HomeMy WebLinkAbout02-22-07
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
KEMP LISA J
1375 BALTIMORE ROAD
SHIPPENSBURG, PA 17257
_n_nu fold
ESTATE INFORMATION: SSN: 178-26-6016
FILE NUMBER: 2107-0172
DECEDENT NAME: CLEVENGER DOROTHY E
DA TE OF PAYMENT: 02/22/2007
POSTMARK DATE: 02/21/2007
COUNTY: CUMBERLAND
DA TE OF DEATH: 03/22/2006
NO. CD 007829
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
06500402 I $2,101.14
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TOTAL AMOUNT PAID:
$2,101.14
REMARKS:
CHECK# 653
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
- '
'~; .~.. \
O8NMONWEA~ OF PENNSYLVANIA
DEPARTMENt OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
*-
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IEV-1S4SA if' ~7.;.i'j..
INFORMATION NOTICE
r\ (\,:'1=:(':- (',:: AND
!:i :::)i._ T.flX~AVER RESPONSE"
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FILE NO. 21 0, l,1...
ACN 06500402
DATE 08-22-2006
LISA J KEMP
1375 BALTIMORE ROAD
SHIPPENSBURG PA 17257
TYPE
2001FEB22 FHI2.~o
} ~~;. OF DOROTHY E CLEVENGER
S.S. NO. 178-26-6016
CLERY\ ().~ . PATE OF DEATH 03-22-2006
O~f~N'S C9~R l:RUNTY CUMBERLAND
CU~JI--i i' '.~' - Pro. REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE1 PA 17013
OF ACCOUNT
o SECURITY
lXJ SEC ACCT
o STOCK
o BONDS
MERRILL LYNCH has p..ovided thtJ Depa..tunt Nlth thtJ InfoMlatlon list.. b.IDN Nhich has be.n uS8d In
calculating the pot.ntial tax du.. TI'lIII.. ..eco..ds Indlcat. that at the death of the above dec.d8l1t. you N.... a beneficla..y of thls as..t.
If YOU f..l this Info...tlan Is inco.....ct. pl.as. obtain Nritt8l1 co.....ctlon f..OII thtJ tMlnsfe.. ag8l1t. attach a copy to this fOMl and
...turn It to the above add...ss. This account Is taxabl. In accordanc. Nlth the Inheritanc. Tax LaNs of the Co_onNllalth of PennSYlvania.
Quastbns ~ IHI ..,~ad by c;.Uing 0'17) 71S7-85Z7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 2AT37N75
DOD V.luatlon
PerC*'\t Taxable
AIIount Subject to T.x
T.x Rete
Potenti.l T.x OWl
x
461692.07
100.00
461692.07
.045
2..101.14
TAXPAYER RESPONSE
To insu... p..ope.. c....it to you.. account. tND
(2) copl.s of this notlc. .ust accoapany you..
pay.ent to the RlIIIlste.. of IUUs. Mak. check
payllbl. to: '"Rlllllste.. of lUlls. Ag8l1t".
x
NOTE: If tax PB~lII'ItS a..e .ade Nithin th....
(3) unths of the dec.dent.s date of death.
yOU .ay d.duct a 5" discount of the tax due.
Any Inheri tance ax due NUl bIlcOll. delinquent
nine (9) .onths afte.. the date of death.
PART
[!J
ft~~I;:::~~::~:;I~I~~~:;~~~;~E:~Ii:r;'~;~~~l~;$:~~I~~~~~1~:~--i;~~:Jit!_;~J~;J;::;=1;iC~!;:::l:.;li:~;r;Z:&=i:1~;;JI
A. fit! TI'lII above Inforatlan III1d tax due Is co....ect.
L..p..1. You.ay choos. to .....it pay..nt to the Regist... of Wills Nlth tND copi.s of thls notic. to obtain
a discount 0.. avoid int....st. 0.. yOU ..y check box "A" and ..eturn this notic. to the R.glst... of
NIlls and an official ass.s..ant Nill b. issued by the PA Depa..ta.nt of R.venue.
B. 0 The above BS..t has b..n 0.. NUl b. ..epo..t.d and talC p.ld Nlth thtJ PemsylvanlB Inh.ritance Tax ...tu..n
to be filed by the decedent.s ..ep.....ntativ..
C. 0 The above info...tlon is Inco....ect and/o.. debts and d.ductions ...... paid by you.
You .ust co.l.te PART 0 and/o.. PART @] belDN.
[CHECK ]
ONE
BLOCK
ONLY
PART
[!J
DATE PAID
DEBTS AND DEDUCTIONS
If you indic.te . different tax rete.. pl..s8 st.te your
relationship to decedent:
PART
~
TAX RETURN - COMPUTATION
LINE 1. DOD V.luatlon
2. PerC*'\t Taxable
3. A.ount Subject to Tax
iii. Debts end Dec:luctions
5. AIIount Taxable
6. Tax R.t.
7. Tax Due
OF TAX ON ABOVE ASSETCS)
1
2 X
3
iii
5
6 X
7
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tex Cu.put.tion)
I
.
have reported .bove .re true..
and
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