HomeMy WebLinkAbout10-08-13 COMM4NWEALTN#PENNSYI.VANIA REV-11 BP EX{t S-9$}
OEpAi{TMENT OF REVENUE
BUpEAU OF INDIVIpUAL TAXES
DEPT.286801
HARRISBUflG,PA t?428-0Bbt
PEtdtdSY�VANIA
RECEIVED FROM: INHERITANCE AND ESTATB 7AX
OFFICIAL RECEIPT
NQ. CD 41 $216
HOMAN RUBY
3363' RITNER HIGHWAY
NEWVILLE, PA 17241
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
""'_' ioia ___""_'
13150127 � S27.28
ESTATE INF{}RMATiON: sSN: �
FILE NUMBER: 2113-1075 �
dECEC}Ery7T NAME: HQMAN MI�DEiED V �
DATEOpPAYMENT: 10/08/2013 �
PoSi'MA�tx dATE: 10/Q8/2013 �
COUNTY�: CUMBERLAND �
DATE p� DEA7H: 09/1 1/201� �
(
TflTAL AMOUNT PAID: 527.26
REMA(�KS: RUBY M HOMAN
GHECK# 6098
INITIALS: DB1
sea� RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REOISTER OF WILLS
eutt�u oF irmtvtouai TNCes Pennsylvania lnheritance Tax i ! P�nnsytvania
Po 9qX 280601 DEPARTMENT OFflEVENUE
HhRRISlURG Pp iriae-osoi Information Notice ��
And Taxpayer Respanse A6Y�t5f!ES OwFXft l!!-!])
FILE NO.21
ACN 1315p127
iDATE 09-25-2013
Type of Account
Estate oi MILDRED V HOMAN Savings
SSN Checking
Date oi peath 0�11-2073 Trust
RUBY HdMAN County CUMBERI.AND Certificate
E363 RTTNER HWY
NEYtYILl.E PA 17241-4502 `.��."-�� %a
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provided the department with the information belaw indicating fhat at the death of the.
abov -named decedent ou were a oint owner or beneficia of the account identified. '
Acco4M No.2�WB Ramit Paymsnt m�!Porms to:
Date$st�ishsd 03-2Q�2010 REGISTEH OF WILLS
Accouf�t Balance $1,275.17 7 COU1i7F10WSE StiUARE
Perce�t Taxat�e X 5d GARLISI.H PA 17pt3
Amou�ht Subject to T� $637.59
Te�c R�te X 0.045
�,Q��a,T�Q� ��g,� NOTE': if tax paymerrts are made within three months of the
T°' decederrt's da#e af death,deduct a 5 parc�rt discaurrt or�the ta��
With�°/,Discount(Tau x 0.95} $(�NOTE") i, due. Any inheritance ta�c due wiii become delir�quent nine months
after the date of deaffi.
�'�� SfB�'i 1: Piease check the appropriate boxas beiow.
A �tio taac Is due. t am the spou�ot the or!am the parent ot a decadent wha was
21 years oid or youn��et da�of death.
Procaed to SMp 2 on reverse. Do not check eny other baxes and disregard the amount
shown above as PotenNal Tax Due.
g �rie informa6on is The s6ave informallon is cwrect,no deductions are being taken,and payment wIII be serrt
correct. wiffi my response.
Prop�ed to Sfep 2 on reverse. Do not check any other baxes.
/
G �The tau rate is incorrect. �� 4.5% i am a Iinesi bertefiaary{�rent,chiid,grandchiid,etc.}of ihe c�ceased.
, (Select correct t�uc rate at
right, and complete Part � y��, I am a siblinq of the deceased.
3 on reverse.)
� t 590 AtI other reiationships{incVudirrg none).
p �Chanqes or decHacdons The iafarmation above is incorc�t and/or debts and deductipns were paid.
� Iisted. ��� ��Canptete?art 2 and part 3 as appropnate o»the badc ot fh�form,
E �Asset will be reparted on 1"he above-itlentified asset hes been or w111 be reported and ta�c paid with the PA Inheritance Ta�c
inheritance tax form Retum fited by ihe sstate representative.
REV-1500. Arpceed fo Siep 2 ort reverse. �s noT oheck any oiher baxas.
Please sign and d�te the back of i�e form when finished.
pA� Debts and Deductions
x
arlawatab do�ana musc rr�taofh af a,e#at�winp criter;a:
A. The decedent was ieqally responsdWe for payment,and the estate is insufflci�t to p�y the deductide ftems.
B. You paid the deDts after the death of the decedent and can fumish proof of payment if requested hy the depxrtment.
{if additronai space�cequirecl,You may attaoh 81 t2"x t i"st�eet&of peper.}
Date Peid Payee Description �rnpu�t Prud
To#ai Er�ter a�i.ine 5 of Tax Ga{cul�ian $
PART Tax Calculation
3 PI��S��S� " " �"�c�iNh�rio .�"{ . 'k ; ��"horp+t�t�tti�s�);
1. Entsr the date the accawnt was esteblished ar titled as it existed at the date of death.
2. Enter the tota!balance ot the account ir�ludit�g any interest�ued at ihe date of death.
3. E�ter the ,..percentaga of tha aceaurrt th�t is taxabie to you-
a. Frst,d�De�mine N�pal�en3aqa c�rled try the decederrt.
i. AccOUnts thaY 8t!8 t�mdd"in-Vt�st for"ahother Or othBrs w8r81QQ%a�MS�d by�tisatlent.
ik For�int .�d� a�py�rFxiorta�t#�dataotde�h.tlte istOQ°,6t�++ir4ed
by the wtai nu or awners ir�,�ih8 deCedent {For 8xemplg:2 owner6=st�,a ��s;R+�wr;ers
=259'0�etc.)
b. NeM,divide Me decedaata pr�med;by the number of surviving owners oc benetidacies.
4. 7he amouni st�xject to t��de bY m�iying�avcouM b�lr�'tlse'ppro��n##e�bie,
5. Entar the tM�i of any debte and deductions ciaimed ftom Part 2.
6. 7he amount texable is detetsmihe�d by subb'�cting the debts and deduetions from ttro{�trpunt subject to tsoc.
7: EMar ihe . :t#�c r�:�an:S4�g 7 4R�d a�yaur reietionahip W ttaa
N ° : � , r8t6�ph�b9tl s�te
yaur reW sF�ip �k#' rrt:
t. Date Established 1
2. Account Balan�z 2 $
3. PerpentTaxable 3 x
4. Amount Subject to 7ac 4 $
5. Debts and Deductions 5 -
6. Amount Taxable 6 $
7. Tax Rate 7 X
8. Tau Due S $
9. With 6%Discou�t(Taz x.95) 9 x
,��:: Si�atrd det�,6�pw. R�m 7'1N�„t�w�!p�eted and.sipttgd 4�ie�ta t� , af s�a ihe f�S�E,�tf,#iis foim,
abng w�h e dfed(for uny paymeM you are maidng: Checks must be ni�d!a payal�e fo oi piaf." CSc rwt send
payment directly to the DepartmeM of Revenue.
Under penairy of pecjury, !declare Utat the facts I have reparted abovs are bue,�rrect aradaa�e�th�6�t of rrq+knawk`idDe and
beiief.
WOrk
�
Taxpayer ignature Telephone Number Dat�
tF YC9L! �6 FUF�"�'��# l�+l�, C�'AiGT P����1�.�i �.< _ "-: >.� ���
DiSTPoC7 OFFiCE, G}�E Ti� i�1�iTA�taiCE TAX QIVi��Jhi A'F 717-78T•83E7. SLRV#�"�S fCJ�
TAXPAYERS WITH SPECIAL H�ARiNG AND/OR SPEAKING NEECtiS ONLY: 1-800-447-3020