HomeMy WebLinkAbout03-14-07 (4)
FE~'J~'JSYL\/AHIA
T,2..:. ES
REV-1162 EX(11-961
SECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
L1PlES MARY
824 L1SBURN ROAD 410
CAMP Hill, PA 17011
r
i eSTATE iNFORMATION: SSN: 190-14-1466
i r-:llE NUMBER: 2107-0239
i
i c::>r-:CEDENT NAME: L1PLES PAULINE
i
i C'; TE OF PA YMENT: 03/14/2007
I POSTMARK DATE: 03/12/2007
i
I
i COUNTY: CUMBERLAND
I
: DA TE OF DEATH: 01/16/2007
NO. CD 007899
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
07108398 I $49.38
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TOTAL AMOUNT PAID:
R E fjJ A R 1< S :
CHECI<# 524
SEi\L
INITIALS: CJ
RECEIVED BY:
REGISTER OF WILLS
$49.38
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
-
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO.
21-ln -2?/1
07108398
03-02-2007
REV-1543 EX AFP (09-00>
EST. OF PAULINE LIPLES
S.S. NO. 190-14-1466
DATE OF DEATH 01-16-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
[i] CHECK I NG
D TRUST
D CERTIF.
i", r~,: ':) I
ii, ,. I.- ~
CARMELLA STARNER
526 FAIRWAY DR
CAMP HILL PA 17011
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PNC BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If yoU feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of PQn~~~lva~i~. Q~e=ti~ns may be a~$wcrcd by c~lli~g (717J 7S7Me327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 5140038441
Date 08-01-1964
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Established
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
2,598.85
X 16.667
433.15
X .12
51. 98
TAXPAYER RESPONSE
NOTE: If tax payments are made within three
(3) months of the decedent's date of death.
you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
PART
[!]
A. rn The
1.
above information and tax due is correct.
You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may 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. [] 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. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
X
PART
~
TAX
If you indicate a different tax rate, please state your
relationship to decedent:
RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1- Date Established
2. Account Balance 2
3. Percent Taxable 3
4. Amount Subject to Tax 4
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7
8. Tax Due 8
PART
~
DATE PAID PAYEE
X
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
$
Under penalties of perjury, I declare that the facts
complete to the best of my knowledge and belief.
(1lUu~ ~~
TAXPAYER SIGNATURE
have reported above are true, correct and
HOME (711
WORK (
TELEPHONE
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NUMBER
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DATE 1)
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