HomeMy WebLinkAbout06-03-14 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX�11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAI TAXES
DEPT.280601
HARRISBURG,PA 1 7 1 28-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 019239
JONES JACQUELINE
20 CHERISH DR
CAMP HILL, PA 1701 1
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold
14119233 � 5128.49
ESTATE INFORMATION: sstv: � �
FILE NUMBER: 2114-0246 �
DECEDENT NAME: JONES AGNES T I
DATE OF PAYMENT: 06/03/2014 I
POSTMARK DATE: 06/02/2014 I
CoUNTY: CUMBERLAND �
DATE OF DEATH: 03/05/2014 �
�
TOTAL AMOUNT PAID: 5128.49
REMARKS:
CHECK# 1317
INITIALS: CJ
SEAL RECEIVED BY: LISA M. GRAYSON, ESQ.
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES Pennsylvania lnheritance Tax � (�eI111S�/(,Va111d
PO BOX 280601
HARRISBURG PA 17128-0601 IllfOffTlat1011 NOtIC@ ° DEPARTMENT OF REVENUE
And Taxpayer Response RE°-15�3 Ex°°`ExEC coe-iz�
FILE NO.2114-0246
ft�G���� ���j�� Q� ACN14119233
„ DATE 04-11-2014
;�:_ �'�, , w�,. �< <,
2�'�� �[�� 3 P(� 3 23. Type of Account
Estate of AGNES T JONES
, Savings
C"6'-�;, ��= SSN
2014 Trust
AGNES T JONES County CUMBERLAND
20 CHERISH DR �+1�kA � n �y� Certificate
CAMP HILL PA 17O11-LO1t�V+�JC��'4"3 �`�.,
RIVERFRONT 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.56609 Remit Payment and Forms to:
Date Established 07-01-1978 REGISTER OF WILLS
Account Balance $6,011.00 1 COURTHOUSE SQUARE
Percent Taxable X 50 CARLISLE PA 17013
Amount Subject to Tax $3,005.50
Tax Rate X 0.045
Potential Tax Due $135.25 NOTE': If tax payments are made within three months of the
With 5%Discount(Tax x 0.95) $(see NOTE*) ? �Z , decedent's date of death, deduct a 5 percent discount on the tax
due. Any inheritance tax due will become delinquent nine months
after the date of death.
PART Ste 1 : Please check the a p
� p ppro riate boxes below.
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 �fhe information is The above information is correct, no deductions are being taken,and paymsnt will be sent
correct. with my response.
Proceed to Step 2 on reverse. Do not check any other boxes.
� �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 � 12qo 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. 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.