Return TWO comple[ed and signed copies to the Regisler of Wills listed on Ihe front of ihis form, along with a check for any payment you are making. Checks mus�be made payable to"Re9ister of Wills,Agent" Do not send payment directly ro the Department of Revenue. Under penalry of perjury, I declare that the tads I have reported above are tme,correct and complete to ihe best of my knowledge and belief. wo�k n�� 7�y 4L� ( l��,s^/1v-o � ��/11��✓�0� Home -]!'1 G45J.5 � �' I( Ill Taxpayer Signature Telephone Number Dat IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 777-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 ` ' `' � '.��,rE OF J.� �� FS: �. 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