HomeMy WebLinkAbout03-06-07
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HIl,RRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SINGER PAULINE M
1453 3 SQUARE HOLLOW ROAD
NEWBURG, PA 17240
___u___ fold
ESTATE INFORMATION: SSN: 194-28-9358
FILE NUMBER: 2107-0209
DECEDENT NAME: MILLER CARRIE J
DA TE OF PAYMENT: 03/06/2007
POSTMARK DATE: 03/05/2007
COUNTY: CUMBERLAND
I
DA TE OF DEATH: 1 2/1 2/2006
NO. CD 007866
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
07103208 I $ 55.49
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TOTAL AMOUNT PAID:
$55.49
REMARKS:
CHECK#1436
INITIALS: CJ
RECEIVED BY:
SEAL
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
'*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 -07 - ;)Jj,
07103208
01-24-2007
REV-1543 EX AFP (09-00)
EST. OF CARRIE J MILLER
S.S. NO. 194-28-9358
DATE OF DEATH 12-12-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
[i] CHECKING
o TRUST
o CERTIF.
'/[\rn I,'!' 'HI). - C Di'l \2.: 54
L:. WI ;'1 \ U \
PAULINE M SINGER
1453 3 SQUARE HOLLOW RD
NEWBURG PA 17240
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
ORRSTOWN BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this infor.ation is incorrect. please obtain written correction fro. the financial institution. attach a copy
to this fo,.. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co..oowealth
of Pennsylvania4 Questions .ay be a"~wer&d by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 605581
Date
Established
10-22-2003
To insure proper credit to your account. two
(2) copies of this notice .ust acco.pany your
pay.ent to the Register of Wills. Make check
payable to, "Register of Wills. Agent".
x
739.81
50.000
369.91
.15
55.49
TAXPAYER RESPONSE
NOTE. If tax pay.ents are .ade within threa
(3) .onths of the decedent's date of death.
you may deduct a 5X discount of the tax due.
Any inheritance tax due will beco.e delinquent
nine (9) .onths after the date of death.
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
x
PART
[!]
A. ~ The above infor.ation and tax due is correct.
1. You.ay choose to re.it pay.ent to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest. or you .ay check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
B. r=J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
c. r=J The above infor.ation is incorrect and/or debts and deductions were paid by you.
You .ust co.plete PART ~ and/or PART ~ below.
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
PART
[!]
DATE PAID PAYEE
I
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4
5
6
7 X
8
PART
.~
TAX RETURN - COMPUTATION
If you indicate a different tax rate. please state your
relationship to decedent:
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
1
TOTAL (Enter on Line 5 of Tax Computation)
.
Under penalties of perjury. I declare that the facts
()comPlete :0 the best of ~ knowledge and belief.
-d!~AJ/7JJ/~~
TAXPAYER SIGNATURE
have reported above are true. correct and
( 117 ) 4~~-54q4.
.
WORK ( )
TELEPHONE NUMBER
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