HomeMy WebLinkAbout05-17-07
COHl10NWEAL TH OF PENHSYL VANIA
DEPARTMEHT OF REVEHUE
BUREAU OF IHDIVIDUAL TAXES
DEPT. 288681
HARRISBURG, PA 17128-0601
.
IEV-~ ,ui~1GO)
INF6RMATION NOTICE
AND
TAX. r~~ER RESPONSE
Pr\ rz. \J I
FILE
AtN
DATE
NO. 21 0-' D4Qz.
07120163
05-09-2007
CLH{-( OF
C' '.\ \" 'I' 1""',1 I",EST. OF HELEN S EGOLF
O;1Ph)~ \)~) ',.).<~ti~.S. NO. 198-22-9115
CU' ',. I , 'riKTE OF DEATH 02-23-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
1iI CERTIF.
CAROLYN SHILLER
735 GREEN SPRING RD
NEWVILLE PA 17241
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
ADAMS COUNTY NATIONAL BANK h.. provided the Depart.ent with the lnfonaaUon listed bel_ which has been usad in
calculating the potential t~ due. Thair reco~ds indicate that at the death of the above decedent, YOU were a joint owner/beneficiarv 4f
this account. If you feel this information is incorrect, please obtain written correction froa the financiel institution, ettach a cOPY
to this fOnl and return It to the abDve eddress. This account is taKable in accordence with the Inheritance TaKL....s of the COMMonwealth
of Pennsvlvanie.Questions .ay be answered bV calling (717) 787-8327.
COMPLETE PART 1 BELOW ~ ~ . SEE REVERSE SIDE FOR FI~ING AND ~AYMENT INSTRUCTIONS
Aooount No. 160391 Date 06-28-2002
Establ1shed
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
14,437.85
50.000
7,218.93
.15
1,082.84
TAXPAYER RESPONSE
To insure prope~ credit to yoU~ account, two
(2) copies of this notice .ust accOGpany your
pay.ent to the Registe~ of Wills. Make check
payable tOI "Register of Wills, Agent".
x
HOTE: If tax payments are aade within th~ee
(3) months of the decedent's date of de.th,
you may deduct a ~ discount of the tax due.
Any inheritanca t~ due will baco.e delinquent
nine (9) months afte~ the date of death.
Tax
PART'
[!]
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[CHECK ]
OKE
BLOCK
ONLY
A. 0 The above inforllatton and taK due is correct.
1. You m.v choose to "ellitp8Yllent to the Register of Wills with two copies of this notice to obtain
a discount o~ avoid interest, or you may check box "A" and return this noUce to the Reglste~ of
Wills and an officiel assessaent will be issued by the PA Department of Revenue.
S. ~ The ebove asset has bean,or w~ll be ~eported end tax paid with the Pennsylvania Inheritance TRK return
~ to be filed by the decedent's representative.
C. 0 The above information i~ncorrect endlor debts and deductions were paid by you.
You IIUst co.plete PART ~ andlo~ PART ~ below.
x
If you indicate a different ta~ rate, please state your
relationship to decedent:
PART
l!1
TAX RETURN - COMPUTATION
LINE 1. Date Established
Z. Account Balanoe
3. Percent Taxable
4. A.ount SUbject to Tax
5. Debts and Deductions
6. A.ount Taxable
7. TalC Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
Z
3
4
5
Ii
7
8
x
PART
[!J
DATE PAID
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL CEnter on ~lne 5 of Tax Computation)
$
Under penalties of perju~y, I declare that the faots I have reported above are true, correct and
COMplete to the best of my knowledge and belief.
HOME (
WORK (
TELEPHONE
)
)
NUMBER
DATE
TAXPAYER SIGNATURE
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
MILLER CAROLYN S
735 GREEN SPRING ROAD
NEWVILLE, PA 17241
____u__ fold
ESTATE INFORMATION: SSN: 198-22-9115
FILE NUMBER: 2107-0492
DECEDENT NAME: EGOLF HELEN S
DATE OF PAYMENT: 05/17/2007
POSTMARK DATE: 05/17/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 02/23/2007
NO. CD 008175
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
07120163 I $130,000.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK#103
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$130,000.00
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS