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Home My WebLink About10-30-13 COMMONWEALTH OF PENNSYIVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280801 � HARRISBURG,PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 018�46 GROUP GARY 1940 STERRETTS GAP AVE CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL � NUMBER -------- fold ---------- -------- 101 � 524.49 ESTaTE INFORMATION: ssN: I FILE NUMBER: 2113-1151 ; � DECEDENT NAME: GROUP GEORGE R � DATE OF PAYMENT: 10/31/2013 � POSTMARK DATE: 10/30/2013 I COUNTY: CUMBERLAND � DATE OF DEATH: 09/18/2013 t I ' I TOTAL AMOUNT PAID: $24.49 REMARKS: CHECK# 6310 INITIALS: HMW SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS B��U OF INDIVIDWIL TAXES ' Po sox Z8o6o� Pennsylvania inheritance Tax �` HARRISEI�tG pA 1,128_0601 pennsylvania AInformation Notice DEPARTMENT OF REVENUE nd Taxpayer Response REV-1543 EX De EXEC f FILE NO.21--��-�� ACN 13155800 DATE 10-22-2013 Estate o#GEORGE TYPe of Account 2q2g R GROUP . GARY GROUP Date of Death 09-18-2p13 Savings 1940�"STERRETTS GAP AVE County CUMBERLqNp Checking CARLISLE PA 17013-1a62 T�ust - Certificate � �� ,�' � ```-' � � #7b � � Th �A � � � � G"s �► �,�", -� � C.J `� �7 ' � C�'3 �� ► '��` �'"�"I _. , �7 � ;�,� `� C� � �. .__ : ._._ -- � � '�, � ._:±�_�, � ;�:.a C;:; - PNC BANr uw . �;� �' .., provided the d - �.� ,_.,j "`� � epartment with the information beiow i�dicati � f � � � � above-named decedent ou were a joint owner � or benefic�a of ng t�t at the cf�� the account identif�ed, ` ° � Acceunt No.5140185185 Remit Pa Date Est�eblish�pq��_�� Yment and Forma to: Account Balance REGI$TER pF yy��LS Percent Taxable �3,436.67 1 ��U�O�� X_16.667 CARLIS�E PA 17�IA�E Amount Subject to Tax Tax Rate $572.79 Potential Tau Due �0.045 $25.78 NOTE*: !f tat�c With 5°f�Discownt(Tax x 0.95) $ �,{�OTE* PaYn'►ents are macie w�thin three months of — � )2 Y 4p d��+�t's date of death,d�u�a 5� the due. Any inheritance tax due wilf become del nquent n netmon� PAf�T. after the date of death. ths y S�ep 1: Piease cf�k. the appropriate boxes below. A [�Mn tax is due. �$m t he spo�o�the��ie�a�or i am the are �`��years old Qr yt�unger at date of p nt of a decedent who w f'r+�ceed to Step 2 on,�everse. Do not h eck any other,boX � aS -- �' show��as Potentia/Tax pue. es and disregar�or the ar��t B •_____-- --,.. ._ ._ . -; �--�.___. " '�he�r�#arma#ian is� � The sbove�n#ormet►on is�correct �n�. � � ��t' with m re � o deductions are being taken,and Y sponse.: PaYment wili be sent P�oc�eed to Step 2 on reverse. Do not check an o C �Th�tax ra�is inct�rrect. o Y ther boxes. ��.�t� [�] 4.5/o I arr�a lineat beneficiary fparent,child r right,and �Te at ,g andchild,etc.)of the deceased. complete Part � 1 p�o I am a sibling of the d 3 on reverse.) eceased. ❑ 15% All other relationships inclu ' ( dmg none). p �Changes or ded�ctions The information abov ' �fs#ed• e is incorrect and/or debts and deductions wer - Comp/ete Pan 2 and pen 3 as apProPriate on e Paid. ��ack of this form. Asset w�!be r _ . _ . ePorted on -��a�ve-identified asset has been or wifl i�lae+�tance�c fiorm - , REV-1�Op, ��}��d by the estate representative, be reported and tax ` . ' .Proceed to Step 2 on reverse. Do not ch ��d�m the PA Inheritance Tax e�ck any other boxes. Please sign and date the back of th - , . e form when finished. PART Debts and Deductions 2 the deductible items. ' le for ayment,and the estate is insufficient to Pay re uested by the department. Allowable debts and deductions must meeib oth of the following cri eria: If q. The decedent was legally respons p ment q ' the debts after the death of the decedent and can f�ac�$P�2°X 1 pasheets of paper.) g. You paid ou may at (If additional space is required,y Amount Paid Description Date Paid Payee Total (Enter on Line 5 of Tax Calculation) $ T Tax Calculation or ercent taxable(Line 3), PAR 3 If you are making a correc tion to the establishment date(Line 1)nd atta�h�tlta t��s f'°��'►� ' P P lease obtain a written correction from the��tled a's!t extsted at the date of death. 1. Enter the date the accounthe accotun�tl1 n�e d ng any interest accrued at the date of death. 2. En ter t h e t o t a l b a l a n c e o f t 3. Enter the percentage of the accou e ohWnedtby he decedent. the decedent. a. First,determine the percentag o the date of death,the percentage taxable is 100%divided i. A ccounts that are held"in trust for"another or othersl�w te 100%owne y o ners=33.33%,4 owners of owners including the decedent. (For example:2 owners=50/o, 3 ow ;i. For joint accountse stablished more than one year p by the total numb =25%,etc.) �S ercentage owned by the number of surviving owners or beneficiaries. b. Next,divide the decedent P multi I in the account balance by the percent taxable. 4. The amount subject to tax is d��duc obs claimed f om Part 2. he amount subject to tax. 5. Enter t he t o t a l o f a n y d e b t s a n nt taxable is determined by subtracting the de b ts lat o n�s a p to the fdecedent. 6. T h e a m o u 1 b a s e d o n y o u r r e � 7. Enter the appropriate tax rate from Step � � � ` � � � � �� rate lease state ��, �� , ,. If indicating a different tax ,P , �� , � � , ,� ;,'��' � � your relationship to the decedent: , ,,, � ; , , 1 , , ,, Established �'��, � \ � �. Date � nt Balance 2 � 2. Accou X � Taxable 3 \ 3. Percent ; , ;� � ; � � � � � � , Amo to Tax 4 � � � ,;,,� � \� 4, unt Subject 5 � � Debts and Deductions � � � � ' ' 5. �, 6 � , .�, � \ Amount Taxable � 6. 7 X '� ,.... , , \ , �,. Rate� T� � � �. �� , . .,.,,._. ._.. • $ . ,.. � Tax Due �� _. ... _..... ._.. 8 � .,___.,,..,. �`,...._,�:.._.., ,..; . g, With 5%Discount(Tax x .95) 9 X Re ister of Wills listed on the front of this form, ' ks must be made payable to"Register of Wills, Agent." Do not send i n and date below. Return TW�completed and signed copies to the 9 Step,2• S g a ment you are mak�ng. Che along with a check for any p Y knowledge and payment directly to the Department of Revenue� re orted above are true,correct and complete to the best of my Under penalty of perjury, I declare that the facts I have p belief. WOrk '�� 7" 2 y 3 '�S � ( /L ��,i �-2Gi� Home t .�" . Date � Telephone Number � Taxpay Signature PENNSYLVANIA DEPARTMENT 4F RESEFOR �F YO U NEED FURTHER ASSISTANCE, CONTAXT DIVISION AT 717-787-8327• _ �S2 RVIC DISTRICT OFFICE, OR THE INHEG�AND OR SPEAKING NEEDS ONLY: 1-800-447 3 TAXPAYERS WITH SPECIAL HEARIN