HomeMy WebLinkAbout04-09-07 (2)
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
TEETER DONA J
110 SLOVER ROAD
MECHANICSBURG, PA 17055
__n____ fold
ESTATE INFORMATION: SSN: 193-10-5458
FILE NUMBER: 2107-0335
DECEDENT NAME: WOODCOCK IRMA
DATE OF PAYMENT: 04/09/2007
POSTMARK DATE: 04/05/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 01/02/2007
NO. CD 007989
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
07111301 I $51.55
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 624
SEAL
INITIALS: CJ
RECEIVED BY:
REGISTER OF WILLS
$51.55
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMIIlltl1lEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0&01
_~ INFORMATION NOTICE
~7~' :-'--'/lAXPAYE:N~ESPONSE
,"-, , '," . '-.. -.
FILE
ACN
DATE
NO. 21-D1-()135
07111301
03-16-2007
1lEY-1541 EX MP"I09-001
(~! [:'ci'l("
nnr-, :~"~:J\
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CC ", . "
hi 1: 0 ~ST. OF IRMA WOODCOCK
S.S. NO. 193-10-5458
DATE OF DEATH 01-02-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
[i] CHECKING
o TRUST
o CERTIF.
)170] !, I~)ID 0
~,...,(j r. \. -:"
DONA J TEETER
11 0 SLOVER RD
MECHANICSBURG PA 17055
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MEMBERS 1ST FCU has provided the Depart.ent with the infor.ation 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..onwealth
ofP~lvafti.. ~efte a.u ~ answered by calline (717) 7B7-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 116987-11
Date
Established
10-02-1990
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".
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
x
2,291.04
50.000
1,145.52
.045
51. 55
TAXPAYER RESPONSE
NOTE. If tax pay.ents are .ade within three
(3) .onths of the decedent's date of death,
you .ay deduct a 5X discount of the tax due.
Any inheritance tax due will beco.e delinquent
nine (9) .onths after the date of death.
x
PART
[!]
The above info~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 assess.ent will be issued by the PA Depart.ent 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 infor.ation is incorrect and/or debts and deductions were paid by you.
You .ust co.plete PART ~ and/or PART ~ below.
PART
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
If you indicate a different tax rate, please state your
relationship to decedent:
PART
~
TAX RETURN - COMPUTATION
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
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3
4
5
6
7
8
x
x
PAYEE
DESCRIPTION
AMOUNT PAID
TDTAL CEnter on Line 5 of Tax Computation)
.
Under penalties of perjury, I declare that the facts
complete to the best of my knOWledge and belief.
have reported above are true, correct and
TAXPAYER SIGNATURE
HOME (
WORK (
TELEPHONE
)
)
NUMBER
DATE
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