HomeMy WebLinkAbout09-04-13 (2) ,
COMMONWEALTN OF PENNSYLVANIA REV-1762 EX111-981
DEVARTMENT OF REVENUE
BUREAU OF�N�IVIDUAL TAXES
DEF'i.289ti01
HARRISBVRG,PA t�128�O60t
PENNSYLVANIA
RECEIVED FRQM: tNHERlTANCE AND ESTATE TAX
OFFICIAL RECEIPT
N0. CD 018105
ULSH DEBBIE R
1622 PINE RC3
CAR�ISLE, PA 17015
ACN
ASSESSMENT ANIOUNT
CONTROL
NUMBER
-- *� ------- -------
i3145165 � 51,743.33
ESTATE INFORMATION: SSN: i
FILE NUMBER: 2113-00$$ I
��cEperuT NAME: STONE CHARLOTTE F �
DATE OF PAYMENT: 09/04f 2013 �
POSTMARK DATE: Q8/04(2013 +
COUNTY: CUMBERI.ANQ �
DATE OF C}EATH: 01 J12j2073 �
�
TOTAL AMt3UPIT PAlD: 61,743.33
REMARKS:
CNECK# 179
INITIALS: DB1
sen� REGEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WI�ES
REGi5TER OF WILLS .
i�
pUREAU qF 1NDIVIDWIL TAXES '7Qn(j� �V•dn�•a �n����t•dnL+e T•t� j i� PennsYlvania
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W1R6ISBURG Pa 1712e-tlsol Information Natice �EPAHTMENTOFREVENUE
And Taxpayer Response °FV��ses E�m<excc <�e-�x�
FILE N0.2113-0088
ACN 13145185
DATE 0&26-2013
Type of Account
Estate of CHARLOTTE F STONE �Savings
S5N Checking
Dete of Death 01-72-2073 Trust
DEBBIE R ULSH CouMyCUMBERLAND Certificate
1622 PINE RD
CARLISLE PA 1�015-4324
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aRasTOwa FINpHCIAi ADVISORS pravided the department with the informatian�elow indica ng that aY
the death of the abave-named decedent ou were a joint owner or beneficia of the account identified.
Account No.0 Rem4t Paymant and Forms to:
Date EataWished Ot-12-2�13 REGISTER OF WILLS
Account Balance $p3p,q3g.pp 1 CQURTNOUSE SQUARE
Percent Taxable X 16.657 CARLISLE PA 17013
Amount Subject ro Tax $38,740.81
Tax Rate X 0.045 NOTE': If tax paymeMs are made within three months of the
Potential Tatt Due $1,743.33 ���nYs date af death,deduct a 5 perceM discount on the tax
With 5°/u DiscouM(Tax x 0.95} $isee NOTE') due. Any inheritance tatt due will become delinquent nine months
after the date of death.
�ART S��p 1: Piease check the appropriate baxes belaw.
t
A �No #ax is due. i am the spause of the deceased or I am the parent of a decedent who was
21 years oId or yaunger af date of dea#h.
Proceed to Step 2 on reverse. Da npt check any pther boxes and dis�egar[i ihe amount
shawn above as Potenfiat Far Due=
g �The informatlan is The a�ve infarmation is careci,no deductions are being taken,and payment wi�I be sent
correct. with my response.
Proceed to Step 2 on reverse. Do not check any other boxes.
c ❑7he ta�c rate is incorrect. � 4.5°fe t am a lineaf beneficiary(pa�eM,chiid,grandchiid,etc.)of the deceased.
(Select oorrect tax rate at
right,and complete Part � �p��a I am a sibling of the deceased.
3 on reverse.}
� 15�Ya AI!ather relationships(including none}.
p �Changes ar detluctians The intormatian above is incorrect andJar debts and deductions were paid.
listed. Complete Part 2 and part 3 as apprupriaYe on ihe back of ihis form.
E �Asset will be reparted on The abav�itle�tified asset has been or wii!be reparted and t�paid with the PA Inheritance Tax
inheritance tax form Return filed by the estate representative.
REV-1500. Proceed fo Step 2 on reverse. Do not check any other boxes.
Please sign and date the back of the farm when finished.
PaRS Debts and Deductions
s
A1lowabie debts and deductions must meet both af the foilowing criteria:
A. The decedent was fegaily resxmnsible for payme�t,and the estate is insufficient to pey the deductible items.
B. You paid the debts after the death of ihe decedent and can furnish proaf 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
Totai Enter on Line 5 of Tax Caiculation $
PART �T�X Cr�ICUl�tlt?tl
3 H you are makinp a coravacdon to the�Flsh�ru d�W{LI�1}accaunt b�{Une 2},ct p�certi tazaele{�ine 3?,
piease tlbtain a wrltten correctlon hom the tinancGrl lnstkutlon and atlach ft to thfs form.
1. Enter the date the accou�t was established or tiUed as i[existed at the date of death.
2. Enter the totai balance of the accoun[including any interest accrued at the date af death.
3. Enter the peroentage of the account that is taxable to you.
a. First,determine the percentage awned by the decedent.
i. Accounts that are heki"in trust for"anottter or athers were 100%owneti by the deced�t.
ii. Far joint aecounts e&tabiished more than on�year priar to the date of death,the percentage ta��able is 100%divided
by the total number af awners i�cludi�g the decedent. {Far example:2 owners=50%,3 owners=33.93%,4 owners
=25%,etc.)
b. Ne7R,divide the deceder�t?s percanta6s owrred by the numt�r oi susvivi�g awners ar berrefiaaries.
4. The amouM subject ta ta�is determi�d by muttiptyirKy the accpunt balar�ce by the percerjt tauable.
5. Enter the total af any debts and deductions claimed from Part 2.
6. The amount ta�cable is determined by subtracting the debts a�d deductions from the amount subject W tax.
7. Enter the appropriate tax rate frpm$tep 1 based on your reletionship to the decedent.
If indicating a dtffer9M tax rate,plegse state
your reiationship to the decedent:
1. Date Established i
2. Accoun#Balance 2 �
3. Percent Taxable 3 X
4. Amaunt Subject ta Tau 4 $
5. Debts and Deductions 5 -
6. Amount Tauable 6 $
7. Ta�c Rate 7 X
8. Ta�c Due 8 $
9. With 5°/a Discaunt{Tax x.85) 9 X
�t@� ,`2: Sign and date below. Retum 7W0 cpmpieted and sign�copies to the Repl6�er of Wi�s li�#ed on 6l�e front of tfiis fam,
aiang with a cMeck for any payment yau are making. Ghecks must be made payable to°Register tr#�,RgenG" Do not send
payment directly to the Department of Revenue.
Under penaity of perjury, i deciare tha#the tacts i have reported above are true,cbrrect and complete ko the best of my k�owledge and
belief. 1� �
� Wark "1d,'-l-'�wac `�7 �o�
Hume � (pa— '�T
Taxpayer Signature Telephone Number DateC� �
IF YOU NEED FURTF4ER ASSISTANCE, GONI"ACT P�A1lVSYLVA¢N!A DEPAFiT1u4ENT QF REVENUE
DISTftfGT OFF4GE, OR TNE lNi�lERIFANCE TAX DIVi�lON AT 717-787-8327. SERVIGES FOR
TAXPAYERS WITH SPECIAL HEARING AND/0R SPEAKING NEEDS ONLY: 1-800-447-3020