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Home My WebLink About10-16-13 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 018263 TUCKEY CHERYL L 1127 OLD GETTYSBURG PI.KE DILLSBURG, PA 17019 ACN ASSESSMENT AMOUNT CONTRQL NUMBER -------- fold � 13150585 � 584.65 ESTATE INFORMATION: sstv: I FILE NUMBER: 2112-1182 � DECEDENT NAME: GEORGE DARRYL E � � DATE OF PAYMENT: 10/16/2013 � POSTMARK DATE: 10/15/2013 � COUNTY: CUMBERLAND � � DATE OF DEATH: 11/05/2012 � � TOTAL AMOUNT PAID: 584.65 REMARKS: CHECK#3809 ' INITIALS: HMW SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGIST�R OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDWL TAXES � p��y�� PO BOX 280601 Pennsylvania inheritance Tax HARRISDUR6 PA 17128-0601 Information Notice DEPARTMENT OF REVENUE - REY-1543 EX DecEXEt(�e-12) And Taxpayer Response FILE NO.2112-1182 ACN 13150585 DATE 09-27-2013 . Type of Account Estate of DARRYL E GEORGE Savings . Checking Date of Death 11-05-2012 Trust CHERYI L� TUCKEY County CUMBERLAND Certificate 1127 �LU-GETTYSBURG PIK , .4 DI�LSBURG PA 17019 C',� � � � _ C5� �? � � 4 c."`� � � G"� `t�W .,� "; �� '�,-�? t"�'1 a'" � � ..k� . �.,�,, �� . � i� �__ �,.. �- � �_.�,, �) :� � "`". �+ :� � �"`° ---� �; '°� � �"� r� � , �m„� � . L� �� :'� ,�.u_-,. �,.,,.�._....�_ n._�..� �,. ' �y �""". ,_ _._ . _ � e... ,�. N �..�.. �,1 — _„ �., ___ _ _ _ _._ ,�.,.;, � __ - ,. _ +a .� � � '�1 � �ULTON BANK NA provided the department with the information below indicating that at�he death of the above-named decederat. ou were a joint owner or beneficia of the acoount identi#ied: , � Remit Payment and Forms to: AccourK Nt�.1125 Date Fstablished 08-13-1991.� RE!GISTER 4F WILLS Account Balance $1,1�8.62 1 COURTHOUSE SQt1ARE Percent Taxable X 50 CAFfLISLE PA 17013 Amount Subject to T�c $564:31 Tax Rate X 0.150 NOTE*: lf tax payments are made within�three mQrrths of the Pater�t#a�t�"�C:�te $84.65 , ;. _ ,, decedent's date of dea#h,deduct a 5 percenf�discoont on the tax With+59� � , �,`?t��t��ut�x 0.95) $�see NQTE*� due. Any inheritance tax due will become delinquent nine months '"'� ��` �� after the date of death. PA� �t@� 1: Please check#he appropriate boxes below. 1 A �No tax is due. 1 a�n the spouse of the deceased or 1 am the parent of a dec;edent.who was 21 years old or younger at date of death. ; Pr�c;eed to Step 2 on reverse. Do nat check any oiher boxes and disregar+d the amount shown above as Potential Taar Due. . . . , _ _ .�,.�.e_ �� .a.�_ ',•r K,.._."'.'.-. � ' � �. .�:� . .�.,..: .. .,ster:�t "��:. . `-`- . . �� .. . . g�'�The iriformation�� The above information is eorrect,no d.eductions are being taken,and payment will be sent ccarr�ct. with'my respons�. . Proceed fo Step 2 on reverse. Do not check any other boxes. C �The tax rate is inco�rect [] 4.5% 1 am a lineal beneficiary(paFent,child,grandchild,etc.)of the deceased. (Select correct tax rate at right,and complete Part � 12% I am a sibling of the deceased. 3 on reverse.) � 15°k Alt other relationships(including none). p �Changes or dQductions The information above is incorrect and/or debts and deductions were paid. � iis#ed. � Complete Part 2 and part 3 as appropriate on the back of this form. �Rss�Cwill�.rep�rted on Th�above-identified asset has been or will be reported and tax paid with the PA tnMe�itance Tax E irit�t°�#ance tax fo�rn Retum�iled by the estate representative. . . REV-15Q0. Proceed to Step 2 on r�everse. Do not check any other boxes. : : , � Please sign �rrd date the back of the form when finished. PART Debts and Deductions 2 Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof 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 Total (Enter on Line 5 of Tax Calculation) $ PART Tax Calculation 3 If you are making a correction to the establishment date(Line 1)account balance(Line 2),or percent taxable(Line 3), please obtain a written correction from the financial institution and attach it to this form. 1. Enter the date the account was established or titled as it existed at the date of death. �� 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First,determine the percentage owned by the decedent. i. Accounts that are held "in trust for"another or others were 100%owned by the decedent. ii. For joint accounts established more than one year prior to the date of death,the percentage taxable is 100%divided by the total number of owners including the decedent. (For example:2 owners=50%,3 owners=33.33%, 4 owners =25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. If indicating a different tax rate, please state �� i,� � , ; your relationship to the decedent: ,� �\��,��'�� ' \� , �;� �� \� 1. Date Established 1 � ��`�� ,�,�, ��,�� ,��;;��; � ��\�`\��\� �\� \��`�\�� \��o�o�o�� , ��; ��\��\��\�Q\��\\\\� \\\��\��\�\ \\\��\��\��\�� 2. Account Balance 2 $ �� Q��\��' ��\\\�� \��\�� :��Q ��\��\��\�� \�\ �\�\�\�\�� \��.�\\\ ��\\��\ '� � ��\��\��\\�. � �� \ � 3. Percent Taxable 3 X � � �;; �� ,; �� \ \� �� \\� \�\� � �\� � �� \ � \\\ � �� , ��\\�� \�� . �\�� \\�\ �� \�\\�\\��\�� 4. AI710Uf1t SUbJeCt t0 TaX 4 � �� :�� _ � 5. Debts and Deductions 5 - �#. � , � �,; � „� ; �� „ � ,,;� � � � � ��\\ ��\�� \��\�\\ �\ 6. Amount Taxable 6 � � ` \ �� ` �� 7. T� Rate 7 X �� , �,� �,� � �;;, ;�, �;��;� �� ..��': � \ ��\\�\\\�� . \ ��\�� \ �\\��\\��\\\\�\\\��\�\\ � \ � �� ` �� \ � 8. Tax Due 8 � � � \�� \� � \ � �� \�� \ �� \\� \ . � �\�� \�\� � �� \ � ��\\�� \��\�� 9. With 5% Discount(Tax x .95) 9 X � .,,,_.. . .�.... �..,..._�; .�,.�`::� �...�.�..�:�.;.__.,��.:��...:.�. _.��...:�.�,.._.�._.�; Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to"Register of Wills,Agent." Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true,correct and complete to the best of my knowledge and belief. Work 7��--?t�,�,,. �5t�� e�� _�S�-c� ; , Home �7i ��-tc. ? �'1N1 i � �I� -1...3 �J��..��_ � Taxpayer Signature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 _ � "� � ,n _ _- - �� - - - -- � - - - _ _ � �,'� - - � 1� - .� - - _ �p � - - _ _ - - r � - -- ' ,�� - v _-_ - � -- � • — _ � - � n �� • '� - -- '� � � C � c�� t"'1 � � ,� c� �., -- - - � (� �~�� ...,. - - �,. �4/� � � �..� ---� t,.� �� -__ � l� - � y:� C._ �-.-...� �,, �`;"1 — �i � , � � � �,� @`�` �-� , �..�� _ — •�, .. : � _ __ � :�'.. 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