HomeMy WebLinkAbout10-26-12BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
MICHAEL A KOSAROWICH
140 CRICKET LN
CAMP HILL PA 17011-8430
Pennsylvania,lnheritance Tax
r' '
r"' ~~ Inforrn'a~ti.bri~otice
~. ~And_Taxpay~elr.~Response
~ Pennsylvania
DEPARTMENT OF REVENUE
,_.~ ~__. REV-1543 EX Doc EXEC (08-12)
FILE NO. 2112-0973
ACN 12155595
DATE 10-08-2012
Type of Account
QR~I ~+:'v~~ `u'J~!~~state of OLGA H KOSAROWICH Savings
~~M~~~1.1~1'~~ ~()„I 142-20-5198 X Checking
Date of Death 08-04-2012 Trust
County CUMBERLAND Certificate
PNC BANK NA 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.
Remit Payment and Forms to:
Account No. 5140269485
Date Established 03-20-1987 REGISTER OF WILLS
Account Balance $ 40
883.00 1 COURTHOUSE SQUARE
, CARLISLE PA 17013
Percent Taxable X 50
Amount Subject to Tax $ 20,441.50
Tax Rate X 0.045
Potential Tax Due $ 919
87 NOTE*: If tax payments are made within three months of the
. decedent s 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 months
after the date of death.
PART Step 1 : Please check the appropriate boxes below.
A ~ No tax is due.
g n The information is
L~ correct.
C ~ The tax rate is incorrect.
(Select correct tax rate at
right, and complete Part
3 on reverse.)
D ~ Changes or deductions
listed.
E ~ Asset will be reported on
inheritance tax form
REV-1500.
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 disregard the amount
shown above as Potential Tax Due.
The above information is correct, no deductions are being taken, and payment will be sent
with my response.
Proceed to Step 2 on reverse. Do not check any other boxes.
® 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased.
12% I am a sibling of the deceased.
15% All other relationships (including none).
The information above is incorrect and/or debts and deductions were paid.
Complete Part 2 and part 3 as appropriate on the back of this form.
The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax
Return filed by the estate representative.
Proceed to Step 2 on reverse. Do not check any other boxes.
Please sign and date the back of the form when finished.
;~
W
W
,~
0
~,M .
},
;;
i~
~~
~
`.~ ~ /~~
l/
r -~.
.L_ `J
a,~ ~y 7~
~ ~'`^` }~
l,' r ..~ ~ ~ ~~~,
G~
'` 'w
~ ~
_
V
~` /
~~
U -i
'3 r
~--
~O p
c~ ~,,,,
y
Y-'a
Q Y
~ 'i =
s U o.
_U o E
~ `t U
~f!
!fi
~j~!
rt~
5
~~~
.t..t
~..._
~• ,
.y...~