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Home My WebLink About01-03-13 (2)COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TA%ES DEPT. 280601 HARRISBURG, PA 1]126-0601 RECEIVED FROM: JUMPER DORIS L 1055 MYERSTOWN RD GARDNERS,PA 17324 told PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: FILE NUMBER: 2113-0005 DECEDENT NAME: WEAGRAFF ROBERT H DATE OF PAYMENT: 01/03/2013 POSTMARK DATE: 01 /02/201 3 COUNTY: CUMBERLAND DATE OF DEATH: 1 1 /22/201 2 REV-1162 EX~11-961 NO. CD 016996 ACN ASSESSMENT AMOUNT CONTROL NUMBER 12168041 ~ 58,516.23 TOTAL AMOUNT PAID: REMARKS: 58,516.23 CHECK#1941 INITIALS: HEA sEaL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-06D1 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. ~ Pennsylvania DEPARTMENT OF REVENUE wev-~s~a Ex ooosxE~ roe-,z, FILE NO. 2170 ACN 12168041 DATE 12-17-2012 DORIS L JUMPER 1055 MYERSTOWN RD GARDNERS PA 17324-9037 Estate of ROBERT H WEAGRAFF SSN Date of Death 11-22-2012 County CUMBERLAND Type of Account Savings Checking X Trust Certificate ~m n w mo m -o m2~ =-- J "a a ~~~, T ~ _*J "Ti .;i C7 n C_5 . =3 ,_ PNC BANK NA provided the department with the information below indicating t-at the depth of_thE above-named decedent you were a joint owner or beneficiary of the account iderl~ied. ; , ;~, Account No. 5002021983 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response Remit Payment and Formst"o: `'~ Date Established 02-27-2012 REGISTER OF WILLS Account Balance $ 59,763.00 1 COURTHOUSE SQUARE CARLISLE PA 17013 Percent Taxable X 100 Amount Subject to Tax $ 59,763.00 Tax Rate X 0.150 NOTE': If tax payments are made within three months of the Potential Tax Due $ 8,964.45 decedent's date of death, deduct a 5 percent discount on the tax With 5% Discount (Tax x 0.95) $ (see NOTE') 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. I am the spouse of the deceased or I am the parent of a decedent who was 27 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. 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. 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. 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 Description Amount Pairs Total (Enter on Line 5 of Tax Calculation) $ 4. Amount Subject [o Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due 9. With 5%, Discount (Tax x .95; g X Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent." Do not send payment directly [o the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. Work Home Taxpayer Signature Telephone Number Date 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 ]7 - ,ay, ~ a o i '„T~.d '`^f ~' i-s rt y1 t.~ u` -, ~.:~ e' Ph fri ~~ n ~~ M 0 rn v v d lY N C2 M j o er- J ~ d C T ~ ~ d O C ~ ~_ y 0 ~ g c7 d v.. ,;~, 4' <, i < • :~ ~:; ~; ~ , e:. , ;' d;M Cr. ~,,> C.' ia~ le' G°: C' c ~r~ ~ ~ c u r~ c:v v _ ~ ~ z a v ~ ra,~ \wv`~~\\ ~` "' t ) ~~~ .~ li t)~! ~P~ ~Y$ (•Ft lYj .~..~ 1 ~~i