HomeMy WebLinkAbout03-21-13 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT,280601
HARRISBURG,PA
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 017357
CALLEN CHRISTOPHER
124 FIFTH STREET
HANOVER, PA 17331
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold ----- --------
13031305 $2,823.08
ESTATE INFORMATION: SSN:
FILE NUMBER: 2112-0652
DECEDENT NAME: CALLEN MATTHEW III
DATE OF PAYMENT: 03/22/2013
POSTMARK DATE: 03/21/2013
COUNTY: CUMBERLAND
DATE OF DEATH: 05/01/2012
TOTAL AMOUNT PAID: $2,823.08
REMARKS: CHRISTOPHER CALLEN
CHECK# 142
INITIALS: WZ
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES Pennsylvania Inheritance Tax Pennsylvania
PO BOX 280601
HARRISBURG PA 17128-06 01 Information Notice DEPARTMENT OF REVENUE
REV-1543 E%OOCEXEO 100-12)
And Taxpayer Response FILE NO.2112-0652
ACN 13031305
RECORDED PFFICE OF DATE 03-14-2013
REGISTER OF
1013 MHO 22 P19 1_ CC Type of Account
Estate of MATTHEW CALLEN Savings
SSN Checking
CLERK OF Date of Death 05-01-2012 Trust
CHRISTOPH P CALLEN ORPHANS COURT County CUMBERLAND Certificate
124 5TH ST
HANOVER PA 17331-2CMBERLAND CO., PA
124 FIFTH STREET provided the department with the information below indicating that at the death of the
above-named decedent you were a joint owner or be ficiary of the account identified.
Account No.0 Remit Payment and Forms to:
Date Established 0419-2002 REGISTER OF WILLS
Account Balance $125,470.00 1 COURTHOUSE SQUARE
Percent Taxable X 50 CARLISLE PA 17013
Amount Subject to Tax $62,735.00
Tax Rate X 0.045 NOTE': If tax payments are made within three months of the
Potential Tax Due $2,823.08 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
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 XThe information is The above information is correct, no deductions are being taken,and payment will be sent
correct. with my response.
Proceed to Step 2 on reverse. Do not check any other boxes.
C F-]The tax rate is incorrect. Xr 4.5% 1 am a lineal beneficiary(parent,chi grandchild,etc.)of the deceased.
(Select correct tax rate at
right,and complete Part ❑ 12% 1 am a sibling of the deceased.
3 on reverse.) .
15% All other relationships(including none).
D Changes or deductions The information above is incorrect and/or debts and deductions were paid.
listed. Complete Part 2 and part 3 as appropriate on the back of this form.
E Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax
inheritance tax form Return filed by the estate representative.
REV-1500. Proceed to Step 2 on reverse. Do not check any other boxes.
Please sign and date the back of the form when finished.
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