HomeMy WebLinkAbout10-25-13 (4) COMMONWEALTH OF VENNSVNANIA REV-1182 EX�11-98)
DEPARTMENT OF qEVENUE
BVREAU OF INDIVIOUAL TAXES
DEpT.280801
HAARI58URG,AA t]i 28�O6�t .
PENNSYLVANIA
RECEIVED FROM: iNHERITANCE A(VD ESTATE-TAX
OFFICIAL RECEIPT
►va. co o� s�� �
WOOL MICHAEL S
135 WRIGHT ROAD
DILLSBURG, PR 17019
ACN
ASSESSMENT AMOUNT
CQNTROL
NUMBER
----- �� ------ ------
T3150133 � 9i ,210.72
ESTATE tNFORMATION: SSN: �
FILE NUMBER: 2113-1 i 33 �
pECEDEN7 NAME: WOOL JOHN D f
DATE OF PAYMENT: 10f 25/2073 �
POSTMARK DATE: 1 q(2412Q7 3 �
COUNTY: CtJlVIBERIAND �
dATE OF DEATH: 49JC}6/2013 1
�
TOTAL AMC7UNT PAID: 51,210.72
REMARKS:
I
I CHECK#5178
INITIALS: CJ
s�a� RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WIILS
REGiSTER OF WILLS -
—
'��" °F j"°=v'°w� T*'�ES Penns ivania lnheritance Tax � Pennsylvarnia
PO !0% 2a0601 Informatian Notice OEPARTMENT OF REVENUE
fMRRIS811RG PA 1712l-O601 x¢v-is�s va o.�cxtc ue-in
And Taxpayer Response Fi�E�va.2� -��-t!33
ACN 73150113
DATE 09�25-2013
RE6fSTER #3F 4YI�LS
Type of Account
1�13 �C� 2� ,�� �2 �7 Estat¢of,lOHNDWOOL �Savings
SSN Gheckirtg
CLfRK p�' oate Yoeett,os-as-2o�s T�ust
MICHAEL WOOL Count CUMBERLAND Certificate
135 WRIGH7 RD ORPNANS COURT
nz��ssuac PA ��oig-�z��11BE�tLA�IE} Cf}.. PA
ME14�ER5 1ST FCFI pravided the department with the information below indicating that at tha death of the
abave-named decedent ou were a 'oint owner or beneficia of the account identified.
Aoaount No.399411 Remit PBy�e�ast a�d Fomalt t0:
�e�#�����8 RCOUR7MOUSE'341UARE
Account BaWnce $169,921.37 CARLISIE AA 1T013
Percent T�stke X 16.�7
AmouM Subject to Ta�c $28,320.79
Ta�c Rate X q.045
Ptiterrtiai Tax pue g 7�p7q,qq NOTE': If ta�c payme�ts are made within lhree months of the
decedenYs da�af death,deduct a 5 percant disc�unt on the t�
With b%D+seount{Tau x 6.95) ${gse NOl'E'} due. Any inheritance tax due will becoma deiinquent nine manths
after the date of death.
PART � 1: Pkase eh�ck#he appropriate boxes be{ow.
A [�Ne tatx is dus. I am th�spo�se of the decasse�d or 1 am the parent af�de�dent who was
2t ysara�d�yaunger s#da�af death.
Procrsed to SYep 2 on reve/se. Do npt chedc any other bpxes and disregerd the amount
g�,,......,,(( shpwn above as Potential Tax Due.
e infarmatiar is The above Informatio�is correct,no deductior�s are being taken,and payment vriN be sent
corcect. with my response.
Proceed to Step 2 on reverse. Do not check any other boxes.
� ❑The ta�t raie is incorrect. � 4.5% i am a liraeai beneficiary{parerrt,child,grandchild,eta}of the deceased.
�
(Select cortect t�ra#e at
right, and complete Part � 12°�, I am a sibiing of the deceased.
3 on reverse.)
� 15°fa AIt other relationships{includirtg none}.
p ❑Changes or deductions The information above is incorrect and/or deMs and dedudions were paid.
listed. GompJete.Fart 2 and paR 3 as approprrate ar the bactc oflhis form.
E �Asset will be reported on 7he above-identified asset has been or will be reported and ta�c paid wRh the PA Inheritance Tax
inheritance tax form Retum fried by the estate representative.
REV-1500. Pmceed fo Sfap 2 an re�rse. Do rrat oireck any aiher bazes.
Piease sign and date the back af the form when finished. �
pj0''� Debts and Deduc#ions
z
Ailowable delt�s ar�daductions must meet baSh of it�failo+vinq oriteria:
A. The decedent was legaily responsibls for payment,and the estate is irMt�Bioieni to pay the deductiWe items.
B. Ypw paklthe debts atter the death af the decedent and can fumish proof of payment if rgquestad by the department.
: (If addidonai spaCe is required,You may Attach$S!2"x 11"sheets of paper.)
Dafe Paid Payee Description Amount Paid
To#aI Enter an Line 5 of Taic Caiculation $
PART Tax Calculation
� �pfllfl�ii►��IM ,fith �ibd 1�,t fa+R�•iu'Pxoemt ta�{I.itte 3},
' 1. Enter the dat�the aarount was eatablished or titled as it existed at the dete of desth,
2. Enter the total halence af the�count i�cit�ng any interast accrued at 1F�e date of deeth.
3. Entet Nro pa ,�f ttre.a�unt�� #o you.
a. First� . $pP�rc:dn�o�niy���der�dent.
i. Aoaounb ihi�a�r+s F�eid"in'hust�eiw�er or others wav�p 100%pwned by 1�iedaoedent.
ii. Fa foirn� d�yeer�mior to tl�date of de�h,the parcentape tsxabie is 1 OD%divi�d
by��e tota!nurrh�er o 6Vimers' lt�ihe decedent. {Fa example:2 owners=5Q°lo,3 owEtet's�`33:�'4 arvaners
' =25%,etc.)
b. Next,divkle Me dsctidf[i'� awr�ed by the number of survivirp owt�er8 or beneHderies.
4. Ti�amGUrit st�ject to ta�c is by�t'sl�tl9e accouM balar�by th+l,@9tcsrrt ta�tabie.
5. Enter ths tofa{of any d+�s a�u!deduclions daimed from Part 2.
; 6: The amouM t�ab�ia�by subtr�riting the debts end deductio�a from th9 amount subJect ro tau.
?; 7. , :Eq�r�e �S}4�Mpi i�Y�aMid on yaw rolatbnship to tl�s
i, :: e. . :,
. �� ��� � , � �.
1. Datp EBtebliehec! 1
2. Accourrt Balar�e 2 $
I 3. Percent Tauable 3 x
� 4. Amouni Subject ta Te�c 4 $
� 5. Detrts ar�Deductions b -
{ 8. Ampunt Ta�cabls 6 $
�
� 7. Tax Rate 7 X
�� � 8. Tax Due 8 S
� 9. With 5%Discount(Tax x,8�'ij 9 x
,
� . ��PS1!��to tkr�, �a'of Wilis NB�ed on tlba-fr�t of this form,
; w��h ^��G�E�� �!�� . »
atong witts a oheck tor emr ptymant you are maidnp. �musf be made payable to" of 1i+�is,Agent. Dsi not aend
? p�yment directly to the Deparime�t of Revenue.
� t}nder penaity of pe�ury, i dec{ace ihat the facts t have r�oRed abave are true,conect and car�lete ta the best af my knpwksc�e and
beiie€.
WOrk �� �e�J `S�'�'
` F##s>tr�s �r7�- 5�Y�"'ao=- ff
a Taxpayer igr�ature Teiephane Nwrr�er Date
j� IF Y{}U 1+l�E� �U�f'1 '�"'�t t��S"1'��+1�, �dT'ACT F�`st�It�YL1t�h1Y�1 F}EPA�"t"M��1`C tJF f��Y�I+IUE
; D#STRiGT OFFICE, t�i THE It�iTAt�tCE TAX DI�IS�+I AT 717-787-8327. S�SFt�t�,'ES FOR
I TAXPAYERS WITH SPECIAL HEARiNG AND/OR SPEAKING NEEbS ONLY: 1-80q-447-3020
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