HomeMy WebLinkAbout04-29-13 COMMONWEALTH OF PENNSVLVANIA REV-11fi2 EX(11-96)
DEPARTMENT OFREVENUE
BUREAU OF INDIVIDUAL TAXES
�EPT.280601
HARRISBURG,PA 1]128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 017552
GREENE SUSAN ELAINE
328 LAMP POST LANE
CAMP HILL, PA 17011
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
------ �a�d
---------- --------
101 � 542,000.00
ESTATE INFORMATION: ssN: ia2-22-s653 �
FILE NUMBER: 2113-0189 I
DECEDENT rvaME: CREE SHIRLEY R �
DATEOFPAYMENT: 05/06/2013 I
POSTMARK DATE: 05/06/2013 �
COUNTY: CUMBERLAND �
DATE OF DEATH: 02/09/2013 I
�
TOTAL AMOUNT PAID: 542,000.00
REMARKS:
CHECK# 528
INITIALS: HEA
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
, REGISTER OF WILLS
BUREAU oF INOIVIDUAL T�ES � pennsylvania
PD BOX 280601 Pennsylvania lnheritance Tax
HARRISBURG PA 17128-0601 Information Notice OEPhRTMENTOFREVENUE
YEY-156}EC OacEXEC lOB-121
And Taxpayer Response FILE NO.2110-0801
RE�l�4�"".� C;::��;��it�'= �F ACN 13031384
�E��SI�;i �iF '';I{i_I._S DATE0402-2013
1�13 APR 29 P(1 �; �6 TypeO,A��ou�t
C�E�iK C+i� EstateofJGCHRISTLIEB Savings
SSN 209-50-9246 Checking
O R P HA N S� C O U r l� Date of Death 06-14-2010 T��St
JANE OBR�111dRFR�AAI� (;O ��� COUntyCUMBERLAND C2rtifiCete
6562 VALLEY"�7�W fzti'
EDMOND OK 73034-8563
REAL ESTATE 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.0 Remit Payment and Forms to:
Date Established 06-14-2010 REGISTER OF WILLS
Account Balance $21,460.00 1 COURTHOUSE SQUARE
Percent Taxable X 8.333 CARLISLE PA 17013
Amount Subject to Tax $1,788.26
Tax Rate X 0.120
Potential Tax Due $214.59 NOTE': If tax payments are made within three months of the
decedenYs 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 dea[h.
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 6oxes and disregard the amount
shown above as Potential Tar Due.
g �The 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 �The tax rate is incorrect. � 4.5% I am a lineal beneficiary(parent,child,grandchild, etc.) of the deceased.
(Select correct tax rate at
right, and complete Part � �2% I am a sibling of the deceased.
3 on reverse.)
� 15% All other relationships(including none).
p �Changes or deduc[ions 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 lorm.
E �Asset will be reported on The above-identified asse as been r will be reported and tax paid with the PA Inheritance Tax
inheritance tax form Return filed by the estate re ative.
REV-1500. Proceed to Step 2 on reverse. Do not check any otherboxes.
Please sign and date the back of the form when finished.
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