HomeMy WebLinkAbout03-19-07
COMMO'"WEAl TH OF PENNSYL VANIA
DEPARTMENT OF REVENUE
BUREAU CF INDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
R!:CEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
FRY C R
112 HILLTOP DRIVE
MT HOLLY SPRINGS, PA 17065
- .__u__ fold
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I ESTATE INFORMATION: SSN: 200-32-2830
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; FILE NUMBER: 2106-0454
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, DECEDENT NAME: FRY HAZEL K
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i DA TE OF PA YMENT: 03/19/2007
i POSTMARK DATE: 03/16/2007
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I COUNTY: CUMBERLAND
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IDA TE OF DEATH: 08/12/2005
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NO. CD 007922
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
05149239 I $5.08
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TOTAL AMOUNT PAID:
REMARKS:
CHECI(# 1025
SEAL
INITIALS: CJ
RECEIVED BY:
REGISTER OF WILLS
$5.08
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
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REY-15U EX AFP '09-001
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21-D~-()45Y
05149239
10-26-2005
,19 PI1
CLEFt\
:F'HNrS
'. j..... r",
EST. OF HAZEL K FRY
S.S. NO. 200-32-2830
DATE OF DEATH 08-12-2005
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
IX] TRUST
o CERTIF.
CHARLES D FRY III
612 W LOCUST ST
CLEARFIELD PA 16830
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CLEARFIELD BANK & TRUST CO 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 from the financial institution, attach a copy
to this for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co..onwealth
04= l'snnC:Yl"iIInia.. QUlastions !!lay be ar::suSlrud by .r.::::!11il"l!] (717.) 7'87-8327.
COMPLETE PART 1 BELOW · . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 12122602 Date 10-10-1997
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
4,892.63
33.333
1.630.86
.15
244.63
TAXPAYER RESPONSE
To insure proper credit to your account, two
(2) copies of this notice .ust accompany your
pay.ent to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Tax
x
NOTE: If tax paY.ents are .ade within thrae
(3) months of the decedent.s date of death,
YOU may deduct a 5% discount of the tax due.
Any inheritance tax due will beco.e delinquent
nine (9) months after the date of death.
PART
[!]
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
[] The above information and tax due is correct.
1. You may choose to reait 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.
If you indicate a different tax rate, please state your
relationship to decedent:
[] 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.
~ above inforaatian is incorrect and/or debts and deductions were paid by you.
You aust co.plete PART ~ and/or PART ~ below.
PART
[!I
TAX RETURN - COMPUTATION OF
LINE 1. Oate Established 1
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
x
x
PART
f!1
DATE
~1.f,S"S"', '"'"" 't V3 = , I rlv~otl'
DESCRIPTION
AMOUNT PAID
perjury, I declare that the facts I have reported
my knowledge and belief.
CJ
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