HomeMy WebLinkAbout09-04-13 COMMONWEALTH OF PENNSVLVANIA REV-7162 EX�11-96)
OEPARTMENT Of REVENUE
BUREAU OF INDIVIDUALTAXES
�EPT.280601
MARRISBURG,PA 1 J128-O801
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
N0. CD 018104
DUNCAM TAMMY F
1620 PINE RD
CARLISLE, PA 17015
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
"'_'__ roia "_'__'__' _"_'_
13145162 � S1 ,743.33
ESTATE INFORMATION: SSN: �
FILE NUMBER: 2113-0088 �
DECEDENT NAnnE: STONE CHARLOTTE F �
DATEOFPAYMENT: 09/04/2013 �
POSTMARK DATE: 09/04/201 3 �
CouNTV: CUMBERLAND �
DATE OF DEATH: O1/1 2/2013 �
�
TOTAL AMOUNT PAID: 51 ,743.33
REMARKS:
CHECK# 2504
INITIALS: DB1
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
. _ .___...__ . . .
BUREAU OF INfJIYIDWL TA%ES s enns lvania
PU BOX 280601 Pennsylvania inheritance T� P y
HARRISBURG PA 17128•06tl1 Information Notice OEPARTMENTOFflEVENUE
And Taxpayer Response a��''su Ex n«cxec�oe-iz>
FIIE NO.2t 13-0d88
ACN 13145162
DATE 08•26-2013
Type of Account
Estate of CHARLQTTE F STONE . �Savings
SSN Ghecking
Date of Death 01•12-2013 � =' Tyast
TAMMY F DUNCAN County CUMBERLAND � � (�tificate
1620 PINE RD � � � :� _� ,.,.y
CARIISIE PA 17015-4324 w � 'T' '- -
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ORRSTOYtN FZNANCIAI ACMYIS4RS peovided the department with the informatian below indicating that at
the death of the abave-named decedent you were a 'aint owner or beneficia af the account identified.
Ac¢our�t Pio.0 Remit Payenerft and Forms to:
Dete EstaWfshed Ot-12-2013 REGISTER OF WILLS
Acoount Balance $232,439.Q0 1 COURTHOUSE SUUARE
Percent Taxabls X 16.867 GARLISIE PA 17013
Amount Subject to Ta�c $36,740.61
Tax Rate X 0.045
Potentiai T� Due �1,743.3g NOTE": If ta�c payments are made within three months of tbe
decedenYs date af cfeath,deduct a 5 percent discount an the ta.c
With 5qo DiscouM(Tax x 6.95) $(see NOTE"} due. Any inheritanpe tax due will become delinquent nine months
efter the date of death.
�'A� SILp 1 : Piease cfieck the apprapriate boxes below.
A �No tax is due. I am the spouse of the deceased or i am the parent of a decedent wha was
21 years aId a�yaunger at date of death.
Proceed to Step 2 on reverse. Da not check any other boxes and disregard the amnunf
shawn above as Potential Tar Due.
g�The infoemation is The abave i�#ormation is cotrect,no deductions are beirig taken,and payment will be sent
orcect. with my response.
Praceed to Step 2 on reverse. Do not check any other boxes.
� he t�rate is irrcarrect. �`4.59s !am a Iinea3 beneficiary{parent,chiid,gra�dchiid,eto.}of#he deceased.
Select correct t�rate at 7•°,�
right,and complete Part � 1 p=�, I am a sibling of the deoeased.
3 on reverse.)
� 15°l AII other relationships{including no�e).
p �Changes or deductions 7he information abqve is incarrect and/or debts flnd deductions were peid.
listed. Camptefe Pan 2 arrd parf&as appropriata on the back of fhis form.
E �Asset will be reported on The above-identified asset hes been or will be reported and tax paid with the PA Inheritance Tax
inheritance i�form Return iiled by the estate representa#ive.
REV•15b0. Froceed fo Step 2 orr reverse. Da npt chectc any other boxes.
Please sig� and date ihe badc of the farm when finished.
PART Debts and Deductions
2
Alfowa6le debts arx3 deductiona must meet bath of the followir�criteria:
A. The decedent was legaliy responsibie for payment,and the estate is insuNicient to pay the deduatibie items.
B. You paid the debts after the death of the decedent and can fumish proof of payment if requested by the department.
{If additionai space is requiretl,you may attach 8112"x t t"sheets of pape�.)
Date Paid Payee Description Amount Paid
TotaE Er�ter on l'ms 6 a#Ta�c Calculatian $
PART Tax Calculation
� if ya�era mNcing a ewRectl4n to tl�e a�sbiishment ds#e{i.lne 1}�r�t bai�t�{line 2),or percent ta�c�e(i.ine 3},
piease ebtain a wrH�carrectipn from thrs 1inw+cts4 InsHtutiqn arid aki�ch ft to tMs fiorm.
1. Enter the date the account was established ar titled as it existed at the date af dea[h.
2 Enter the roial balarnce of the accounf including any interest accrued at the date of death.
3. Enter the peresntage of the accaunt that is taxable to you.
a. First,det9rmine the percentag@ owned by the decadent.
i. Accounts that are held"in trust for"anather or others were 100%awned by tltie decedent.
ii. For joint accounts eatablished more than o�year prior to the date of death,the percentage taxat�le is 100°Io divided
by the total number of owners inciuding the decedent. (For example:2 awners=50%,3 ownars=33.33%;#:owners
=25%,etc.)
b. Next,divide the decedert's peroeMage owned by the number pf surviving owners or beneficiaries.
4. The amourrt su0ject to tar is deiertnined by mulppiyir�g the account baiance by the parcerrt taacabie.
5. Enter the totai of any dabts and deductions ciaimed from Part 2.
6. The amount taxable is determined by sub[raating the debts and deductions from the amount subject to tax.
7. Enter the apprcipriate ta�c rate from Step t based on your relationship fo She decedent.
It inrlicatir�a�flerenf tax rate,piease state
your relationship to the decedent:
1. Date EBtablished 1
2, Account Balance 2 $
3. Percent Taxable 3 x
4. Amount Subject to Ta�c 4 $
5. Debts and Deductians 5 -
6. Amount Ta�cable 6 $
7. Ta�c iiate 7 X
8. Ta�c Que 8 $
9. With 5% Discount (Tax x .85) 9 X
Step Z: s��a�,a aai��w. �wm�rwo�amp�ec�a a�a s�,�a cop��co me�er or w����s�t o�,cn�r�ont of t��s�r�,,
aiong with a check tor any payment you are making. Checks must be made payabie to egister of 4Yiis;Agent" Do not send
payment directly ro the Department ot Revenue.
Under penalty of perjury, I deciare ihat the facts t have reparted above are irue,correct ar�d nomplete to the 6est of my knowied�e and
beiief.
�'""" ,—.---- Work r Q C� — �7
�4R1@ �Q
Taxpayer Signature Telephane Number Date � � �
IF Y{}U NEED FtJRTH�R RSSiS7AtdGE, GC�F+lTAGT PENNSYt.1t,4N1A [?EPAFiTi41ERiT (,� REVEF}t1E
piSTRICT OFFiCE, OR THE INHERITANGE TAX DIVISiON AT 717-787-8327. SERViGES FOR
TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020