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.��,� 'F �NO���o�,� TAXES Penns ivania lnheritance Tax � enns Lvania
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x�aeiseixes Pn �,��a-obo, � Information Notice DEPAR7MEN70F REVENUE
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And Taxpayer Response FILE NO.21 —13^O�I'�7
ACN 13139659
DATE 07-22-2013
Type of Account
Estate of RUBY E BRIGGS Savings
SSN 104-14-9704 Checking
Date of Death 06-20-2013 X Trust
ERNEST C WILSON CountyCUMBERLAND �, rtificate
2458 VICTORIA WAY n �
COpLAY PA 18D37-2447 � � �, � p
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P�_ e_ _�_t�e provided the department with the information below indicating that at the death of the
abov�-named decedent ou were a 'oint owner or beneficia of the account identified.
� �.�� Remit Paymsnt and Fams to:
Date ishsd 09-1&Z012 REGISTER OF WILLS
Accou t Balance $3,511.00 � C������1ARE
Percen4r Taxable X 100 CARLISLE PA 17013
Amounk Subject to Tax $3,511.00
Tax R�e X 0.150 NOTE•: If tax paymeMS are made within three months of the
Potenti I Tax Due $526.65 decedenCs date of death,deduct a 5 peroent discount on the tax
Wrth 5 Discount(Tax x 0.95) $(see NOTE') due. Any inheritance tax due will becrome delinquent nine months
after the date of death.
PA� St@p �: Please check the approprfate boxes below.
A ��lo 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 ro SYep 2 on reverse. Do not chedc any other boxes and disregard the amount
, shown aboiro as Potential Tax Due.
g ��e informa[ion is The above informatfon is correct, no deductions are being taken,and payment will be sent
�orrect. with my response.
I Proceed ro Step 2 on reverse. Do not check any other boxes.
� � e tax rate is incorcect. Q 4.5% I am a lineal beneficiary(parent,chiid,grandchild,etc.)of the deceased.
Select correct tax rate at
ight, and complete Part � �p=�, �am a sibling of the deceased.
on reverse.)
' � 15% All other relatlonships(including none).
p hanges or deductions The information above is incorrect and/or debts and deductions were paid.
� sted. Comp/ete PaR 2 and part 3 as appropriate on the badc ol this form.
E sset will be reported on The above-identified asset hae been or will be reported and tax paid with the PA inheritance Tax
i heritance tax form Retum filed by the estate representative.
EV-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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