The URL can be used to link to this page

Home My WebLink About01-22-13COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 017079 ELLIOTT LUCINDA H 27 N WASHINGTON ST SHIPPENSBURG, PA 17257 fold ESTATE INFORMATION: SS-v: FILE NUMBER: 21 1 3-007$ DECEDENT NAME: HICKMAN REBEKAH E DATE OF PAYMENT: 01 /22/2013 POSTMARK DATE: 01 /1 9/201 3 COUNTY: CUMBERLAND DATE OF DEATH: 1 2/31 /2012 REMARKS: LUCINDA H ELLIOT CHECK# 1010 SEAL ACN ASSESSMENT AMOUNT CONTROL NUMBER 13102556 ~ 522.73 TOTAL AMOUNT PAID: 522.73 INITIALS: DMB RECEIVED BY: GLENDA EARNER ~TRncRel ir_u REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response ~ Pennsylvania DEPARTMENT OF REVENUE REV-1543 EX DocE%EC (88-12) FILE NO.•~t3 ~~ ~ - ~~ °_ OG~ ACN 13102556 DATE 01-17-2013 LUCINDA H ELLIOTT 27 N WASHINGTON ST SHIPPENSBURG PA 17257-1420 Estate of REBEKAH E HICKMAN SSN Date of Death 12-31-2012 County CUMBERLAND Type of Account Savings X Checking Trust Certificate ~-=-; ~ _. u.-~ ~ ~ rrt r~ ~~ ~- ..n ~~ ...,.~ ::~s:t .µ,~ ., _ _ rv y~ _. . -_ _, ,.t ~.._ , ~. , ,° ~ . ;;~ °'+~ ORRSTOWN BANK provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Account No. 103004043 Date Established 08-12-2002 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due With 5% Discount (Tax x 0.95) Remit Payment and Forms to: $ 1,063.67 X 50 $ 531.84 X 0.045 23.93 REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 NOTE': If tax payments are made within three months of the decedent's date of death, deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent nine months after the date of death. PART St@ 1: Please check the a 1 p ppropriate boxes below. A [~ No tax is due. I am the spouse of the deceased or I am the parent of a decedent who was 21 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. B ~ The information is correct. C ~ The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) ~ p ~ Changes or deductions listed. E ~ Asset will be reported on inheritance tax form REV-1500. 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. 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 Debts and Deductions 2 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.) PART Tax Calculation 3 If you are making a correction to the establishment date (Line 1) account balance (Line 2), or percent taxable (Line 3), please obtain a wntten correction from the financial institution and attach it to this form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "in trust for" another or others were 100% owned by the decedent. ii. byrthe total numbersof olwners nclud ng the de edenrt. r(Fo hexamplef 2 o ne se p50%n3 ownersbl 33.33 ~%4 o n eas = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. If indicating a different tax rate, please state ~ •: ~~~ ~ _ ~- ' ~ `~ your relationship to the decedent: 1. Date Established 1 ~` ~ '~ ° - ~ , ~_" , xf~"~ ~ _ "°; r^r~r,- __ ,. ~. 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 2 ~ 3 X 4 ~ 5 = 6 $ 7 X .,. j ~.i . i >c ~~ ~, 1 .. ,. - -~ 8. Tax .. . f.' a- 7 ; , ~.~ 4.M ;_. E Due 8 ...:. . a~;.,~ ..:; _~~o~ ...:_~..._:... ~ ..__~.... 9. With 5% Discount (Tax x .95) 9 X "" ~"W Step~?a check for any paymentyotu areTmaOk ng Che ks musgbe made payable toegRegister ofIWillseAge the Donnot sendorm, alo g payment directly to 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 7 `7 '" y7 7 r ~ ~~ ,~ /~ ,_ ~, .,,r./.-. ~~~>'~~i~~ Home '71'7 - S3U'~G~ ~ Taxpayer Signature Telephone Number Date r- ~5 -~ ~~ 3 IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DAXPAIYER WITH SPECIAL HEARINGI ANND ORTSPEAK NGIONEEDS 717-787-8327. SERVICES FOR ONLY: 1-800-447-3020 _ .. .,_.___ nasrrintion Amount Paid ~~ ~ v ~, n ~., ~V ~, ~• ~ o ~_ ~ ~ ,~ \~~ V f ~..~. 1 i F''• ~E3 (t~ ~,1 f~~ tt.) \~ E a fi ~~ w~ c ~. ~, to ..y J 1 ;~ i - `~( (:~ ~ }~ r~ ~ { i ~ D f q ^~` ~~~ . ~~.R ;~ i<. (:* i ~ ~ ": i f .,f c i ~ ~ ~~. `' ~ _f ~ ~~ ~ .. 1 ~ ~ S ~y M C r~ a' ~ ~~~ ~~ ~. _ {t ~ ^ _~