HomeMy WebLinkAbout05-01-07
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
NO. CD 008098
MIXELL TYLER A.
506 S. FAYETTE ST
SHIPPENSBURG, PA 17257
CONTROL
NUMBER
._____n fold ---------- --------
07116372 I $33.50
ESTATE INFORMATION: SSN: 191-18-3865 I
FILE NUMBER: 2107-0124 I
DECEDENT NAME: MIXELL KATHLEEN C I
DA TE OF PAYMENT: 05/01/2007 I
POSTMARK DATE: 04/24/2007 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 02/01/2007 I
I
TOTAL AMOUNT PAID: $33.50
REMARKS:
CHECK#174
INITIALS: OM
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
I
I
ACN
ASSESSMENT
AMOUNT
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG, PA 17128-0601
-
REY4543 at..p 'D'-DDI
FILE
ACN
DATE
NO. 21 ~ l \ '(),. Y
07116372
04-11-2007
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
'J I~ 30
TYPE OF ACCOUNT
[i] SAVINGS
D CHECKING
D TRUST
D CERTIF.
Fl
EST. OF KATHLEEN C MIXELL
S.S. NO. 119-18-3865
DATE OF DEATH 02-01-2007
COUNTY CUMBERLAND
CLER\( ,
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REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
TYLER A MIXELL
177 CENTERVILLE RD
NEWVILLE PA 17241
ADAMS COUNTY NATIONAL BANK has provided the DepartMent with the inforllation 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 for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co..onwealth
of Pennsylvania. Qd.s~ions .D~ b. answ6red by cdlling (717) 78i-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 9652132
Account Balance
Percent Taxable
Amount SUbject to Tax
Tax Rate
Potential Tax Due
PART
ill
Date
Established
12-31-2002
To insure proper credit to your account, two
(2) copies of this notice .ust acco.pany your
payment to the Register of Wills. Make check
payable tOI "Register of Wills, Agent".
x
446.68
50.000
223.34
.15
33.50
TAXPAYER RESPONSE
NOTE I If tax paYMents are .ade within three
(3) .onths 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.
x
The above infor.ation and tax due is correct.
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 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 infor.ation is incorrect and/or debts and deductions were paid by you.
You .ust co.plete PART ~ and/or PART ~ below.
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:
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
PART DEBTS AND DEDUCTIONS CLAIMED
[!]
DATE PAID
1./ ~ ;;l">' -OJ
PAYEE
-rVUll A M rxetL
DESCRIPTION
-rS),lt' OU~
AMOUNT PAID
I '~::r.zO "J"","<AI 3too
.
TOTAL (Enter on Line 5 of Tax Computation)
Under penalties of
complete to the best of
c~
TAXPAYER SIG
are that the facts I have reported above are true, correct and
nd belief.
(
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HOME
WORK (717 ) 7?'1-~S(pa
TELEPHONE NUMBER
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