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Home My WebLink About09-05-13 C6MM0 ERITN OF PENNSYIVANid REV-11$2 EX{�k-9&I OEPAPTM NT OF qEVENUE BUREAU FINDIVIDUALTA%E5 DEPT.28 801 HARRt58 RG,PA t7128-0BOt PENPISYLVANIA RECEIVED F�ROM: INHERITANCE AND ESTATE TAX I OFFICIAL RECEIPT NO. CD 41813 2 BKEE E GAII. C 12205 HARBOR DRIVE WOODBRIDGE, VA 22192 ACN ASSESSMENT AMOUNT CONTROI NUMBER .•---- ,ob ---••----- -------- 13503480 � 52,885A9 ESTATE t FORMATt4N: SSN: ( FILE NUMBER: 2113-0901 � DECEOEN NAME: GAMPBELL KATHEftINE R � DATE OF AYMENT: 09/05/2013 � POSTMA K DATE: 09J03J2013 � CouNTY: CUMBERLAND � � DATE QF EATH: 07/1$/2013 � � T07AL AMC}UNT PAID: 92,8$5.09 REMAR�S: GAIL C SKElLE HECK#$S98 INITIALS: WZ seA� RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OP W�LLS tiEGISTER OF WILLS � _ . _ __ __ . . - BUREIIU OF INDIVIDURL TAXES Penns Ivania lnheritance Tax � pennsylvania PO 60% 260601 Y FNRRIS URG PA 1�12B-O601 Information Notice '��T DEPARTMEN70FREVENUE REY-156]1 EY ppcESEC (�!-�2) And Taxpayer Response FILE NO.21 -- (?j - G'6I ACN 13503480 DATE 08-30-2013 . i\....4.0 .. . . . .. ._ RE;:� � . .� 'v� _`....� Type of Account 'i�';3 �,�i' S 1� 11�te of KATHERINE R CAMPBELL Secueity `,` SSN SEC Acct G IL C SKELLE �� r,;: DateofDeath07-t&2013 $tpcic County CUMBERLAND Bonds W ODBRIDGEOVA 22192-22D3 �kPHQNS� �'�URT G17MBERLAND CO.. PA I - provided the department with the information below indicating that at the death of the abov named decedent you were a joint owner or beneficia of the account identified. RemR Payment and Forms to: A nt Pb.872 Date stabNShed REG�TER OF WILLS Accou t Balance $202,464.37 1 COURTHOUSE SOUARE Perce t Tattable X 33.333 CARLISLE PA 17013 Amou t Subject to Tax $67,487.45 Tax R te X 0.045 Potent al Tax Due $3,036.94 NOTE': If tau payments are made within three months of the decedenYs date of death,deduct a 5 percent discount on the tau With 5 o Discount(Tax x 0.95) $(see NOTE") .?i AJ •0 due. Any inheritance tax due will become delinquent nine months after the date of death. PA� St@p 1 : Please check the appropriate boxes below. t A No tax is due. I am the spouse of the deceaeed or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on 2verse. Do not check any other boxes and drsregard the amount shown above as Potential Tax Due. g The information is The above informaHon is correct, no deductions are being taken,and payment will be sent correct. with my respo�se. Proceed to Step 2 on reverse. Do not check any other boxes. � The tax rate is incorrect. � 4.5�o I am a lineal beneficiary (parent, child,grandchild, etc.)of the deceased. (Select correct tax rate at right,and complete Part � �p=/o I am a sibling of the deceased. 3 on reverse.) � � 15�o Ail other relationships(inciuding none). p Changes or deductions The information above is incorrect and/or debts and deductions were paid. listed. Complete Part 2 and part 3 as eppropriate on the back ol this form. E AsseE will be reported on The above-identified asset has been or will be reported and ta�c paid with the PA Inheritance Tax inheritance tax form Retum 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. �,_J PART Deb#s and Deductions 2 Alloweble debts and deductions must meet both of the foliowing criteria: A. The decac#eni was Iegaily responsible for payment,and the estate is insufficient to pay the dedwcEibie items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requesEed by the department. (tfi additionel space is fCqUir@d,you may attach 81/2"x 11"sheets of paper.) E)ate Paid Payee Description Arz�uat P�#, Total EMer on Line 5 of Tau Calcuiation $ PART Tax Calculation 3 �f�.. �+IW�CY�r ��t�"f�finMel�i�n (��) _ �S�fdnn.��or A�►wnt t�abb+(L�e 3b 1. Enter Me date the account was establiehed or titled as it existed at the d8te of death. 2. Enter the tatal balance af the account including any interest accrued at the date of death. 3. Entor the,ps�t�ppa of;th�,p�untlhat is taxak�le to you. a. First,dstermkl4 Nae ow�ed by the:decedent. i. AccouMS thffi�'e t�ekl"in tn�t for"anoMer or others were 100%owned by the decedent. ii. For joint accou� move•than one year pdor to the dete of death,the percentage taacp�t6'ts 1Q�div�cled by the totel number of owners including the decadent. (For exampie:2 owners=50%,3 aimers e 38.9�°,'e;+t o�Yners _�%,etc.) b. NeM,dNi�tlro deceded�t's, o�emed by the number of survivi�{qw�1eF�of beneficiarfes. 4. The amount wt�ject to tax is �by mu19p1ying the account batarrce by�(�neant taXable• 5. Errter the total cf any debRS arttf d�ctions daim�from Part 2. 6. The amouM t9xabte is d9tertni�by swbVactin9 the debts and t�rludiens hom tPlq<amaunt subject to tax. 7 .[� �11tr��7,1 hpl�d on your relatiohsh�"W ttftl , , . ,, : .. . .. ,. , :, . , If. . r�s�ida your re Non to��e��`3ee�M 1. Date Established � 2. Account Balance 2 $ 3. Percent Tauable 3 X 4. Amount Su4j6Gt to Tax 4 $ 5. Debts and Deductions 5 - 6. AmouM Taxable 6 $ 7. Tax Rate 7 X 8. Taz Due 8 $ 9. With 5% Discount(Tax x_85) 9 X �'(�ry`�. �ipc��nai da�b�low. Retum�AIMA cvmplated and siprrecl eopies to U» . ' of WiNa:NstaKtm tlae�t aFthis tarm, along with a chedc for any payment you are making. Checks must be made payaWe to ` 'ster of V�I1s.Agemt:" Do rrot send paymenYdirectly to the DepartmerK of Revenue. Under penalty of perjury, I declare that th8 tacts I have reported above are true,correct and complete to the hest of my knowledge and belief. work �0 3 ' �S� - �o�� /�.�� '�l'�v ►�� d:� - �s o — 8'�q'� � �.zai3 Taxpayer Signature TelepMone Numb�r Date IF YC7U NEED FURTF�ER l�I�al°ANCE, T ��l�� f��lR�N1' 4"� "�W�NtJ� DISTRICT OP�ICE, C3�1 11� iT�dt�l�f#iTAP�CE TR7C DtVI�� RT 717-787-8327. ��#�ES FOR' TAXPAYERS WITH SPECIAL HEAR1tdG AND/OR SPEAKING PtEEDS ONLY: 1-800-447-3Q20 ", _ o. _ �� N N N O W - �� W �� I��' � � 1+� 11! � �r`(� C1 / (— 4, � m o rn � 1� � G � � _ 'Z. i,n �7 a ; �� 1-` 1'%'1 � r z � cn ,, >� , ;,c � �, y � o � , � . � � "^ ` „ `� '�,� � i i . r ' �ri :. 0 _t V7 ��.t . . SA -- . y3 . � � r, 'J - � �r � ` Rh! � � � � I � . V �`r,, = L` ;� c � � L � � o rn A � s A � �. �[ '� �. � �... �,::.�,_.��W.WL�