HomeMy WebLinkAbout08-01-07
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1712B-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
MITCHELL DORIS J
332 DOUBLING GAP ROAD
NEWBURG, PA 17240
____Uh fold
ESTATE INFORMATION: SSN: 201-16-2286
FILE NUMBER: 2107-0723
DECEDENT NAME: BROWN PEARL M
DA TE OF PAYMENT: 08/01/2007
POSTMARK DATE: 07/19/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 11/02/2006
NO. CD 008486
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
07130220 I $13.95
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 1146
SEAL
INITIALS: CJ
RECEIVED BY:
REGISTER OF WILLS
$13.95
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128.0601
*!:
NO.
21 ....bl-01J-"3
07130220
07-03-2007
INFORMATION NOTICE
crFlfT~XPA YE:N~ESPONSE
I'
REV-1543 ~)F}:toCJ-$H6
FILE
ACN
DATE
DORIS J MITCHELL
332 DOUBLING GAP RD
NEWBURG PA 17240
TYPE OF
ACCOUNT
D SAVINGS
Ii] CHECKING
D TRUST
D CERTIF.
20Ql ft.UG - I
I: ~T. OF PEARL M BROWN
S.S. NO. 201-16-2286
DATE OF DEATH 11-02-2006
COUNTY CUMBERLAND
Pt1
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REMIT PAYMENT AND FORMS TD:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
F & M TRUST 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/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in aLcordance with the Inheritance Tax Laws of the Commonwealth
,,:,f PQn.!'~s.ylvanii!, !:hJ9stions May be ans\1ered b~' c~1!.i~2 (717) 787-8!o27.
Account No. 34-33641
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
08-07-2003
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
PART
[!]
Date
Established
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to. "Register of Wills, Agent".
x
619.80
50.000
309.90
.15
46.49
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 become delinquent
nine (9) months after the date of death.
x
[CHECK ]
ONE
BLOCK
ONLY
A. [] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "An and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
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 information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
PART If yoU indicate a different)\ax rate, please state your
@J relationship to decedent: '/(}CJ.,tp~
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
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DEBTS AND DEDUCTIONS CLAIMED
LINE 1. Date Established
2. Account Balance
3.
4.
Percent Taxable
Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
PART
@]
DATE PAID
PAYEE
1
2
3
4
5
6
8
DESCR I PTI ON
AMOUNT PAID
$
TOTAL (Enter on Line 5 of Tax Computation)
Under penalties of perjury, I declare that the facts
~~mPlete to the best of my knowledge and belief.
V~Lo () /J?2J;<~.u/
TAXPAY~ SIGNATURE
have reported above are true, correct and
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