HomeMy WebLinkAbout10-31-12COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 016721
BREITENBACH RITA G
41 1 EISENHOWER DR
CARLISLE, PA 17013
-------- fold
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
12158495 ~ $19.16
ESTATE INFORMATION:
FILE NUMBER: 21 12-1 151
DECEDENT NAME: BREITENBACH GERALDINE P
DATE OF PAYMENT: 10/ 31 / 2012
POSTMARK DATE: 1 0/31 /201 2
COUNTY: CUMBERLAND
DATE OF DEATH: 10/ 15/2012
REMARKS:
CHECK# 4507
SEAL
TOTAL AMOUNT PAID:
INITIALS: HMW
REV-1162 EX~11-96)
$19.16
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
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.
~ Pennsylvania
DEPARTMENT OF REVENUE
~~~~~~~~~~ REV-1543 EX DocEXEC C08-12)
FILE NO. 2170 ~, ~ ' ~ ~.,"
ACN 12158495
DATE 10-24-2012
11~~
RITA G BREITENBACH
411 EISENHOWER DR
CARLISLE PA 17013-1679
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.
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MEMBERS 1sT Fcu 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. 29327
Date Established 12-20-2004 REGISTER OF WILLS
Account Balance $ 13,449.92 1 COURTHOUSE SQUARE
Percent Taxable X 3.333
CARLISLE PA 17013
Amount Subject to Tax $ 448.29
Tax Rate X 0.045
Potential Tax Due
$ 20
17 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*) r 1, 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 The information is
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.
Pennsylvania Inheritance Tax
Information Notice
And Taxpayer Response
Type of Account
Estate of GERALDINE P BREITENBACH Savings
SSN 195-16-9494 Checking
Date of Death 10-15-2012 Trust
County CUMBERLAND X Certificate
® 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.