HomeMy WebLinkAbout11-09-12 (2)~' (PENNSYLVANIA INHERITANCE TAX
BUREAU OF ]INDIVIDUAL Taxes I NF O RMAT I ON NOT I C'E
PO BOX 280F01 penns,.,~l n~y
HARRISBURG PA 17128-0601 '!.. IC AND FILE N0. 21 12-0958
oOrABrneu adAevehut '' ~ `/'- AXPAYE R ACN 1 2 1 52455
ae. „~~ E1 <rr lq,rle. ~ I ~ RESPONSE
' ~~ ~~~ ~' DA7E 09-21-2012
ELIZABETH PICCOLO
1206 MITCHELL' DR
MECHANICSBURG'~. pA
PSECU
Recortls indicate that at the tlea
deceased and any amount oth~
notify the department of yoi
it to uthelabove atltl ress rmaP~ease
COMPLETE PART 1
Account No. O1
Account Balanc e~
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
r ',,
. - - .. -~ ~?i,t ~.~' ZC
Cl:~: BE~Ri_A~JD C;O~ aA
17050-3132
EST. OF DOROTIiY P PICCOLO
SSN 1li0-16-1992
DATE OF DEATH 12-31-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
provided the department with the information below, which
~ of the above -nametl tle cadent, you were a joint owner/benefi ci ar
relationshi r of this account. If you are the spouse of the
than zero is reflected below on the Potential Tax Due line asnote no talx umay' be tdue,~hbuttanou mustue.
incorrect, please obta en deceased by checking Box C 1n PART y
all 717-78]-8327 with written <prrecti on from the financial instib ufl[OO and Writing "5p0UBe" in PART 2.
ouesti ohs. attach a copy to this form and return
:LOW ~ SEE REVERSE SIDE FOR FILING AND PAYM EN7 INS TR UCTIDNS
.992-S1 Date 01-20-1989
EsYablishetl To ensureproper cretlik to the account,
copies of this notice two
Payment tq the Re oust aeconpany
2,988.58 Sister of Wills. Make check
X 16.667 payable to "Reai star of Wills, Aaen t'•.
NOTEr If tax payments are natle within three
non the of 4he tlecetlant's tlate of tleath,
tleduct a 5 percent tli scount an the tax tlue.
Arty inheritance tax tlue will become delinquent
nine months after the date of tleath.
^_•~~• warnent to the Resister of Wills with two copies of this notice Yo obtain
a tli scount or avoid interest, or return this notice to the Rea i;:t er of Wills and
an official assessment will be issuetl by the PA Oepa rtnenk of Rc~venue.
above asset has been or will be repo rtetl entl tax
d by the estate ropresentati ve. paitl with the Pennsylvania inheritance tax return
AMOUNT PAID
~~hc tenter on Lina 5 of Tax Computation)
Under penalties of pe rd ur I declare that 8
the facts I reportetl above are true, Corr
w e e o f bas m knowl tlea entl belief.
HOMED Erc/'7 ~ya
XP R SIGNATURE ~~~ ~ C ?/7 ) lpgr q _c~3
i TELEPHONE NUMBER
Debts and Deductions
Date Paid Payee Descr(ptbn
AmOUnt Paid
1/2/12 Giant Food Store food for meeting at house with
family and funeral director
1/6/12 Priests, o anists, altar
cash; gift envelopes $SF
servers at.St. Joseph's Church
1/11/12 Giant Foo Store
postage stamps for bills, thank $320
you notes, misc. expenses
1/11/12 Barbara M digan Preston -18 reimbursement for incidentals $17
N Walnut t. Mechaniaburg and serving meals on two
PA '~ occasions
1/23,/12 Communi Life Team EMS Date of Service 11/28/11 $22
1/23/12 L'Koste Vill Cafe Ambul char a
Memorial Mass Luncheon $40;
1/23/12 Royer's Flo en and Gifts
wreath for urn table $831.
1/23/12 Richardson Funeral Home Funeral Home partial pay $106.1
1/24/12 Pinnacle H alth Hospital Date of Service 12/22/11- $2,0001
1/24/12 Pinnacle He Ith Med Services Date of Service 12/22'/11- $15.(
2/7/12 Richardson uneral Home funeral home ba ance due re $25.(
3/2/12 PharMerica $807 4
3/2/12 Susquehana Township EMS prescription drugs
d 5306.2
ate of service 12/28/11-
3/11/12 PA Dept of evenue ambula ce ill
Pennsylvania personal income $75.0
4/13/12 Orthopedic I statute of PA Dates of service 11/1/11 and $3 0
!, 11/8/11-steroid shots in knee
5/6/12 Catholic Ce etaries
opening ground at grave site $25.4!
5/6/12 Olive Garden
Post-interment luncheon $645.«
5/8/12 Golden Lavin Nursing Home - post-surgical care $299 ~
Bfue Ridge M untain
5/25/12 Pinnacle Heal h Hospital Dates of service 11/19 -11/28/11 $~ ~
8/23/12 Karen Balaba co- s $S00 ~
9/5/12 Register of W Its attorney fees
$250.00
inheritance tax form and
9/5/12 Office Max invent f m filin f s
photocopying for filing $15.00
~ 92
TOTAL• $7,012.78