HomeMy WebLinkAbout11-25-13 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG,PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
N0. CD 018442
ZAGORIC LINDA G
6401 S WESTSHORE BLVD APT 1 101
TAMPA, FL 33616
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- told
__________ ________
13150578 $21 .84
ESTATE INFORMATION: SSIV:
FILE NUMBER: 2113-1254
DECEDENT NAME: ZAGORIC EMILY E
DATE OF PAYMENT: 11/25/2013
POSTMARK DATE: 11/20/2013
COUNTY: CUMBERLAND
DATE OF DEATH: 09/18/2013
TOTAL AMOUNT PAID: $21 .84
REMARKS: LINDA ZAGORIC
CHECK# 2071
INITIALS: WZ
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES Penns lvania Inheritance Tax 10, pennsylvania
PO BOX 280601 y
HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE
REV-1543 EX)EXEC (08-12)
And Taxpayer Response FILE No.21 — 13 6 q
CORDED OFF OF ACT 9-27
DATE 0 09-27-22
013
1`11:611b I R OF FILLS
P n � Type of Account
sta e6of EMILY E ZAGORIC Savings
SSN C L E R It O F Date of Death 09-18-2013 T ustking
LINDA G ZAGORIC ORPHANS' COUI�juntyCUMBERLAND Certificate
149 N 25TH ST CUMBERLAND CO ' Rt4
CAMP HILL PA 17011-3609
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.27230 Remit Payment and Forms to:
Date Established 05-28-1981 REGISTER OF WILLS
Account Balance $970.87 1 COURTHOUSE SQUARE
Percent Taxable X 50
CARLISLE PA 17013
Amount Subject to Tax $485.44
Tax Rate X 0.045
Potential Tax Due $21.84 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
AF-]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 FAThe 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, hild grandchild, etc.)of the deceased.
(Select correct tax rate at
right, and complete Part ❑ 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. Al �J
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