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Home My WebLink About09-28-15 Ef1REAU OF INDIVIDEIAL TAXES �� ."i Po BOX 280601 Pennsylvania lnher�tance Tax � pennsyLvania HFaZRISBUR6 Pq 17128-0662 Informa�iOfl NviiCE �V �=r�KTMENTOFREVENUE And Taxpayer Response REY-1543�=�E<«s_LZ� FILE n0.21 vl �� ACN 15125578 �`� DATE Q5-71-2015 TyK7e of Accoun#,-� Estate of PATRICIA A HAWKINS � ��a "'' Savcn sr -; SSN 179-4-4-8407 ' �:~' � Date of 05-2015 - '''�hecl4ing-- DONNA L NEGLEY County CUMBERL4ND ` Trus� ' 202 WHISKEY RUN RD '� Certificate NEWVILLE PA 17241-8612 �. ,;: _�� . �_ . , , �' . acr�s 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.90002623Q5 Remit Payment and Forcns to: Date Esfablished 06-22-2012 REGISTER OF WILLS Account Balance $73,166.62 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $36,583.31 Tax Rate X 0.045 Potential Tax Due NOTE*: If tax $1,646_25 payments are rnacfe within three months of the With 5%Discount(I ax x 0.95) $(see NOTE') decedenYs date of death,deduct a 5 percent discouni on the tax due. Any 6nheritance tax due wilt become delinquent nine months after the date of death_ P;RT Step 1: Ptease check the appropriate�oxes below. A ❑No ta�c is due. 1 am the spouse of th�deceased or I am the parent of a decedent who was 27 years old or younger at date of death. P�oceed to Step 2 on reverse. Do not check any other boxes and disregard the amount snorvn above as Potential�ax u�e. B �The information is The above information is carrect,no deductians are being faken,and payment will be sent correct. with my response. Proceed to Sfep 2 on reverse_ Do nat check any otl�er boxes. C �The tax rate is incarrect. � 4_5% I am a lineal beneficiary(parent,chifd,grandchild,etc.)of the decsased. (Select correcf tax rate at right,and complete Part � �2o�a ��sibling of the deceased. 3 on reverse.) � 15% All other relafiortships (including none). p �Changes or deductions The infarmation above is incorrect and,�or debts and deductions were paid_ listed. Complete Part 2 arrd art 3 as P appropriate on the back of thrs form. ��S �a� ��E �Asset witl-be reported on The above-identified asset has been or will be reported and fax paid with the PA Inheritanc � inheritance tax form Return fited by the estafe representafive. e�� REV-1500_ Proceed to Step 2 on reverse. Do not check arry ofher boxes_ �� Please sign and date the back of the form when fiinished. PART Debts and Deductions 2 Allowab{e debts and deductions must meet both of the foflowing criteria: A_ The decedent was legaf�y responsib[e for payment,and the estate is insufificient fo pay fhe deductible items. B. You paid the debfs after the death of the decedent and can furnish proof of payrnznt if requested by the aepartment. (!f additional space is required,you rnay attach 8 1/2"x 11"sheets af paper_) Pa ee Descripfion Amount Paid Date Paid Y Total(Enter on Line 5 of Tax Calculation) $ PART T�( CaICI.lISflOfl 3 �_ „.. �....__. ..r.._ �—......,,� If s�+nT_�ro m�kir��e_�o�tin!t tr,a#!�n g_#`?i+(i_�?r!'Lgnt rlatg`I�ne��?�4^C!!!}�lgnro!1 inrva 7\ nr rorr�nt+�va�ln!1 inn r��sQ obtain a written correct�on from the financial institution and attach it to this form 1. Enter the date the account was established or titled as it exisfed at the ciate 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 taxabke 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. ii. by the totalu mber oolwne s nclud g the dececient r(Forhexamplef 2 ne e p50%n3 ownersbl 33 33%/4 o ne�rs =25%,etc.) b. Next,divide the decedent's percentage owned by the nurnber of surviving owners or beneficiaries. 4. The amount subject to tax is 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 taxabie 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. �. � �v�� a 2�§ �,� ct�� i��b x � xa:' +� V ` t , � flf��ta�ll��On�y � �A��t��: � � � If f�li'JIC3[iilg 8 Cfi�2F8�it Z3X(8t2, 1B3SB St3t2 �, 'ee t 1 �� ,;n n oe. -�'"� �+ ` s`°�`'"�td �;;`�` i,a'e?`' your reEationship to the deeedent: �"�' Y`�`��; �` � � x`�'`��''�°� ��j4� � � y�� PA Depar'�men��Rsvenue �� , � :� , � � = ti,�5x 1. Date Established 1 ��`y� '��'��'�,��,��r��'�'��ysi��%�.��-�'�� `� 4�,�X 2;�, ��'�� v�.t'��4s.`�`r$�' alk�.r ��a�`+t�•k. f�`� ¢.s u ^�*� t si�� P �� ,y .,�, �� w.� �y '� ��i ti t�z .:Cs y��t r,�a tv'}5'��,y_ . `Z. ACCOUfIt 63�3�1C0 �� t �f � �ir � a�xY�' � �� at�,A u��a�:y��.L'^ti��t` � ��F ��.� � � 3 X ��i�rA'`�` �a��z"�'`'a�"�t�'�.�� '�� 1"�'��*�..'��''�'�1�'�``��.�r'a�"'.+�'��w� 3. Percent Taxable h ;'�"�`3� ' �" � " � `� ' ' '�'' � Q ��`"�. , �S t��"S`s"�s`ss.i. L"�u a '�t� a'�t�4ti'ti�.fi$�'X n�r 4�$ � z � 4� �i� F '' � ' a l��t t3s` �?�,hrt aE �.. { k Ai�"SY�31iY �-�. 4. Amount Subject to Tax �'` �u " s�s,��,'"� ,� �` y> �� ;, .�f��;,�`«�`' .�` � �,''� .« ,�x.�„ zzy . � � r -F ' AY� `��'. $'�.� n )i �y(�.i� !}�1 �. �s7.�`�a°�.,r+ru'r�l �Xt q.k:"}e 0.� ��. @ .�i ��Yl��'�G��`�� F��" ''l � c 1�.�� a '4�n }' k�. -.. .a 5}...; 5. Debts and Deductions 5 � �„ � ,�,�� j� , � , �� ,� � � � B. AIT1OUflt T1XalJIe C) W J`i�s•�.� �s t S�}q�..�k Y �tx i?+G �a ev a`� t�'.� �� "Y g ��ctt� 7,+, � �. �,��t��u�.�''"��"a�j�F�''��- �"a'�`i�y�v � .�`��w.�z�. 1 � � a „h t� e �14� � 7. i ax Ratz % l� �3��"e`��i, ��'s,��J�`��e°\��d�,�e 3..�:�r a�.�'� t��'`4.�,E »?�u� � ��fi � 1 . �� i � 8 � ��i _�,i � �a,�'s `�'S'��.i � �. k��..�'',�''�v��-�v�'a t'�..i"'ns�' i� �.v�i 8. TaJ(�UB �r� � v>�v a��d� 1*a.�:, a' a h R. � � � ' � <� a .� 9. With 5%Discount{Tax x.95) 9 X k.��i:;.�,.�..��.,��,.�._.,. ,:.�;�.. .�.��r�;��.�,�.�,,.,��:r��.�,..,�.wyNy��...�.�.,.�� S#ep 2: Sign and date below. Return 7W0 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 af Wills,Agent" Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare fhaf the facfs I have reported above are true,correct and complete to the best of my knowledge and belief. Work �,,�,y��` �_ Home , =7 �D _ 1 , / .� Taxpayer Signature Telephone Number Date iF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANlA DEPARTMENT OF REVEhUE DIST A'YERSOWfTH SPEC(AL HEAR(NG'AND OR SPEAKING N�E S ONLY78 800 447-30 ORVICES FOR TAXP