HomeMy WebLinkAbout03-14-07 (5)
l~ ,:)[.",1 M ':~ r\J'/V'EAL Tf-. OF PEr\JNSv ~ \,'ANIA
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REV-1162 EX(11-96)
f1ECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
LlPlES MARY
824 LlSBURN ROAD 410
CAMP Hill, PA 17011
--
I
i ESTATE INFORMATION: SSN: 190-14-1466
: 2107-0239
i FiLE NUMBER:
L
,
: DECEDENT NAME: LlPlES PAULINE
I
: DA TE OF PA YMENT: 03/14/2007
,
! POSTMARK DATE: 05/1 2/2007
,
COUNTY CUMBERLAND
UA TE OF DEATH: 01/16/2007
NO. CD 007900
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
07108400 I $595.8e:
I
I
I
I
I
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TOTAL AMOUNT PAID:
REMARI<S:
CHECI<# 523
SEAL
INITIALS: CJ
RECEIVED BY:
REGISTER OF WILLS
$595.88
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
';I""':'"""!-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 210'01
HARRISBURG, PA 17121-0'01
Rf........ . .. .. -. F. 'J.t CrFORMA~I.NODN NOTICE
i~ '.i; TAXPAYER RESPONSE
'~-'. '. '~I -
REV.l543i EX AFP CIt.11)
FILE
ACN
DATE
NO.
21-01- 1.. 'b~
07108400
03-02-2007
2001 MAR 13 PM 3: 2 I
CLER!( OF
ORP:H- !\~,I'(~ ('("\1 'RT
",.Ij VVIJI I
Cllr\ r. ,"(1 P^
Vir 0' . '-." ,__. I /'~\
EST. OF PAULINE LIPLES
S.S. NO. 190-14-1466
DATE OF DEATH 01-16-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
iii SAVINGS
o CHECK! NG
o TRUST
o CERTIF.
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 hu provided the Departaent with tha inforaaUon listed below which has been used in
calculating the potantial 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 inforaation is incorrect, please obtain written correction frQa the financial institution, attach a copy
to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Coaaonwealth
.n "-_lvania. Qwesl10ftS _ be answered by corll1nll (117-)-1'1~1.
COMPLETE PART 1 .~LOW . .. SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 5130105006 Date 01-14-1983
Establ1shed
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potent1al Tax Due
x
31,361.11
16.667
5,226.96
.12
627.24
TAXPAYER RESPONSE
To insure proper credit to your account, two
(2) copies of this notica .ust accoapany Your
pay.ent to the Register of Wills. Make check
payabla to. "Register of Wills, Agant".
x
NOTE. If tax pay.ents are .ade within three
(3) .onths of the decedent's date of death,
YOU .aydeduct a 5X discount of the tax due.
Any inheritance tax due will beco.e delinquent
nine (91 ,aonths.after the date of death.
Tax
PART
[!J
11~.~~:~:~:~::~" ".:~::~:.:,.: :~. '. ..:.~.":.:: i;.:' ,',:, :\~ .::~.;.;~:: rr:'j :,.: ~: ..' :...'.~ ',~ "." ,.".."" ..~"j :., ~;::.:~:;.L.::~'h~.~L':.~;f::~. . ;':;..:.::~t~
A. ~ The above inforaaUon and tax due is correct.
1. You.ay choose to n.tt pay.ent to the Register of Wills with two copies of this noUce t.o obtain
a discount or avoid interest, or YOU aay check bax "A" and return this notice to the Register of
Wills and an official assess.ent will be issued by the PA Depart.ent of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
B. c:l The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax raturn
to be filed by the decedent's representative.
C. c:l The above inforaation is incorrect and/or debts and deductions were paid by you.
You .ust co.Plate PART 0 and/or PART [!] below.
If you 1nd1cate a d1fferent tax rate, please state YOUr
relat10nsh1p to decedent:
PART
[!]
TAX RETURN - COMPUTATION
LINE 1. Date Estab11shed
2. Account Balance
3. Percent Taxable
4. A.ount Subject to Tax
5. Debts and Deduct10ns
6. A.ount Taxable
7. Tax Rate
8. Tax Due
PART
[!J
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3
4
5
6
7
8
x
x
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL CEnter on L1ne 5 of Tax Co.putat10n)
. ... I
.
Under penalt1es of perjury, I declare that tha facts I
complete to the best of my knowledge and be11ef.
have reported above are true, correct and
HOME ( ..., ''1 ) '1' - ~S-5'"
WORK ( )
TELEPHONE NU . R
06
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