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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
HURST WILLIAM B
624 MILL RACE COURT
CARLISLE, PA 17013
__h_n_ fold
ESTATE INFORMATION: SSN: 545-80-0303
FILE NUMBER: 2108-0137
DECEDENT NAME: STOKES JAMES E
DATE OF PAYMENT: 02/07/2008
POSTMARK DATE: 01/30/2008
COUNTY: CUMBERLAND
DATE OF DEATH: 06/03/2007
NO. CD 009271
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
07500598 I $210.92
,
I
I
I
I
,
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 1013
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$210.92
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO BOX 2B0601
HARRISBURG PA 1712B-0601
-
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 O~ 0131
07500598
07-18-2007
REY-1543A "AFP .n..!oo)
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WILLIAM B HURST
624 MILL RACE COURT
CARLISLE PA 17013
EST. OF JAMES E STOKES
S.S. NO. 545-80-0303
DATE OF DEATH 06-03-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SECURITY
[i] SEC ACCT
D STOCK
D BONDS
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
EDWARD JONES has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, YOU were a beneficiary of this asset.
If you feel this information is incorrect, please obtain written correction from the transfer agent, attach a copy to this form and
return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania.
Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 6931128810
06-27-2006
DaD Valuation
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
4,687.00
100.00
4,687.00
.045
210.92
TAXPAYER RESPONSE
x
x
PART
[!]
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
NOTE: If tax payments are made within three
(3) months of the decedent's date of death,
you may deduct a 5% discount of the tax dUe.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
[CHECK ]
ONE
BLOCK
ONLY
A. ~ The above inforraation and tax due is correct.
~l. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "An and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. DThe above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
C. DThe above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
PART If you indicate a different tax rate, please state your
~ relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSETCS)
LINE
1. DaD Valuation
2. Percent Taxable
3. Amount Subject to Tax
4. Debts and Deductions
S. Amount Taxabll!
6. Tax Rate
7. Tax Due
2 X
3
4
5
6 X
7
PART
[!]
DEBTS AND DEDUCTIONS CLAIMED
DATE PAID
PAYEE
DESCR I PTI ON
AMOUNT PAID
$
and
of perjury, I declare that the facts
of my knowledge and belief.
TOTAL (Enter on Line 5 of Tax Computation)
have reported above are true, correct
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WORK C )
TELEPHONE NUMBER
d;. (/-"$
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable
interest based on information submitted by the transfer agent.
2. Inheritance tax becomes delinquent nine months after the decedent's date of death.
3. Assets held by a decedent "in trust for" another or others are taxable fully.
REPORTING INSTRUCTIONS
PART
1
TAXPAYER RESPONSE
1. BLOCK A _ If the information and computation in the notice are correct and deductions are not being claimed, place an "X"
in block "At! of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of
tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment
(Form REV-1548 EX) upon receipt of the return from the Register of Wills. Do not use the envelope provided.
2. BLOCK B _ If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one
copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 2B0601, Harrisburg, PA 17128-0601 in the
envelope provided.
3. BLOCK C _ If the notice information is incorrect and/or deductions are being claimed, check block "e" and complete Parts 2 and 3
according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register
of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt
of the return from the Register of Wills. Do not use the envelope provided.
TAX RETURN - PART
2
TAX COMPUTATION
LINE
1. Enter the total balance of the account including interest accrued to the date of death.
2. The percent taxable assets owned by the decedent but held in trust for or payable
to another individual(s) (beneficiaries):
1 DIVIDED BY TOTAL NUMBER OF BENEFICIARIES
X 100
PERCENT TAXABLE
Example: Assets registered in the name of the decedent in trust for two other persons...
1 DIVIDED BY 2 (BENEFICIARIES) = .50 X 100 50% (TAXABLE FOR EACH BENEFICIARY)
3. The amount subject to tax (line 4) is determined by multiplying the account balance
(line 2) by the percent taxable (line 3).
4. Enter the total of the debts and deductions listed in Part 3.
5. The amount taxable (line 6) is determined by subtracting the debts and deductions
(line 5) from the amount subject to tax (line 4).
6. Enter the appropriate tax rate (line 7) as determined below.
A. For dates of death occurring after 6/30/94, the tax rates for transfers to spouses are as follows:
1. Dates of death on or after 7/1/94 and before 1/1/95 the rate is 3%.
2. Dates of death on or after 1/1/95 transfers to spouses will be taxed at 0% tax rate.
Note: For dates of death prior to 7/1/94 transfers to spouses are taxable at 6%.
B. Transfers to lineal descendants including father, mother, son, daughter, grandchildren, son-in-law,
daughter-in-law, stepchild and their issue are taxable at six percent (6%). A date of 7/1/2000 and after
are taxable at four and a half percent (4.5%) .
C. Transfers to siblings will be taxed at twelve percent (12%) for dates of death on or after
7/1/2000 .
D. Transfers to all others including Uncle, aunt, nephew, and niece are taxable at fifteen percent (15%).
E. For dates of death on or after 7/01/2000, transfers from a child (age 21 or under) to a
natural parent, adopted parent or step-parent are taxable at 0%.
F. If you change the tax rate, please specify your relationship to the decedent in the area provided.
7. The amount of tax due (line 8) is determined by mUltiplying the amount taxable (line 6)
by the tax rate (line 7).
CLAIMED DEDUCTIONS
PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are determined as follows:
A. You legally are responsible for payment, or the estate subject to administration by a personal
representative is insufficient to pay the deductible items.
B. You actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being claimed must be itemized fully in Part 3.
If additional space is needed, use plain paper 8 1/2" x 11". Proof of
payment may be requested by the PA Department of Revenue.