HomeMy WebLinkAbout04-09-07
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
CAMPBELL JENNY
2005 ELM STREET
MARYSVILLE, PA 17053
-------- fold
ESTATE INFORMATION: SSN: 195-14-0653
FILE NUMBER: 2106-0840
DECEDENT NAME: RODDY VIRGINIA
DATE OF PAYMENT: 04/09/2007
POSTMARK DATE: 04/05/2007
COUNTY: CUMBERLAND
DA TE OF DEATH: 00/00/0000
NO. CD 007988
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
06147875 I $12.32
I
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TOTAL AMOUNT PAID:
REMARKS:
CHECK# 5237
SEAL
INITIALS: CJ
RECEIVED BY:
REGISTER OF WILLS
$12.32
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2110601
HARRISBURG, PA 171211-0601
-
INFORMATION NOTICE
r-,,'- ,', AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 -(J(,-i1D
06147875
09-15-2006
IEY-lS41 EI lAW In"'.,)'
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TVPE OF ACCOUNT
rJl; j?: 20
r i I.... EST. OF VIRGINIA RODDV 0 SAVINGS
S.S. NO. 195-14-0653 IX] CHECKING
DATE OF DEATH 07-06-2006 0 TRUST
COUNTY CUMBERLAND 0 CERTIF.
REHIT PAYHENT AND FORHS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
10-.'J 9
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JENNV L CAMPBELL
2005 ELM ST
MARVSVILLE PA 17053
FIRST NATIONAL BANK hBS prDvided the DapBrtaent with the InforntlDn listed belDw which hBS been used In
cBlculBtlng the pDtentlBl tax due. Their recDrds IndlcBte thBt Bt the deBth Df the above decedent, YDUWere a jDlnt Dwner/beneflclary Df
this account. If you feel this InfDr.atlDn is IncDrrect, plea.. obtain written cDrrectlDn frDB the financial Institution, attach a copy
tD this forB and return It tD the abDve address. This accDunt Is taxable In eccDrdance with the Inheritance Tax Laws Df the CDllllDnw_lth
Df ~lv....la. CIuas1:ions..y be _red by calUng (717:l 7117-11327.
COMPLETE PART 1 BELON . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 417416 hte 01-02-2003
Established
Account Ballll'lce
Percent Taxllble
A.ount Subject to Tax
Tax Rate
Potential Tax Due
x
1,642.53
16.667
273.76
.045
12.32
TAXPAYER RESPONSE
TD Insure proper cradl t tD your BCCOunt, tlfD
(2) cDples Df this nDtlce BUst BCCOBpany your
paY8ant tD the Register Df II111s. llIIke check
pal/llble to: "Register Df II111s, Agent".
x
NOTE: If tax paYBents are BBde within three
(3) aonths Df the decedent's date Df death,
YDU "Y deduct B SlC discount Df the tax due.
Any Inheritance tax due will becoae delinquent
nine (9) Bonths after the data Df death.
PART
[!I
The &bave Infor..tlon and tax due Is correct.
1. You Bay choo.. tD r_jt paYlHI1t tD the Register Df II111s with tWD copies Df this notice tD obtain
e discount Dr aVDld Interest, Dr YDU BBY check bDX "A" and return this notice tD the Register Df
NIlls and an &fflclel assessaant will be Issued by the PA Departaant Df Revenue.
B. 0 The &bave asset has baan Dr wlll be repDrtad and tax paid with the Pennsylvania Inheritance Tax return
tD be filed by the decedent's representative.
C. 0 The above InfDraatlon Is Incorrect 8I1d1Dr debts and deductions ware paid by you.
You IIUSt cDaplete PART 0 and/Dr PART @] belOll.
[CHECK ]
ONE
BLOCK
ONLY
If you indicate a different tax rate, please state your
relationship to decedent:
PART
I!I
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PART
[!]
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. hte Estllb1ished 1
2. Account Balence 2
3. Percent Taxable 3 X
4. Mount Subject to Tax 4
5. hbts and Deductions 5-
6. A.ount Taxable 6
7. Tax Rate 7 X
8. Tax D~ 8
PAVEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax CoIIputation)
I
.
Under pena1ti.s of perjury, I declare that the fects I have reported above are true, correct and
of .y knowledge and beUef. HOME ( ~ I 7 ) CIS 7 - tf<:i /,3
WORK ( )
DATE
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