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Home My WebLink About08-18-15 a�R�^� �F ��^� T^*Es Pennsylvania lnheritance Taz �j �j-�� PennS�/LV8�11B ao eox �mco� • �� DEVApTMENTOFPEVENOE xazaiseuac Pa v�ze-aso� Information Notice And Taxpayer Response ��-��•-�•, FILE N0.2115-0714 RECORD�� C•'"F �E OF ncN isaoma - -' . - ,�'�I I � DATE 07-28-2015 ?p15 FpG 18 �fl 3 51 Tvaeorn��o�� Es�ale o�TORE R JOHNSON Savings X Checking �fi F '. Date o� Dea�h 06-17-2015 Tmst LAURA M RUNVAN (�.��1 R - � � CountyCUMBERLAND C2hifica�e 2769 TANBLEWOOD"S'I""' � � WOOSTER OH 44691 rNc BANK NA provided the department with the information below indicating that at the death ot the above-named decedent you were a joint owner or beneficiary of the account identified. Account No.50070057507 Remi�Paymen�and Forms�o: Date Establishetl OS-14-1986 REGISTER OF WILLS Account Balance $1,605.11 1 COURTHOUSE S�UARE PercentTaxable X 50 CARLISLE PA 17013 Amount Subjec�to T� $802.56 TaxRa�e %0.�45 Potential Tax Due $36.12 NOTE': If tax paymen[s are made within three months of ihe decedenPs date of death,deduct a 5 percent discount on lhe tax With 5% Discount(Tax x 0.95) $(see NOTE') due. Any inheritance tax due will become delinquent nine months atterthe date ofdea[h. PART 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 nof check any other boxes and disregard the amount shown above as Pofenfial Tax Due. g �The information is The above in(ormation is correct, no deduc�ions are oeing taken, and payment will be sent correct. with my response. Proceed to Srep 2 on reverse. Do not check any other boxes. � �The tax rate is incorrect. � 4.5% I am a lineal beneficiary (parent, child,grandchild, etc.) of the deceased. (Select correct tax ra[e at right, and complete Part � �p� I am a si6ling of Ihe deceased. 3 on reverse.) � 15% All other rela�ionships(including none). p �Changes or deductions The information above is incorrect and/or debis and deductions were paid. listed. Complete Part 2 and part 3 as appropriate on the 6ack ol this lorm. E �Asse�will be reported on The above-identified asse�has been or will be reported and t� paid wi[h Ihe PA Inheritance Tax inheri�ance tae form ReNm filed by�he esta�e represen�ative. REV-1500. Proceed to Step 2 on reverse. Do nof check any other boxes. � � Please sign and date the back of the form when finished. PART Debts and Deductions 2 Allowable debis antl tleductions must mee�both of ihe following criteria: A. The decedent was legally responsible for payment,and ihe estate is insufficient to pay the deductible items. B. Vou paid ihe tlebis after the death of[he decedent and can Wmish pmof of payment if requested by the depariment. Qf adtlitional space is required, you may attach 81/2"x 17"sheets of paper.) Dale Paid Payee Description Amount Paid Total (Enter on Line 5 of Tax Calcula�ion) $ PART Tax Calculation 3 H ou are makin a correction to the establishment da[e Line 1 account balance Line 2 ,or y g ( ) ( ) percent taxable(Line 3), please obWin a wrinen corcec�ion irom ihe financial instifution antl attach if io Ihis tortn. t Enter the date the account was esta6lished or titled as it existed at ihe date of death. 2 En�er the total balance of�he account including any interest accrued at�he da�e o�dea�h. 3. En�er�he percentage of the account that is taxa6le to you. a First,determine the percentage owned by Ihe decedent. . Accounts that are held "in tmst for"another or others were �00%owned by the decedent. ii. For join[accounis established more Ihan one year prior to the date of death,the percentage taxable is 100%divided by the�o�al number o�owners including the tlecetlenL (For example:2 owners=5�%,3 owners=33.33%,4 owners =25%,etc.) b. NexL. divide Ihe decedenfs percentage owned by the number of surviving owners or beneficiaries. 4. The amouM subject to tax is determined by multiplying ihe accoun�balance by the percent taxable. 5. En�er�he total of any deb�s and deductions claimed from Part 2. 6. The amount taxable is determined by subiracting the debts and deductions from the amount subject to fax. 7. Enter the appropriate tax rete from Step t based on your relationship to the decedent. If indicating a diHeren�tax ra�e, please state �((�gjy��Sy p��y'��p� your relationship[o lhe decedent: pA�C(f8({777EI1[�Of flBYBfip@ 1. Date Established 1 2. Account Balance 2 $ PA� 3. Percent Taxable 3 X � 4. Amount Subject ro Tax 4 $ 2 $ 5. Debts and Deductions 5 - 4 - 6. Amount Taxable 6 S � 7. Tax Rate 7 X 6 e. 7ax �ue e S 7 �� 8 9. Wi[h 5% Discoun( (Tax x .95) 9 X .. . . . StBP 2: Sign and date below. ReWrn TWO comple[ed and signed copies to the Re9ister 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,Agen�" Do not send paymen[directly to the Department of Revenue. Under penalry of perjury, I declare�hat the fac�s I have reported above are true,correct and complete to the best of my knowledge and belief. �� wo�k 330-3»- oio `� Homea330-3i9-a/Oy ��li �' Taxpayer Signatu 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 HEARWG AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 � 1 .' y � r' - i �� ` � r �{j/ _ ; � �t�t '! _ ffi " _ i '�; � _ �: s; a �' = � � � � = ; � � � _ ' 1 = �' � � �- �-- n �" � _ o, ` j ii � �n i�, � l q _ � li*i l� � � N � � 4 � �'j � r �. � � � � i�awno � 7 3 < I';,IdaO � � � �� d I; E W ; 8T 9fU �Iu� �� `� sr��, � ;s�a � �, �o a�i��:; �;azoo3a � ' � 9 u ry � 3 � � .AeL::.�.��.�.JJ.c�'�.i•.�'�:•L��'F��.': ti��;��t71;��1'�J.,y\'.fG;\'`.'f1:\�'fl-��l-�;f�=�\'��=� i;J�\ l,,,\G/_\��/�\tirG��\//�//j�\\�f1�\��1!\�� ?`''s��\/i\�_�i'/\��?�'f._r,'�;:l_�'{/.\��\~�/ \ F�ti�!%:!'.,y\�Il j,�\jj;i�\:�_�\:�j;`�:fl_•,:�;%f_\:f//,��'.:%'� .�O'l�f'\�'f1�i�"JIS\\i:�:��°'/l/_Q!lj.��:f/\11\%.:� %/;\� �1\ f1:\�fj� \/�\� 9/i�%l,\�,fj�\/1l_�C:% �:r�:\y��_��%jf�\:fj��ti'.Yl/.;\\:f1�\'l_1,_\:�/_\�f�'� ��1�'f%�\~'�1.\~'l/_\�'�l�\'l1�\:l/;\��%1\��'`��J ��gi�_`C�'�j��\.J:\'�l�\:j/_\�;ll`\\�'f/j:��'//i;��\j'//j�ti �_�\.l1,.\\�t�_�t1•`\:7��\�_1,_\�f_��fj�l��'�'''''. \\'.fG`_:'%!_\��f1 z\%1_\�'�/�\:%^�\�f,j��'?l_\�:�1t� Jj��\I/��\/j_�\//1�\//f_\OG1\�1�\f/\��'��' �...0!%f;\ti;'fjji�?%��\�%\\;1/,\�'�/_.,;\�`�/:\/l��.�f:: !'(/j�\j%�,.\:l/p\\///�\'rl\\f/\f/\11\��!\�y t��s':��1'�`�1��*��`��'��'f�`�4�r�-�~�/��,�f�� .f,\�_f,-\�.//.\�./�.`�.�j`��_`�.lf��f��/j;�\vi i\\�/.�:t/�\1�ls.\��_\~f/_\f/7\\!//�!1/\`l/p� ,.��_\�:lj;��vjll_�\Fj/,_�\:�!/,_\%1_,,:�N%1\��/\'f�Q\i .��.��`��j��;Y��!j�_�>j��:��0'?l��\�%j_,.�0'i%j\�!�l�� '.%l/,\`�/\{1�\��1\�_1.\\f/\f1\f1\��1\\: :\'i�;\�'�1t\`'�/:\1;f1,,_\�I/_,_\�/\\fjG_\//�_�\//f:: �%�;�\:r�_�\�%f_\�.I/;\,'fl/.\'f/_,_\�'�1�;\:�/�\%li\\�; :.��/;,�;'//j;�\//�z\;lji�\�j,_\1li\\//1..\��i\\i�r: 'f/\t�1\,'�/\�1\�`�l\ff\�f1\�Q��/_ ��> :.\'f/_.,�\'ll_`��/j��\�jjL�\'.lj_�\�'//�;�1;%/,:\:!/_\�'!%�:�� ;f�_�\,j��\'.'//>L�\//j��\'.F1'.\\/l\�'l1\~11\,:�/\\':, �\'fi_\%�1_\��/+\\,!/_�\//.`\f��\fj/_..\1 l_l.�\'.1>>': '�1;\\;%1�\\'7l/,_\\�j,_\�'�l�\'f/L\'f�_��f�_\%f�'�1��. ;`\:%j\\'.fj_\\'.fj�Q'�/l_\�'f1_..:\'11\�;1��.f1.\:'///� ;lj�ti\.'//j_�\�'f/j,\.�/,�\�'%l:\��/.,\'�/\�f!\�''�1 j��. i`�/f,�?'fj�_`I�i�\%j�_�\%/,`\fj�L�\fj/�\fj,��11•: .//��1,fly�,j�_`\fjjL�\,`//j,�\j/,_�\�%_�\fjj�\�'//�;\:, s\'!<<\'f/�,\11;\�'/1_.y\�1_.,;\��1�\\fj/\\Qj;Q'//j; ;y�\�;lj;�\��j_Q\��j;��v'//j;.,.�0'�`//��f��\�:(11_.,.\'%/:\-. .\�,�j1�1,/�_�/�,�\�'//j��\fjj�\!/�_�\//��\f/jt`\lj ,i'//j_�\;ljF��O'?'//j��\%%/:\�%j��\�'//j4�\�Yj_�\�%�\�'�1�\ :\'�l_\,�J1L`��t��=`f�-��f��\��\�l`�,'f� ftj_�\'.f1_\1'l1i\�'f/i\'�/.\�f�'\�%1;r�:j�-�\�fj\\ ;:\'%f;\�'�/t\��;\��1�_�\//j,�\//1�\f1\11_.,!\�%l. >?`!/j;O'fjy.\'f/i\,'�1:,.\:�/_._\�'�1 r\<:f1�\~,%1�\�v��\ ;;\\fjf_�\%j_O//fy\!/j_�\//l�\//�\�l\`��/_��f `_�i,\` /'-\�.�'t\�./�,\�.�1,\��/'.��;/f.��/�V�`�/�;�� ;�\�;l/:\�;�1:\��l:\'%1_•-\\//_�11�\\/�_�\//�:\%i �%i.�\//i��\'.%1\��1,.\�'�.\��l��fl`*��