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Home My WebLink About11-09-12 (4)y ~ i BUREAU OF INOIVI DUAL TAXES PO BOX 280601 HARRISBURG PA 1]128-0601 ~ PENNSYLVANIA INHERITANCE T y~ INFORMATION NOTICE "~',°~`"`~ r TAXPAYERNRESPONSE' Ga cx <rr ~a5ti~i. J DATE 09-21-2012 EST. OF DOROTNIY P PICCOLO SSN 160-16-1992 DATE OF DEATH 12-31-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SgUARE CARLISLE PA :L 7013 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. ~.7~`lh - ~ 1 iOj ~'~ A MICHAEL p~~~~L i r.v~1 L~,. P 120b MITCHELL'~,DR MECHANICSBURG '. PA 17050-3132 PSECU Records intli Cate that at the dea deceased and any amount oth~ notify the department of yoi If you believe lie informs ti an i it to the above atltlress. Please COMPLETE PART I 1 e,......._ - _ _ _ •~. ut Account Balance Percent Taxable Amount Subject tp Tax Tax Rate Potential Tax Due A. ^ CHECK ONE BLOCK ON B' ^ LY ~' ^ PART If indYcaYing a dif relationship t0 tlBC TAX RETURN - CALCULATI LINE 1. Date Established ~• Account Balance 3. Percent Taxable 4. Amount ;tubjeet to Ta 5. Debts and Detluctions 6. Amount Taxable 7. lax Rate 8. Tax Due PART DATE PAID DESCRIPTION ~'~c center on Line 5 of Tax Computation) ' Untler penalties of perjury I tle Clare that the facts I re portetl above are true, correct antl complete to the best of my knowledge and belief. provided the tlepa rtment with the infprmatf on below, which was used in cal cul atin of the above-named decedent, you were a faint owner/beneficiary of this account. If than zero is reflected Delow on the Potentlal Tax Due line, note no tax may be tdue,~hbutt you must ue. relationship to the deceased by checkin You are the spouse of the ncorrect, please obtain written rorrectipn from 6he Cna ~cf aARinst itUti ° and wri tin 11 717-787-832] with questions. attach a copy to 0th is form and Tr turn LOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS 992-S1 Date 01-20-1989 Esta6115hetl To ensure proper credik to the account, two copies of this notice oust accompany $ 2, 988.58 Paywent to the Register of Wills. Make check ~( payable to "Register of Wills. Agent". 16.667 $ 498.11 X .15 ~ 74.72 NOTES If tax payments are made within three months of khe decedent's data of tleath, deduct a 5 pe reent discount on the tax tlue. Any inheritance taz tlue will become delinquent nine nonYh:: after the date of tleath. above information and tax tlue is correct. Remit pays ent ko the Register of Willz with two copies of this notice to obtain a discount or avoitl interest, or return this notice to the Resister of Wills an official assessment will be issued by the PA Oepa rtment of Revenue. and above asset has been or will be reported and tax paitl with the Penns d by the estate representative. yl vania inheritance tax return above info rna ion is incorrect and/or debts antl deductions were paid. lets PART ~ antl/or PART 3^ below. are nt tax rate, please state lent: OF TAX ON JOINT/TRUST ACCOUNTS ./__ •~- 7 AMOUNT PAID M~ (7 /7 ~~ _ . ~ -~~ ~r P,~d~ Debts and Deductions Date Paid Payee Descrlptlon 1/2/12 Giant Faod Store Amount Pa1d food for meeting at house with family and funeral director 1/6/12 Priests, or anists, altar cash; gift envelopes $58.70 servers at t. Joseph's Church postage stamps for bills, thank you notes, misc. expenses arbara M digan Preston -18 reimbu-rsemen~ fofor incidentals I Walnut S .Mechanicsburg and serving meals on two A occasions immunity Life Team EMS Date of Service 11/28/11 Koste Villa Cafe 'fib I char e Memorial Mass Luncheon Dyer's Flo ers and Gifts wreath for um table chardson uneral Home Funeral Home partial pay inacle He Ith Hospital Date of Service 12/22/11- oracle Hea th Med Services Date of Service 12/221/11- hardson F neral Home funeral home a ante due r arMerica prescription drugs ~quehana ownship EMS date of service 12/28/11- Dept of am ul nce ill venue Pennsylvania personal incom e hopedic In itute of PA Dates of service 11/1/11 and 11/8/11- steroid shots in knee colic Cem Caries openin round at B 8 grave site e Garden Post-interment luncheon fen Living ursing Home - post-surgical care Ridge Mo Main acfe Healt Hospital Dates of service 11/19 -11/28/11 n Balaban co- attorney fees Yer of Will inheritance tax form and e Max inv nt f rm fi in s _~~---- _ -- TOTAL: $7,O:L2.78 li