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HomeMy WebLinkAbout11-03-14 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 NO. CD 019874 SUDOL MALGORZATA 931 WILLCLIFF DR MECHANICSBURG, PA 17050 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold __________ -------- 14156099 $7.70 ESTATE INFORMATION: SSN: FILE NUMBER: 2114-1045 DECEDENT NAME: SKIBA ZYGMUNT DATE OF PAYMENT: 11/03/2014 POSTMARK DATE: 11/01/2014 COUNTY: CUMBERLAND DATE OF DEATH: 09/19/2014 TOTAL AMOUNT PAID: $7.70 REMARKS: CHECK# 5330 INITIALS: DMB SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS M o.Q O &I low, ! ! R Dv- -- ECORDcO OFFICE OF � t eCI'UOJA cs6u.v , PA E7��REMSTER OF FILLS 201 NI0U 3 PIA 2 53 CLEK1"'. 0F ORPHANS COURT �J CUt �.ERLMI0 00.. PPS. ( ,pLA„VfkoU S2. flifilI; '}i}IIFfI 4 1 r� BUREAU OF INDIVIDUAL TAXES Pennsylvania Inheritance Tax pennSylvanla PO Box 2BU601 ! DEPARTMENT of REVENUE HARRISBURG PA 1712B-0601 Information Notice Yl p And TaXpayer Response REV-1545 EX EXEC(00-12) FILE NO.21 , `(M 5 ACN 14156099 r DATE 10-13-2014 REGISTER OF WILLS Type of Account 2014 !\0 3 PI 1 2 53 Estate of ZYGMUNT SKIBA Savings SSN Checking C L E r.s'� U-F Date of Death 09-19-2014 Trust MALGORZAT SUDOLCounty CUMBERLAND Certificate 931 WILLCLIFF DRORPHANS' COURT MECHANICSBURG (rLAMULt1R0 7.625,�; 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. 180905 Remit Payment and Forms to: Date Established 12-31-1998 REGISTER OF WILLS Account Balance $360.21 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $180.11 Tax Rate X 0.150 Potential Tax Due $27.02 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 F1 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% 1 am a lineal beneficiary(parent,child,grandchild, etc.)of the deceased. (Select correct tax rate at right,and complete Part F-] 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.