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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128-0601
REV-1162 EXi11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
PIPER JOYCE
24 BELLAIRE AVENUE
CARLISLE, PA 17013
___u___ fold
ESTATE INFORMATION: SSN: 186-09-6709
FILE NUMBER: 2107-0563
DECEDENT NAME: PIPER GLADYS
DATE OF PAYMENT: 06/08/2007
POSTMARK DATE: 06/08/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 11/14/2006
NO. CD 0082.68
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
07108415 I $104,58
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$104.5B
REMARKS:
CHECK# 4915
SEAL
INITIALS: CJ
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUC;H
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HAPRT~BURG, PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21
07108415
03-0;~-2007
REV-1543 EX AFP <09-00>
EST. OF GLADYS PIPER
S.S. NO. 186-09-6709
DATE OF DEATH 11-14-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
[iJ CHECKING
o TRUST
o CERTIF.
JOYCE PIPER
24 BELLAIRE AVE
CARLISLE PA 17013
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MEMBERS 1 ST FCU 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/bene"ficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attaeh 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 Cllmmonwealth
ot Pennsylvania. ~uestions may be answer~d by caliing (717J 767-832,.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 226901-11
Date 02-13-2003
Established
To insure proper credit to your acc:ount, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Ag,!nt".
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
4,647.93
X 50.000
2,323.97
X .045
104.58
TAXPAYER RESPONSE
NOTE: If tax payments are made 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 becom€~ delinquent
nine (9) months after the date of death.
PART
[!]
A. 00 The
1.
above information and tax due is correct.
You may choose to remit payment to the Register of Wills with two copies of this
a discount or avoid interest, or you may check box "A" and return this notice to
Wills and an official assessment will be issued by the PA Department of Revenue.
notice to obtain
the RegistE!r of
[CHECK ]
ONE
BLOCK
ONLY
B. [J 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. [J The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
DEBTS AND DEDUCTIONS CLAIMED
PART
~
TAX
If yoU indicate a different tax rate, please state YOUr
relationship to decedent:
RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established
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
@J
DATE PAID PAYEE
X
X
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
$
~J/f
T P ER
Under penalties of perjury, declare that the facts
complete to the best of my knowledge and belief.
{' /- I -
S i-GNA ~~A-'
have reported above are true, correct and
2'13 - (//(c 7'
(7/7 )
WORK ( )
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