HomeMy WebLinkAbout06-20-07
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG, PA 1712B-0601
-~.D OFFl~~~RMATlNODN NOTICE
'alRj::b \L :!,i~XPAYER RESPONSE
I ILI".)!\.) l...>: j vi i; ill L\~
REV-1S43 EX MP <09-00)
FILE
ACN
DATE
NO. 21 ()1 05'9S-
07125511
06-08-2007
SANDRA K ROBERTS
203 POTATO RD
CARLISLE
2007 JUN 20 PM I: 2nST.
f OF DONALD L FITE
CLERK OF S.S. NO. 167-40-1756
ORPHAN'S COURT DATE OF DEATH 04-28-2007
CUMBERLAND CO.. PA COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
TYPE OF
ACCOUNT
Ii] SAVINGS
D CHECK! NG
o TRUST
D CERTIF.
PA 17013
MEMBERS 1ST Feu has provided the Depart.ent with the inforaation lishd below which has baan 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 inforaation is incorrect, please obtain written correction froa the financial institution, attach a copy
to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Coaaonwealth
of Pennsylvania. Questions aay be answered by ~alliftg (717) 787-8327.
COMPLETE PART 1 BELOW. . . SEE' REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 223010-00
Date
Established
01-16-2004
To insure proper credit to your account, two
(2) copies of this notice aust accaapany your
payaent to the Register of Wills. Make check
payable to. "Register of Wills, Agent".
Account Balance
Percent Taxable
Amount SUbject to Tax
Tax Rate
Potential Tax Due
x
422.64
50.000
211. 32
.15
31.70
tAXPAYER RESPONSE
NOTE. If tax payaents are aade within three
(3) aonths of the decedent's date of death,
you aay deduct a 5% discount of the tax due.
Any inheritance tax due will becoae delinquent
nine (9) aonths after the date of death.
x
PART
[!]
The above inforaation and tax due is correct.
1. You aay choose to reait payaent to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you aay check box "A" and return this notice to the Register of
Wills and an official assessaent will be issued by the PA Departaent 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 inforaation is incorrect and/or debts and deductions were paid by you.
You aust coaplete PART ~ and/or PART ~ below.
PART
[!]
DATE PAID
nEBTS AND DEDUCTIONS CLAIMED
If you indicate a different tax rate, please state your
relationship to decedent:
PART
~
TAX RETURN - COMPUTATION
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
4
5
6
7
8
x
x
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation)
.
facts I have reported above are true, correct and
11LP,Q .J..3c'
( 7"
WORK (
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)
NUMBER
ttJ-lq~ I
DATE
TAX
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
IN HE ITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ROBERTS SANDRA K
203 POTATO RD
CARLISLE, PA 17015
------ fold ----------
ESTATE INFORMATION: SSN: 167-40-1756
FILE NUMBER: 2107-0595
DECEDENT NAME: FITE DONALD L
DATE OF PAYMENT: 06/20/2007
POSTMARK DATE: 06/20/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 04/28/2007 !
NO. CD 008309
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
07125511 I $31.70
I
I
I
I
I
I
I
I
tOTAL AMOUNT PAID:
REMARKS:
CHECK# 826
!
IINITIALS: JA
ECEIVED BY:
SEAL
REGISTER OF WILLS
$31 .70
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS