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Home My WebLink About02-27-13COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 017239 GIRARD CHRIS 74 LONGSTREET DR CARLISLE, PA 17013 -------- fold ACN ASSESSMENT AMOUNT CONTROL NUMBER ---------- -------- ESTATE INFORMATION: SSN: FILE NUMBER: 2113-0243 DECEDENT NAME: GIRARD NANCY F DATE OF PAYMENT: 02/ 27/ 201 3 POSTMARK DATE: 02/26/201 3 COUNTY: CUMBERLAND DATE OF DEATH: 1 2/ 1 7/201 2 REMARKS: 12169642 ~ 516.62 TOTAL AMOUNT PAID: 516.62 CHECK# 3554 INITIALS: DMB SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH 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 RECORDED IOr i"fDE OF 10I3 FEB 27 P~ 1 17 CLERK Q CHRIS M GIRARD ORPNAHS' CQURT 74 LONGSTREET DR ~gERLANC CC., I'A CARLISLE PA 17013-811 ~ Pennsylvania DEPARTMENT OF REVENUE REV-1543 EX DotEXEC (08-12> FILE NO. 2170 ACN 12169642 DATE 12-26-2012 Estate of NANCY F GIRARD SSN Date of Death 12-17-2012 County CUMBERLAND Type of Account Savings Checking Trust Certificate MEMBERS 1sT Fcu 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. Remit Payment and Forms to: Account No. 81184 Date Established 06-23-1986 REGISTER OF WILLS Account Balance $ 325.92 1 COURTHOUSE SQUARE CARLISLE PA 17013 Percent Taxable X 16.667 Amount Subject to Tax $ 54 32 . Tax Rate X 0.045 f h i hi h h * n t ree mont s o t e : If tax payments are made w t NOTE Potential Tax Due $ 2•~ 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. A ~ No tax is 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. 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. 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 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 Paid Total Enter on Line 5 of Tax Calculation $ 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 :~ C7 m ;~ in' N O O~ .~ ~ cb a D V rr W ~ 01 Q 1./` ~ ;~ 'L` V ` O `` V \n~ \r v v~, ~` /+\ 'M V\ ;,;. i!y~' ',~ pi•- r~; ~ ri 1.* "~' .~ /yy5~' r J^~' ~L ~~. i .~ Q xj ~,.~ 8 ~ ,. 1~~p~ 38Wt1~ :~ :~ '". 4 ; +;. ~¢, ,, S" '~~ "Q ~3jSlg3~ ~ ~~ ~ ~` ~~ ~ ~~~ ~;; Q3880~3~ k . ~~ • 4 ~~,' 1, t l7~ ~ r C ~ ra c; n~ z rf ~. ~; -_ __._ _.. __~_...r.