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_r;~, C INHERITANCE TAX pennsylvania
BUREAU OF INDIV A~'t95 1 t'.~ V: RECORD ADJUSTMENT DEPARTMENT OF REVENUE
INHERITANCE TAX DIVI t BENEFICIARY FORM ASSETS REV-1604A EX AFP (12-11)
PO BOX 280601, h..~ , ;,,,ry, . • -;-'j
HARRISBURG PA 17128-}060~13
t wtJtU 1 .J FN 12: 2J
DATE 08-01-2012
ESTATE OF WOLF ROGER A
DATE OF DEATH 08-07-2011
i, r FILE NUMBER 21 11-0970
CR~FAN6UUCOUNTY CUMBERLAND
MARJORY J D CO., PA SSN/DC 199-34-9504
366 N 24TH ST ACN 11502648
CAMP HILL PA 17011-3605
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS 4
REV-1604A EX AFP (12-11)
INHERITANCE TAX RECORD ADJUSTMENT BENEFICIARY FORM ASSETS
DATE: 08-01-2012
ESTATE OF: WOLF ROGER A DATE OF DEATH: 08-07-2011 COUNTY: CUMBERLAND
FILE NO.:21 11-0970 S.S/D.C. NO.: 199-34-9504 ACN: 11502648
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
BENEFICIARY FORM ASSETS
NAME OF SECURITY: AMERIPRISE ACCOUNT NO.: 000074232448602
TYPE OF ACCOUNT: (X) SECURITIES C ) SEC ACCT ( ) STOCK ( ) BOND
DOD Valuation .00 NOTE: TO ENSURE PROPER CREDIT TO YOUR
Percent Taxable X 0.333 ACCOUNT, SUBMIT THE UPPER PORTION
Amount Subject to Tax .00 OF THIS NOTICE WITH YOUR TAX
Debts and Deductions .00 PAYMENT TO THE REGISTER OF WILLS
Taxable Amount .00 AT THE ADDRESS SHOWN ABOVE.
Tax Due X .12 MAKE CHECK OR MONEY ORDER PAYABLE
Tax Rate .00 TO: "REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS
A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
PAYMENT: Detach the top portion of this notice and submit with your payment made payable to the Register of
Wills whose name and address is printed on the reverse side.
Make check or money order payable to: REGISTER OF WILLS, AGENT.
REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from
the Department's Web site at www.revenue. state. Pa.us, any Register of Wills or Revenue District Office, or from
the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or
speaking needs: 1-800-447-3020 (TT only).
REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg PA 17128-0601, or call
(717) 787-6505.
DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount
of the tax paid is allowed.
INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to
the date of payment. Taxes which became delinquent before Jan. 1, 1982 bear interest at the rate of six percent
per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on and after Jan. 1, 1982, will
bear interest at a rate which varies from year to year with the rate announced by the PA Department of Revenue.
Rates for years 1982 through 2006 can be found in the Pennsylvania Resident Instruction Booklet (REV-1501),
the Pennsylvania Non-resident Instruction Booklet (REV-1736) or on the Department of Revenue Web site
www.revenue.state.pa.us. The applicable interest rates for years 2007 through 2012 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
2007 8% .000219 2008 7% .000192 2009 5% .000137
2010 4% .000110 2011 3% .000082 2012 3% .000082
Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
notice, additional interest must be calculated.
INHERITANCE TAX
BUREAU OF INDIVIDUAL TAXES ''-f"~'1l`~"D ADJUSTMENT Pennsylvania
INHERITANCE TAX DIVISION f"•.i.'; ~ DEPARTMENT OF REVENUE
PO BOX 280601 REN. tMIARY FORM ASSETS REV-1604A EX AFP C12-11)
HARRISBURG PA 17128-0601
DATE 08-0
a ° 12 ALIG 13 ESTATE OF WOLF1 -2012 ROGER A
DATE OF DEATH 08-07-2011
FILE NUMBER 21 11-0970
MARJORY J DENGLER OtiPHAj v\)~Jh COUNTY CUMBERLAND
19-34-
366 N 24TH ST WMBEBLAND CO., PR ACN/DC 11502648504
CAMP HILL PA 17011-3605
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS
REV-1604A EX AFP (12-11)
INHERITANCE TAX RECORD ADJUSTMENT BENEFICIARY FORM ASSETS
DATE: 08-01-2012
ESTATE OF: WOLF ROGER A DATE OF DEATH: 08-07-2011 COUNTY: CUMBERLAND
FILE NO.:21 11-0970 S.S/D.C. NO.: 199-34-9504 ACN: 11502648
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
BENEFICIARY FORM ASSETS
NAME OF SECURITY: AMERIPRISE ACCOUNT NO.: 000074232448602
TYPE OF ACCOUNT: CX) SECURITIES C ) SEC ACCT C ) STOCK C ) BOND
DOD Valuation .00 NOTE: TO ENSURE PROPER CREDIT TO YOUR
Percent Taxable X 0.333 ACCOUNT, SUBMIT THE UPPER PORTION
Amount Subject to Tax .00 OF THIS NOTICE WITH YOUR TAX
Debts and Deductions - .00 PAYMENT TO THE REGISTER OF WILLS
Taxable Amount 00 AT THE ADDRESS SHOWN ABOVE.
Tax Due X .12 MAKE CHECK OR MONEY ORDER PAYABLE
Tax Rate .00 TO: "REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+)
DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
+ IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS
A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
PAYMENT: Detach the top portion of this notice and submit with your payment made payable to the Register of
Wills whose name and address is printed on the reverse side.
Make check or money order payable to: REGISTER OF WILLS, AGENT.
REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from
the Department's Web site at www.revenue. state. pa.us, any Register of Wills or Revenue District Office, or from
the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or
speaking needs: 1-800-447-3020 (TT only).
REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg PA 17128-0601, or call
(717) 787-6505.
DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount
of the tax paid is allowed.
INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to
the date of payment. Taxes which became delinquent before Jan. 1, 1982 bear interest at the rate of six percent
per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on and after Jan. 1, 1982, will
bear interest at a rate which varies from year to year with the rate announced by the PA Department of Revenue.
Rates for years 1982 through 2006 can be found in the Pennsylvania Resident Instruction Booklet (REV-1501),
the Pennsylvania Non-resident Instruction Booklet (REV-1736) or on the Department of Revenue Web site
www.revenue.state.pa.us. The applicable interest rates for years 2007 through 2012 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
2007 85, .000219 2008 77 .000192 2009 5% .000137
2010 4% .000110 2011 3% .000082 2012 3% .000082
Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
notice, additional interest must be calculated.