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Home My WebLink About08-18-15 (3) a°°�^° °f �^'��"��•� T^*Es Penns Ivania lnheritance Tax �� Pennsy�vania POBO% 280601 Y � OEFNPTMENTOFPEVENOE HARRISBORG PA V13B-O601 Information Notice �� And Taxpayer Response "`�-"�'�`°�"""°•", RLE NO. 2114-0�53 RECOR2: D n,-.I��E OF ACN iaiaasso �cCici�. .- _ onreos-az-zoia ?015 flUG 18 e(� y 05 Type of Accoun� V, ; _ Estate of FOV D WRIGHT Savings � Checking ORPH^, :� ' oeceoroeamm-ii-zoia rr�sc +• �ORO7HY M WRIGHT ��q;-.... � � CountyCUMBERLAND X Cetlificate 444 MOHAWK RO - �� , � - NEWVILLE PA 17241-9424 � - AGNB 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.900043206687 Remit Payment and Forms to: �ate ESWblished 03-12-2014 REGISTER OF WILLS Account Balance $ 727,3W.14 1 COURTHOUSE S�UARE Percent Taxable X 100 CARLISLE PA 17073 Amoun[Subject b Tax $127,350.14 Tax Rate X 0.120 Po�ential Tax Due $15,282-02 NOTE': If�ax payments are made within Ihree mon�hs o�the decedenPs date ot death,deduct a 5 percent tliscount on the tax With 5%Discount(Tax x 0.95) $(see NOTE') due. Any inheritance tax due will become delinquent nine months aherthe da[e ofdeath. 7ART StEP 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 reverse. Do not check any other 6oxes and disregard the amount shown above as Potenfial Tax Due. g �The information is The above information is wrrect, no deductions are 6eing taken, and payment will be sen� correct. with my response. Proceed to Step 2 on reverse. Do not check any other 6oxes. p �7he tax rete is incorrect. � 45% I am a lineal beneficiary (parent,child,grandchild, etc.)of the deceased. (Select correct tax rate at right,and complete Part � �p� I am a sibling of the deceased. 3 on reverse.) � 15% All other rela�ionships (including none). p �Changes or deductions The information above is inwrrect and/or debis and deduc�ions were paid. listed. Complete Part 2 and part 3 as appropriate on the 6ack ol this lorm. E Asset will be repotled on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax inheritance tax form Fetum filed by the estate representa�ive. REV-1500. Pmceed to Step 2 on reverse. Oo not check any other boxes. Please sign and date the back of the form when finished. ]� V PART Debts and Deductions 2 Allowable debts and deduc�ions mus�meet both of lhe following criteria . A. The deceden�was legally responsible for payment,and the estate is insufficient to pay the deductible i�ems. B. You paid the debts after the death o��he deceden�and can �urnish proof of payment if requesled by the department. Qf additional space is required,you may attach 8 1/2"x 11"sheets of paper.) Da�e Paid Payee Description Amoun� Paid To�al Enter on Line 5 of Tax Calcula[ion) $ PAflT Tax Calculation 3 H you are making a correc[ion to ihe eslablishment tlate(Line 1)account balance(Line 2),or percenl taxable(Line 3), � please obiain a written correction fmm the financial ins�itutlon and aitach it to Ihis torm. L En�er the da�e the account was established or titled as it existed at the date of death. 2 En�er�he mtal6alance of�he accoun�including anyin�eres�accrued at�he date ofdealh. 3 Enter the percentage of the account ihat is taxable to you. a. Firet,determine�he percentage owned by Ihe decedent. i. Accounls that are held"in�mst for"ano[her or olhers were 100%owned by lhe deceden�. ii. Porjoint accounts es�ablished more than one year prior to Ihe da�e of death,the percen�age taxable is 100%divided by ihe total number of owners including the decedent. (Por example:2 owners=50%, 3 owners=33.33%.4 owners =25%, etc) b. Next,divide the decetlent's percen�age owned by lhe number o�surviving owners or beneficiaries. 4. The amount subjec��o tax is de�ermined by mul�iplying[he account balance by�he percen�taxable. 5. Enter Ihe total of any deb[s and deductions daimed from Patl 2. 6. The amount taxable is tletermined by subtracting ihe debts and deductions irom the amount subject b�ax. Z Enter the appmpriate lax rate�mm S�ep 7 based on your relationship lo Ihe decedent. If indlcating e tllfferanf lax rate, please state � Qry'jpj� �J�y Qq�Y:�qpp�:y your relationship�o�he decedenL pA DepartmCflZ�{SeVe[i�i@ 1. Date Established 1 {z� �_ PAD��. `z'� '; ' 2 Account Balance 2 $ h, , �>_.�_- �� 3. PercentTaxable 3 x 2. � -�. � "?'?�r�G�?�,.� �. 4. Amount Subject to Tax 4 $ 3 ; 5. Debts and Dedudions 5 - ¢..JL.• � ,, 6. AmountTazable 6 $ � � z 7axAate � X 6�� B. Tax Due 8 $ � � 8 s* - 9_ Wi[h 5%Dlscount(Tax x .95) 9 X - � �� .Step 2: Sign and date below. ReWrn TWO completetl and signed copies to the Re9ister of Wills listed on lhe�ron�of this form, along with a check for any payment you are making. Checks must be made payable to"Fegister of Wills, Agent" Do not send paymen�directly to the Depanment of Revenue. Under penalry of perjury, I declare that the facts I have reported above are irue,correc�and complete to the bes[of my knowledge and belief. ( >1 ) p ��i �O2.L ��.4:0�� /�/Of� �1 71 ( / �� >�5 �/ � Home �"j � � � Taxpayer Signature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DNISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020