HomeMy WebLinkAbout10-29-13 _
COMMONWEA1.7H4FPENNSYIVANtA REV-11$�1EX(11-g$} ,
OEPARTMENT OF REVENUE �
BUREAU OF INDIVIDUAL TAXES
DEPT.280801 .
HARR158U8G,PA 17128A5�i
PENNSYI.VANIA
AECEIVED FROM: INHERITANCE AND ESTATE TAX
QFFICIAL RECEIPT
NO. CD 01833�7
dUNN TiNA
21 REDSHED RD
SHIPPENSBURG, PA 17257
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fok --------. _...�.--
13155053 � 528.37
ESTATE fN�4RMAFiON: ssN: �
FILE NUMBER: 211�-0144 �
DECEDENT idAME: EAR�EY DOR{}THY J �
DATEOFPAYMENT: 10/Z9f2013 �
POSTMARK DATE: 10/28/2d13 (
couN7r: CUMBERLAND (
DATE OF DEA7H: O1/�O/2013 �
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TOTAL AMt7UNT PAfQ: S2$.37
� REMARKS:
�
CNECK#883
INlTlALS: DB1
sEa� RECElVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
� REGISTER OF WI4LS
oureenu oF INDSVIDIIRL T/J(ES Pennsylvania lnheritance Tax � Pennsylvania
ro eoX 280601 DEPARTMENTOPREVENUE
NARRISBUR6 PA 17128-06 0 1 Information Notice
And Taxpayer Response •`�.,"'"'."Y`� ��•-��,
FILE N0.2113-0144
ACN 13155053
DATE 10-17-2013
Type of Account
Estate of DOROTHY J EARLEY Savings
SSN Checking
Date of Death Ot-30-2013 -�. Trust
TINA DUNN CountyCUMBERLAND � �=• Certificate
21 REDSHED RO � p � �� c�
SHIPPENSBURG PA 17257-9769 � � -� '=� « o
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p"� Debts and Deductions
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Allawable debts and dedur�ons must meet both of ths foil�ving criteria:
A. TttB deced8nt was Iegaiiy responsiWe for payment,and the estate is insufficient to p8y the deductibie items.
B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department.
(If additionai space is raqttired,you may attach 81t2"x t i"shests of paper.)
Dpte PBid Payee Description Ampunt Pa�Ct'
Total Er�ter on�i�e 5 of Tax Calculation $
PpRT Tax Calculation
� �f Y�,�#, ���a�i���e{t.ins 1)aca�u)t�{Lir�e 2},ar paraent tasr�Erie(t.ino 3},
plW�iit a�n tror�t`i w}n�nefal IflaNprtiae and a#h�d►� .tlNs hrm.
1. Enter the date the account was e�t�btished pr titled as it existed at the date of death.
2. Enter the total balance of!he aceouM includir�g any interest accrued at the date of death.
3. Enter the @ of tl�e accouM tha#is taxable to you.
a. First,det�mirre the percer�tsge owned.k�y the decedent.
i. Accounta thek are held"in Must for"another or others were 100°/a owned by the decedent.
ii. Far jant accaunt8 �nme�n orb}rear prior W the date of�azh,the percentage taxabl�is 100°l�divided
by the tatai�umber af awners mciGding#he deoedent. (For example:2 aamers�5Q%,3 awners=33.�;d owhers
=25%,eic.)
b. Next,dividm the deCadeM"s p6rGemq�1'i�timed.by the number of surviving ow�r8 or benQflCiaries.
4. Th8 amaunt subject t0�is�Sbrrh3r�d by htq the acc0unt baianc8 by ttrs pBrCeM ta�cable.
5. Enier itse fote7 a#any�and deductia�cisimed ftom Part 2.
6. The amount taxatle is cbtemiined by sut�racHrg the debts and deductions from tF�e,emount subject to tatt.
7. E�ikf9 ta�a�hom S�1,ba1�d pn yput relationship to the dece�nt.
ifi � : ����
your relatbnship M the rK:
1. Date Eatablished 7
2. Account Balance 2 $
3. Percent Taxable 3 x
4. Amount Subject to Tau 4 $
5. Debts and Deductions 5 -
6. Amount Taxeble 6 $
7. Tax F1aie 7 X
S. Tsx Llue 8 $
9. With 5°h Discount(7ax x.96) 9 X
�+`di,� Sign:asul dete,-��qvt. R�m"f�@�d arul signed cppiss to Ehe I�g�t oi Wilts}us#ed on U�e frorrt of#iis form,
along with a check fpr any peyment you are maicing. Checks must be made payabie to"Register of WIi�,Agsnt:" Do not serrd
payment directly to the Deparbnent of Revenue.
Under penalty o#peryury, 1 deciare itrat the facts 1 have repcRed above are hue,corcect and campiete ta the best of my knowledge and
belief.
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Work 711- 3(p�-P�3 3
t�''�t✓�..,�._ Ho�rse 2t�-3t,t0-r�833
Taxpayer Signature Telephane Number Date
tF YOU NEEI} �UF{TF#ER ASSiSTRIVGE> �!1"AGT P�NNSYI.VA�lfi1 t?EPAR'i'hl�l+}7 flF i�YENUE
DISTRICT OFFICE, OR TtfiE INHEFttTANGE TAX DiVfSION AT 717-787-8327. SEFiViGES FOR
7AXPAYERS WI7H SPECIAL HEARING ANDJOR SPEAKING NEEDS ONLY: 1-800-447-3020
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