HomeMy WebLinkAbout08-08-06 (2)
CF cHJI'JS'ILVANIA
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2,UF:c,L:U ":F TAXES
DE~'T
REV-1162 EX(11-96)
RECEIVED mOM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
BETZ DOUGLAS J
308 ERFORD ROAD
CAMP Hill, PA 17011
I ESTATE INFORMATION: SSN: 169-28-7475
I FILE NUMBm 2106-0705
! DECEDENT NAME: BETZ JANE M
IDA TE OF PA YMENT: 08/08/2006
I
I POSTMARK DATE: 08/07/2006
COUNTY: CUMBERLAND
DA TE OF DEATH: 12/06/2005
NO. CD 007071
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
06118872 I $32.49
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARI<S: DOUGLAS J BETZ
CH ECI<# 2839
SEAL
INITIALS: AJW
RECEIVED BY:
REGISTER OF WILLS
$32.49
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
REVISED NOTICE ~ ~ ~
FILE
ACN
DATE
NO. 21 (Jls; 'l(:)c;
06118872
07-10-2006
~
REV-1545 EX AFP <09-00)
~
EST. OF JANE M BETZ
5.5. NO. 169-28-7475
DATE OF DEATH 12-06-2005
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
[X] CHECKING
o TRUST
o CERTIF .
DOULGAS J BElZ
1342 SCONSETT WAY
NEW CUMBERLAND PA 17070
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
COMMERCE 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 Pennsylvania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 512038027 Date 05-17-1988
Established
x
4,332.00
16.667
722.01
.045
32.49
TAXPAYER RESPONSE
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".
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
NOTE: If tax payments are made within three
(3) months of the decedent's date of death,
you may deduct a 5Z discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Tax
PART
[!]
The 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
8. [] 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.
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 X
4
5
6
7 X
8
PART
~
TAX RETURN - COMPUTATION
If you indicate a different tax rate, please state your
relationship to decedent:
PART
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
$
of perjury, I declare that the facts I
of my knowledge and belief.
have reported abov~ are true, correct and
HOME ('111 ) 11~wUl.o..l ~
WORK (111 ) 511,.1'" Cl11y :~, tb
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