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Home My WebLink About11-02-12REV-1162 EX(11-961 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TA%ES DEPT. 280601 HARRISBURG, PA 1~128~0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BREITENBACH BARRY 7500 OYSTER BAY WAY MONTGOMERY VILLAGE, MD 20886 ACN ASSESSMENT CONTROL NUMBER ---___ mm TOTAL AMOUNT PAID: REMARKS: SEAL CHECK# 8574 INITIALS: CJ RECEIVED BY: AMOUNT 519.16 GLENDA EARNER STRASBAUGH REGISTER OF WILLS N0. CD 016729 REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES Po Box zaosal HARRISBURG PA 1]128-0601 I am the spouse of the deceased or 1 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 O EPARTMENT OF REVENUE xcv-~s~3 cr moc~EC sae-~z~ FILE NO. 2170 ACN 12158493 DATE 10-24-2012 ~~_/',~ RK C ~tiJ'S CO!.. BARRY W BREITENBACH 917 HAMILTON ST CARLISLE PA 17013-1526 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 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*) /q. /6 due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1: Please check the appropriate boxes below. 1 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. 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. r.. P~l{~~I n~"Inheritance Tax ;;=q f~irrhf~tion Notice And Taxpayer Response -2 PM I=~~ ! y 4.5% I am a lineal beneficiary (parent, child, gnBndchild, 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 b:3ck of this form. The above-identified asset has been or will be reported andl 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 finiished. PART 2 Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach 8 1/2" x 11"sheets of paper.) Date Paid Payee uescnpnon Hmount rasa Total (Enter on Line 5 of Tax Calculadion $ IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY:1-800-447-3020 J~ ..! 1(4~~dy; '^' ~ h ~ ~ j O 3 ~ .J ( ~ ` rl ~ W. T V y` 1 0 0 ~ ~ ~ ~ l 5 y o V ~ ~ d ~ V ~ N L ~ ~ ~ T~ z ~ ~0~ a ~' dd "0~ ~~ ~H8 m m ~ ~ ~~~,0_- --, 5~,~ T m° ~ ~ z , Z-,gONtiill ~ o o ~ 5i ~Zlkd J~~ A -, 1!lnN ~ - z , ~ > ~ ~. ~~ ~.~ ;d!~~' o w 1 n tlti m c*~i •M _~ r- M