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HomeMy WebLinkAbout03-06-13COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT RINES NICHOLES S 9218 OAK RIVER DRIVE W SOUTH CHESTERFIELD, VA 23803 -- ----- ,eld ESTATE INFORMATION: FILE NUMBER: 211 1-1 1 16 DECEDENT NAME: STONER GRACE E DATE OF PAYMENT: 03/06/2013 POSTMARK DATE: 03/04/2013 COUNTY: CUMBERLAND DATE OF DEATH: 09/30/201 1 REV-1162 EX111-961 NO. CD 017275 ACN ASSESSMENT AMOUNT CONTROL NUMBER 13031133 ~ 53,566.02 TOTAL AMOUNT PAID: REMARKS: CHECK# 2226 SEAL INITIALS: HEA RECEIVED BY 53,566.02 DA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES PD BOX 28060] HARRISBURG PA 17128-0601 RECaRtiED OFD Pennsylvania Inheritance Tax Information Notice And Taxpayer Response E OF CLERK C. NICHOLE RINES ORPHANS CQURT 9218 OAK RIVER~',~fpFR! dtJ(1 CO. 3~A S CHESTERFLD VA Pennsylvania DEPARTMENT OF REVENUE PFV-1343 EM UecF%EC (OB.Ii) FILE NO. 2111-1116 ACN 13031133 DATE 02-07-2013 Estate of GRACE E STONER Date of Death 09-30-2011 Coun[y CUMBERLAND Type of Account Savings Checking Trust Certificate Z ~1- 35- 444 5 SS/l/ Skp t~o~h~er ~~ ~s~~a t'~'L°'t'~-~`-t Q5 ~,;~;~ WOODMEN OF THE WORLD 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. 99999 Date Established 09-30-2011 REGISTER OF WILLS Account Balance $ 79 244 86 1 COURTHOUSE SQUARE . , CARLISLE PA 17013 Percent Taxable X 100 T S b 79 244 86 ject to ax Amount u $ . , Tax Rate X 0.120 e months of the thr ithi If d TE' e w n e tax payments are ma : NO Potential Tax Due $ 9,509.38 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. 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 wilt 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 z 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.) oats Paid Amount Paid Paves Description Total Enter on Line 5 of Tax Calculation $ 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 to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true, corr ct a d complete to the best of my knowledge and belief. ~ ~~ ~ ~ I / ~ ~ ~ ~Q Y Z ~.(~~O~AA/1(I/ll _ Home ~04 SAD l4S g z124/fL 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 ~~ N C~ .~ ~~ N~ '^f \~, ~' 4~• ESI \. ~? U~ a ~ ~~ ~" ~. - - - o -: _ CH ~Jd •~o~ aNVlb3awn~ -~ l~^O~ .SNVHdtlO ~ _ '~ ~d31~ f~I !'~ q BMW E?r;~ °, s A AIL ~ O r Ru ' ~ x