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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
NO. CD 008072
MCNAMEE CAROL W
414 E CATHERINE STREET
CHAMBERSBURG, PA 17201
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
nn____ fold
07116392
$788.46
ESTATE INFORMATION: SSN: 145-09-1132
FILE NUMBER: 2107-0394
DECEDENT NAME: WRIGHT GEORGE H
DA TE OF PAYMENT: 04/24/2007
POSTMARK DATE: 04/23/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 03/13/2007
TOTAL AMOUNT PAID:
$788.46
REMARKS:
CHECK# 3209
SEAL
INITIALS: OM
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPAR~ENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO.21 01 - 3qL\
07116392
04-11-2007
REV-1543 EX AFP (09.00)
: _-:J
EST. OF GEORGE H WRIGHT
S.S. NO. 145-09-1132
DATE OF DEATH 03-13-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
!iJ SAVINGS
D CHECKING
D TRUST
D CERTIF.
CARaLW MCNAMEE
41~~E CATHERINE ST
CHAMBERSBtlRG PA 17201
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
(~ '"--
'-
FARMERS NATI:ONAL BANK has provided the Departllent 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 cal!ing C717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 9635661
Date 07-08-1999
Established
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: I'Register of Wills, Agent".
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
35,042.67
X 50.000
17,521.34
X .045
788.46
TAXPAYER RESPONSE
NOTE: If tax payments are .ade within three
(3) months of the decedent's date of death,
you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
PART
[!]
A. ~ 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 lIay check box "An 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
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 information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
If you indicate a different tax rate, please state your
relationship to decedent:
DEBTS AND DEDUCTIONS CLAIMED
PART
~
TAX RETURN - COMPUTATION OF
LINE 1. Date 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
PART
[!]
DATE PAID PAYEE
TAX ON JOINT/TRUST ACCOUNTS
X
X
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
$
Under penalties of perjury, I declare that the facts
complete to the best of my knowledge and belief.
~w.IIlL..~#- ~e-Il
TAXPAYER SIGNATURE
have reported above are true, correct and
(1.. ) dLP4-
('II) d-tR4-
TELEPHONE NUMBER
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