HomeMy WebLinkAbout10-16-13 (2) 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
NO. CD 018257
KINGSBOROUGH BONNIE C
153 LOGAN ROAD ROOM 220
DILLSBURG, PA 17109
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold
__________ ________
13143304 $99.01
ESTATE INFORMATION: SSN:
FILE NUMBER: 2113-1098
DECEDENT NAME: KINGSBOROUGH PEARL M
DATE OF PAYMENT: 10/16/2013
POSTMARK DATE: 10/15/2013
COUNTY: CUMBERLAND
DATE OF DEATH: 06/16/2013
TOTAL AMOUNT PAID: $99.01
REMARKS: BONNIE KINGSBOROUGH
CHECK# 103
INITIALS: WZ
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES Penns��Iv_ania Inheritance Tax pennsytvanid
PO BOX 280601 7� /� _ Y
HARRISBURG PA 17128-0601 R E C s it E l} C i 1 C E-Information Notice DEPARTMENT OF REVENUE
.,. And Tax a er Res onse REV-1543 EX DocEXEC COB-12)
REC1 3 _ � p y, p FILE NO.21— '�j
ACN 13143304
1 ? C� DATE 08-13-2013
Type of Account
'F 1J ! t Estate of PEARL M KINGSBOROUGH Savings
CUM B E R L to'CO.,) C '`A SSN Checking
Date of Death 06-16-2013 Trust
BONNIE C KINGSBOROUGH County CUMBERLAND Certificate
RM 220
153 LOGAN RD
DILLSBURG PA 17019-9501
PNC BANK NA 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.5030002165 Remit Payment and Forms to:
Date Established 01-01-1979 REGISTER OF WILLS
Account Balance $4,400.41 1 COURTHOUSE SQUARE
Percent Taxable X 50
cARt1SLE PA 17013
Amount Subject to Tax $2,200.21
Tax Rate X 0.045
Potential Tax Due $99.01 NOTE*: If tax payments are made within three months of 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 El The 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 F_�The tax rate is incorrect: 4.5% 1 am a lineal-beneficiary(parent,child,grandchild,etc.) of the deceased.
(Select correct tax rate at 77700
right, and complete Part ❑ 12% 1 am a sibling of the deceased.
3 on reverse.)
15% All other relationships(including none).
D El 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 ❑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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