HomeMy WebLinkAbout01-02-13
REV-1313 EX (4-10) APPLICATION FOR
pe1111SytV8111c7 REFUND OF Official Use Only
!
DEPARTMENT OF REVENUE PENNSYLVANIA
BUREAU OF INDIVIDUAL TAXES INHERITANCE/ ESTATE
PO BOX 280601 TAX
HARRISBURG, PA 17128-0601 gee Instructions on Reverse
TO: PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
FROM: Official Representative Decedent Information
Name Raymond Sipe Name of Decedent Charles Sipe
Address 321 Run Rd. File Number 21 12-0457
Date of Death 04/08/2012
Carlis{e,PA 17015-8946 Social Security Number 17 -7 -z y - Sy 5~
Phone Number (717) 254-5041
E-mail Address raymondsipe@directv.net
The undersigned requests a refund in the amount of $ 155.77 for the above-referenced
decedent's estate.
REFUND REQUESTED ON:
Original or Supplemental Joint/Trust Assets FIRemainder Return a Estate Tax
PfObAto Return
EXPLANATION OF OVERPAYMENT
L._
a• . r -V 7
Ul
C~J
ld,
I7 rz, Q
ignature D to
Please allow six to eight weeks for the processing of your refund request.
NOTICE OF INHERITANCE TAX pennsytvania
BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP (12-12)
PO BOX 280601
HARRISBURG PA 17128-0601
DATE 12-17-2012
ESTATE OF SIPE CHARLES E
DATE OF DEATH 04-08-2012
FILE NUMBER 21 12-0457
COUNTY CUMBERLAND
RAYMOND W SIPE ACN 101
321 RUN RD APPEAL DATE: 02-15-2013
CARLISLE PA 17015-8946 (See reverse side under Objections)
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-1547 EX AFP C12-12~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE, OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: SIPE CHARLES EFILE NO.:21 12-0457 ACN: 101 DATE: 12-17-2012
TAX RETURN WAS: C ) ACCEPTED AS FILED C X) CHANGED SEE ATTACHED NOTICE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) .00 NOTE: To ensure proper
.00 credit to your account,
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3) 0 0 submit the upper portion
of this form with your
4. Mortgages/Notes Receivable (Schedule D) (4) .00 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) C5) 76,246.12
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) .00
8. Total Assets (8) 76,246.12
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 11.484.16
10. Debts/Mortgage Liabilities/Liens (Schedule I) CIO) .00
11. Total Deductions (11) 11,484.16
12. Net Value of Tax Return (12) 64,761.96
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax (14) 64,761.96
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15) .00 X 00 = .00
16. Amount of Line 14 taxable at Lineal/Class A rate (16) 64.761 .96 X 045 = 2,914.29
17. Amount of Line 14 at Sibling rate (17) 00 X 12 = .00
18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00
19. Principal Tax Due (19)= 2,914.29
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+)
DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID
07-30-2012 CDO16371 .00 3,070.06
TOTAL TAX PAYMENT 3,070.06
BALANCE OF TAX DUE 155.77CR
INTEREST AND PEN. .00
TOTAL DUE 155.77CR
IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
~e
321 Run Rd.
Cadisle, PA 17015
1-4
MW
c\J
r 57
rw• cw< C 1 / 70/
a W
Co
rcr °
°
• +!!lj~~!!l+jJl FF F?Fl/Ff731lE rl F!?~~!(, ( j (
l~~F £?!1311?1l Ftl~3F!l ~~If