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Home My WebLink About10-16-13 i COMMONWEALTHOFPEMNSYLVANIA I REV-11Q2EXIll-961 OEPARTMENT OF R�lENUE � BUREAU OF INDIVI¢UAL TpXES ;� DEFT.28a801 1 HAFRIS9URG,PA 1 7 7 28-0801 . ! PENNSYIVAfiIIA J RECEIVED FROM: INHERITANCE AND ESTATE TAX ( 4FFICIAI RECEIPT � � NO. CD 018266 � RtCHARD A GOdFREY i 26910 WHITE PLAINS WAY ' IEESBIiRG, F� 3474&1311 AGN ASSESSM� 7 AMOUNT CONTR NUMBE . ..'---'- roia 1350406 ( ..—..51,347.86 ESTATE �NFORMA710N: sSN: � FILE NUMBER: 2113-0�10 � �ECEDENT NAMe: GODI=REY JUDITH A { DATE OF PAYAAfNT: 1{?Jl$J2013 � POSTMARK DATE: 1 0/1 61201 3 ( COUNTY: CUMBERLANd � DATE OF DEATH: 06/'I',�/ZO13 I � TOTAL AMOUNT PAID: $1,347.86 REMARKS: CHECK# 5522 � INITIALS: D61 � SfRL RECEIVEd BY: G�END � ��FARNER STRASBAUGH REG)ST R OF WILLS REQISTER OF WILLS � I . . _ _ .. . .. ._ ... . . �..��...�.... . ... . . . ___,_ . . . _ _ 1 _ _ .�n�� oF INOIYIDWL T/V(ES Pennsylvania lnheritance Tax pennsylvania ro ewc zeo6oi IuRRISBURG PA 17128•06a1 information Notice DEPARTMENT OF REVENUE • And Taxpayer Response "`�.""""""'�` "•."> FI E NO.2113-0710 � A 13504062 D E 09-30-2013 Type of Account Estate of JUDITH A DFREY Security SSN SEC Acct Date of Death 06-13 13 Stodc RICHARD A 60DFREY CountyCUMBERLA . � Bonds 2691D WHITE PLAINS WAY LEESBURG FL 34748-1311 n � - „� ;,ss ��> rrt � c _ � � c::, " < : __ � f-�7 ..., �,. —_+ V) � .,..� c:: �� ^ — F._a ..,..� Pr: r�� G`� ._ ;.::� � � .�, c t� -�; �; , , �j - i r-� -�-_ � , `-_ ^ � �_.. .: _ _..� � V� � - �, � AKERIPRISE provided the department with the information below indicati that at the death of the above-named decedent you were a 'oint owner or beneficiary of the a nt identified. A�� RemR Payment and rms to: DaM EshbNshed REGISTER OF WILL +. Account Balance $59,904.71 1 COURTHOUSE J1RE CARLISLE PA 1701 ' Percent Taxable X 50 Amount Subject to Tax $29,952,36 Tax Rate X 0.045 Potential Tax Due $7,347.86 NOTE': If tau paymen are made within three months of the decedenYs date of de ',deduct a 5 peFCerN discoun[on the tax With 5%Discount(Tax x 0.95) $(sae NOTE') due. Any inheritance ' due will become delinquent nine months after the date of death. PART �ep 1 : P�ease check the appropriate boxes below. � I A �No tax is due. I am the spouse of the deceesed or I am parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check an other boxes and disregard the amount shown above as Potential Tax Due. g �The information is The above infortnation is cortect, no deductians are b$i g taken,and payment will be sent correct. with my response. Proceed to Step 2 on reverse. Do not check an other boxes. � �The tax rate is incorrect. � 4.5% I am a lineal beneficiary (parent,chil ;grandchild,etc.)of the deceased. (Select correct tax rate at right,and complete Part � �p�, I am a sibling of the deceased � 3 on reverse.) � 15% All other relationships(including no � ). i p �Changes or deductions The information above is incorcect and/or debts and d uctions were paid. listed. Comp/ete Part 2 and part 3 as appropriate on e back o/this form. i i E �Asset will be reported on The above-identified asset has been or wili be reporte and tax paid with the PA Inheritance Tax inheritance tax form Return filed by the esiate representative. REV-1500. Proceed to Step 2 on reverse. Do not check an other boxes. � 9 Please sign and date the back of the form whe finished. \��C' �n� ,_._.... .. . .. _ � _.._.�_.__. . __ : ..._. . . . .. . P"RT Dekats and Deductions x Aiiowebie disbts end deductions musk meet boih of the toilowing criteria: A. The dec�d�t was�e9a�Y��e�PaYmeM�and the esiate is insufflcienY to P�X#� items. B. You peFi�th9�ffi after the death of the decedent arx!can fumish proof of peyment if requeated by the department. {if addt�pnnt epaea ig re�ired,you may attaeh 8112"x 11"sheets af paper.} Cfatte Paid Payee Description Amount Pa� Takai Errrt�er an L'me 5 af Ta�t Caicwlapa� $ PA�T Tax Calculation 3 �t rP��. a�ua�1Ms�i' ��'), . t��or n�ro�nt t�eiwi.tu�r 8r, , p�M�Al�lr . r��t�Ml4! �I�i�t 1. Enter the date the account was est0biished or tiHed as it existed at the dafe of death. 2. EnYar tha Wtai bfliance of�e accau�t inGudir�g any interest accruqd at the slate of death. 3. Enter thw percentape of the account that is tauable to you. a. Firet; � �+wr�d by the d�aderrt. i. ACCOUM6 ihat�re h8M'7n ttuet tot^BnWhpir or tlther6�rA 440%0�by tl�dro�Id�erN. ii. For joiM atxountS m than qne y4ar priw to ihe da�e 4f death,tl16 piu'cer�pQ@ i�is 100%�vid6d bY xthe)toMte�l nuftitfe kn�9 tli8 d�:adeM. {For exa�Me:2 awn�rs=5U%.3 0��33«�lK�4 ex�aters �W6f6�GW.� b. Next,divkk tlw�s $ oNr�pc�by U�a number of survivi�ownars or berreticiaeies. 4. The artrourrt subject to tau is cb�mlaneCbby�tRre account balance 6y.tl�peir�eit ta�wbie. 5. Enter tha total of any debts arx!dedue�ons claimed hom Pact 2. s. Tne amourn tax�e�e�rmi�ed by subtaactimg the de�ts and�tud�ms frqKnl�t'ati�,M subject to tax. 7. EntBr!�p�}P�a S�4.x�tR.k�#.�(s 1,bosec!on�r relatianek��-ta.�. M in�a�ati i� �lr�e �si� Y�� . '�' . 7. Data E�tAblished 1 2. Account Balance 2 $ 3. Pereent Taacabie 3 X 4. Amount Su6jec[to Tau 4 $ 5. Debts and Cl�Buctions 5 - 8. Amount T�able 6 � 7. Ta�c Rate 7 x 8. Tax Due 8 $ 8. With 5%DiscouM(Tau x.95} 9 x � �: Sign ar�dat��i��d�R�Wm TYI�complet�i and sipned�t�'es ta thq . af Y�IUs ' sm tl�e frarn of iqia form, along with�ehe�lt tw arry �i qou 8re malilrrg. �hbeks must t� paY+at�to . ot' ,'i�ryt.' Cfa rsoY�! payment directly to the D�trnerri of Revenue. Under pe�atty of perjury, I t�daro that the facts I have repcarted above are#rue,correct and compiete to the b�t oi my hnowledpe and belief. � WOek N�f► �c+ie E Tau�payet Signature Telephone Number Date �-. . -°. fF S�3U N�i�" '�' �� d�`� . ' i� RICT OFFICE, C�i 7HE IIu1F;l�R!'� . �"AX 01 1'�Pl piT '717- 8�7-�i . � S Ft�ft TAXPAYERS WiTN SPECIAL HEAFiiNG ANDIOR SPEAKING IYEEDS ONLY; 1-8p0-447-3420 _ _. . __ _..__ .__ . • . . . . . . . .. ... - .'T —. . � ) � �� } .�� A�� ;� �� 5 .� � � � - -, � � � � ; p - � �=�� , _ �� •� ; 4, v� C N �t l� �� ,�, r;i � �t� - «, � � 4 � � = o� � �_ � - c � �� _ � Q � �. g�� _. � °� ` '`• � 7a '� — eo �r i "� � � � � � �Y n ��)� r A C:., � _ � M, : ...� f'^ � F "? G 7 �ii � 'T � � _ � CJ-J : t.� �� _ e-� ` j -�,� -`� .t� �. � — `''�j Cl ^� 7,:� �7' ��. ... � � Sr I,r (n O ("�� .q� 'x - � �F � �+; k � � � ` r � �' - � gy�b O "/ ' < 3� . .. . _ ..__ . ...._ A � ` � �....__.. im.'