HomeMy WebLinkAbout06-26-07
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
DAVIS JAMES
3929 BROOKRIDGE
MECHANICSBURG, PA 17050
-------- fold
ESTATE INFORMATION: SSN: 040-42-3539
FILE NUMBER: 2107-0594
DECEDENT NAME: DAVIS CYNTHIA
DATE OF PAYMENT: 06/26/2007
POSTMARK DATE: 06/25/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 04/12/2007
NO. CD 008337
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $7.99
I
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TOTAL AMOUNT PAID:
$7.99
REMARKS:
CHECK# 3992
SEAL
INITIALS: CJ
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
RECf/M,C
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1tEV-1SQ EX MP (ot-II)
FILE
ACN
DATE
NO. 21-0'1-0t{"q'l
07123129
05-31-2007
(".rINFORMATION NOTICE
1.- AND
~. TAXPAYER RESPONSE
2001 JUN 26 PH I: lt2
TYPE OF ACCOUNT
[i] SAVINGS
o CHECKING
o TRUST
o CERTIF.
EST. OF CYNTHIA DAVIS
5.5. NO. 040-42-3539
DATE OF DEATH 04-12-2007
COUNTY CUMBERLAND
ClERK OF
ORPHAN'S COURT
CUMB,:Pl,'''[,!e CO. PA
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CHRISTOPH DAVIS
3929 BROOKRIDGE DR
MECHANICSBURG PA 17050
MEMBERS 1ST FCU has Itrovided the Deparhent with the infol'llation 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 infol'llation is incorrect. please obtain written correction fro. the financial institution. attach a cOPY
to this fol'll and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co..onwealth
of Pennsylvania. Questions.ay be answered by calling (717) 787-8527.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 181555-00
Date
Established
02-01-1999
To insure proper credit to your account. two
(2) copies of this notice .ust acc08pany your
pay.ent 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
PART
l!l
x
NOTE. If tax pay.ents ere .ade within three
(5) .onths of the decedent's date of death.
you .ay deduct a 5X discount of the tax due.
Any inheritance tax due will beco.e delinquent
nine (9) .onths after the date of death.
x
The above infol'llation and tax due is correct.
1. 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 Depart.ent of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
B. c: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. c:J 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
4
5
6
7
8
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
PART
~
DATE PAID
PAYEE
x
x
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
.
Under penalties of perjury, I declare that the facts I
complete to the best of my knowledge and belief.
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2007 JUN 26 PM I: 42
CLERK OF
ORPHAN'S COURT
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