HomeMy WebLinkAbout11-25-13 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX01-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG,PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
N0. CD 018445
GREENE RAYMOND E
438 FIRST STREET
CARLISLE, PA 17013
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- told
---------- --------
13161420 $11 .42
ESTATE INFORMATION: SSN:
FILE NUMBER: 2113-1256
DECEDENT NAME: GREENE JOYCE A
DATE OF PAYMENT: 11/25/2013
POSTMARK DATE: 11/22/2013
COUNTY: CUMBERLAND
DATE OF DEATH: 10/25/2013
TOTAL AMOUNT PAID: $11 .42
REMARKS:
CHECK# 109
INITIALS: DMB
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
rl"I BUREAU OF INDIVIDUAL TAXES Penns lvania Inheritance Tax Pennsylvania
PO BOX 280601 Y
HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE
aEVasaa ex no<excc <oe-iv
And Taxpayer Response FILE NO.21 - 1
ACN 13161420
RECORE ED OFFICE OF DATE 11-08-2013
REGISTER OF WILLS
Type of Account
1013 NOU 25 FN 1 L% Type
Savings
SSN X Checking
CLERK OF Date of Death 10-25-2013 Trust
DEBBIE R GREENE ORPHANS' COURT County CUMBERLAND Certificate
438 1ST ST
CARLISLE PA 17013-1881CUMBERLAND CO., PA
MEMBERS 1sT FCU provided the department with the information below indicating that at the death of the
above-named decedent you were a joint owner or beneficiary of the account identified.
Account No.55077 Remit Payment and Forms to:
Date Established 02-07-1997 REGISTER OF WILLS
Account Balance $1,522.13 1 COURTHOUSE SQUARE
X
Percent Taxable 16.667
CARLISLE PA 17013
Amount Subject to Tax $253.69
Tax Rate X 0.045
Potential Tax Due $11.42 NOTE If tax payments are made within three months the
decedent's date of death,deduct a 5 percent discount on the tax
With 5%Discount(Tax x 0.95) $(see NOTE') due. Any inheritance tax due will become delinquent nine months
after the date of death.
PART Step 1 : Please check the appropriate boxes below.
1
A ❑No tax is due. I am the spouse of the deceased or I am the parent of a decedent who was
21 years old or younger at date of death.
Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount
shown above as Potential Tax Due.
B Q he information is The above information is correct, no deductions are being taken, and payment will be sent
correct. with my response.
Proceed to Step 2 on reverse. Do not check any other boxes.
C The tax rate is incorrect. 4.5% 1 am a lineal beneficiary(parent,child,grandchild, etc.)of the deceased.
(Select correct tax rate at
right,and complete Part F-1 12% 1 am a sibling of the deceased.
3 on reverse.)
15% All other relationships(including none).
D F]Changes or deductions The information above is incorrect and/or debts and deductions were paid.
listed. Complete Part 2 and part 3 as appropriate on the back of this form.
E F_�Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax
inheritance tax form Return filed by the estate representative.
REV-1500. Proceed to Step 2 on reverse. Do not check any other boxes.
Please sign and date the back of the form when finished.
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