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HomeMy WebLinkAbout05-22-14 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 1 7 1 28-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 019198 STARNER VICKIE L 18 HILL ST MT HOLLY SPRINGS, PA 17065 ACN ASSESSMENT AMOUNT CONTROL NUMBER """" fold ""____" 14501727 � 59,623.08 ESTATE INFORMATION: ssN: � FILE NUMBER: 2114-0504 � DECEDENT NAME: ELLIS CLIFFORD W � DATE OF PAYMENT: 05/22/2014 � POSTMARK DATE: 05/22/2014 � COUNTY: CUMBERLAND � DATE OF DEATH: 12/27/2013 � � TOTAL AMOUNT PAID: $9,623.08 REMARKS: CHECK# 916701 INITIALS: HMW SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES Penns �vania �nheritance Tax � Per11'1S�/LVa1118 PO BOX 280601 y DEPARTMENT OFREVENUE HARRISBURG PA 17128-0601 Information Notice � REV-1543A EX DocEXEC (08-12) And Taxpayer Response FILE NO.21 ACN 14501727 DATE 03-28-2014 Type of Account Estate of CLIFFORD W ELLIS Security X SEC Acct Date of Death 12-27-2013 Stock VICKIE L STARNER CountyCUMBERLAND Bonds 18 HILL ST MT HOLLY SP6S PA 17065-1307 � � � 0 � � � � � � r�,i �7 �rj � C7 ...�� �s=a p . ('-�-- a'D -�J � �,t.! �Y' +�y ..,� r�"� � �...,y_� . �� c,� c,'3 "rj :�,`, 4� �, `;1 � r 'r7 . ,�y � ,;� FIDELITY provided the department with the information below indicating that at#�death of`tFie r" r;' above-named decedent you were a joint owner or beneficiary of the account identified. �'' � c� Remit Payment and Forms to: Account No.872 Date Established REGISTER OF WILLS Account Balance $64,153.85 1 COURTHOUSE S�UARE Percent Taxable X 100 CARLISLE PA 17013 Amount Subject to Tax $64,153.85 Tax Rate X 0.150 Potential Tax Due $9,623.08 NOTE': If tax payments are made within three months of the decedenYs 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. g �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 �The tax rate is incorrect. � 4.5% I am a lineal beneficiary(parent,child,grandchild, etc.)of the deceased. (Select correct tax rate at right, and complete Part � �2% I am a sibling of the deceased. 3 on reverse.) � 15% All other relationships (including none). p �Changes or deductions The information above is incorrect and/or debts and deductions were paid. listed. Comp/ete 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.