HomeMy WebLinkAbout09-16-15 auaenu or �xorv�ow� uzss pennsylvania lnheritance Tax ��� Pennsylvania
PO BOX 36Y601 �� OEPAflTMENTOFPEVENUE
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. - ��� i � RLE NO.2115-0668
� � '-�� ACN15138280
DATE 0745-2015
J_ �. '
� - Type of Account
Oi2Fli�.����� EstateofWILDAHOLD Savings
. Checking
C u f,i I'.��F.I'.� Da�e oi Death 06-042015 X Tms�
LINOA OLO CountyCUMBERLAND CertifiCate
207 S 18TH ST
CAMP HILL PA 1]011-5514
we��s FAR60 provided the department with the information below indicating that at the death of the
above-named decedent you were a joint owner or beneficiary ot the account identified.
Remit Payment and Forms to:
AccountNo.247412061511479
Date Established 04-26-2001 REGISTER OF WILLS
AccountBalance $g,g69.42 1COURTHOUSESOl1ARE
CARLISLE PA 17013
Percen[Taxable X 33.333
Amount Sublect to Tax $2,956.44
Taz Rate X 0.045
Po�en�ial Tax Due $ 733.04 NOTE': I�tax payments are made wi�hin�hree mon�hs of the
decedenYs date of death, deduct a 5 percent discount on the tax
With 5% Discount(Tax x 0.95) $(see NOTE') due. Any inheritance tax due will become delinquent nine monihs
akerthe date of death.
PART SteP 1 : Please check ihe 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 reverse. Do not check any other boxes and tlisregard the amount
shown above ns Fuier�iidl Tex Due.
g �The information is The above information is correct, no deductions are being taken, and paymen�will he sent
correc�. with my response.
Proceetl fo Step 2 on reverse. Do not check any other boxes.
p �The tax rate is incorrecL � 0.5% 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 the deceased.
3 on reverse.)
� 15% All olher relationships Qncluding 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 appropriate on fhe back ol this�orm.
E Asset will be repohed on The above-identified asset has been or will be reported and[ax paid with ihe PA Inheritance Tax
heritanCe��form Retum filed 6y�he estale representa�ive.
REV-1500. Proceetl to Sfep 2 on reveise. Do nof check any otherboxes.
�f
Please sign and date [he back of the form when finished. �
PART Debts and Deductions
2
Allowable debis antl deductions must meet both of the following criteria:
A. The decedent was legally responsible for payment,and the estale is insuNicient to pay ihe deductible items.
B. You paid the tlebts after the death of the decedent and can furnish proof of payment if requested by the depariment.
(If additional space is required,you may attach 81/2'x 11"sheets oi paper.)
Date Paid Payee Description Amount Paid
To[al En�er on Line 5 of Tax Calculation $
PART Tax Calculation
3 N ou are makin a cortection to the establishment dale Line 1 account balance(Line 2 , or
Y 9 ( ) ) percent taxable(Line 3),
please obtain a wrii�en correction irom Me financial Institutlon and atlach it to this form.
1. Enter the date ihe account was esta6lished or titled as it existed at the date of death.
2 Enter ihe total balance ot ihe account including any interest accrued at the date oi death.
3. Enter ihe percentage of the account that is taxable to you.
a. Firs�,de�ermine Ihe percen�a9e owned by ihe deceden�.
i. Accounts that are held "in tmst tor'another or others were 100/owned by ihe decedent.
ii. Por join�accounis eslahlished more�han one year prior�o�he date of dea�h,the percentage t�able is 100%divided
by the total number of owners including[he decedent. (For example:2 owners= 50%,3 owners=33.33%, 4 owners
=25%,e�c.)
b. NeM, tlivide the decedenTs percentage owned by[he number of surviving owners or beneficiaries.
4. The amount subject to tax is determined by multiplying ihe account balance by the percent taxahle.
5. Enter the total of any debis and deductions claimetl from Part 2.
6. The amount taxable is determined by subirecting the debts and deductions from ihe amount subject to tax.
7. Enter the appropriate tax m�e from Step 1 based on your relationship to�he tlecedent.
If indicating a diflerent tax re�e, please state ��r��fl�a ,
yourrelationshiptothedecedent: _..., 1 } �������e _
1. DateEstablished 1 ;y�.M� �s3F� �� „y ��}.;;.
2. Account Balance 2 $ *�g
������� ,���w �4�� � "��.;
3. PercentTaxable 3 X 2
f 'v"�'". er .� `� �"+
a. Amount subject ro rax a S g � ra� ,� �,.
5. Debts and Deductions 5 - 4 . �.� 4� s� �,�„ x
6. AmountTaxable 6 S S � z
� ���t�.�`��..�36�$. x,, � ,;y<:
7. Tax Rate 7 X F =�
B. Tax Due B $ $ ! �� '„ �a � ..� �x
9. With 5%Discount(Tax x .95) 9 X -;,��' g , .
St@P 2: Siqn and date below. Return TWO completed and signed copies to ihe Register of Wills listed on ihe+iront of this form,
along with a check for any payment you are making. Checks must be made payable to"Register of Wilis,AgenC' Do nof send
paymen[directly to ihe Department oi Revenue.
Under penalty of perjury, I tleclare that the facts I have reported above are tme,wrrect and complete to ihe best of my knowledge and
helief.
Work (,
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Taxpayer Signature Telephone Number Da�
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 SPEAKWG NEEDS ONLY: 1-800-4473020