HomeMy WebLinkAbout08-01-07
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRIS8URG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
GILBERT JACK N
150 TIMBERCREST DRIVE
YORK, PA 17408
nn_u_ told
ESTATE INFORMATION: SSN: 207-34-6322
FILE NUMBER: 2107-0542
DECEDENT NAME: KEEFE SHARON A
DA TE OF PAYMENT: 08/01/2007
POSTMARK DATE: 07/17/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 05/17/2007
NO. CD 008480
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
07130596 I $217.65
I
I
I
I
I
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TOTAL AMOUNT PAID:
$217.65
REMARKS:
CHECK#1559
SEAL
INITIALS: CJ
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
r*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO.21 07-0542
07130596
07-06-2007
REV-1543 EX AFP C09-DOl
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EST. OF SHARON A KEEFE
S.S. NO. 207-34-6322
DATE OF DEATH 05-17-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
[i] CHECKING
D TRUST
D CERTIF.
Z007 ~.UG -I FH I: 09
JACK N GILBERT
150 TIMBERCREST DR
YORK PA 17408
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MEMBERS 1 ST FCU has provided the Deparbent with the inforllation 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 inforllation is incorrect, please obtain written correction froll the financial institution, attach a copy
to this forll and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Comllonwealth
of Pennsylvania. Questions lIay be answered by calling (717) 7B7-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 100762-11
Date 11-12-1993
Established
To insure proper credit to your account, two
(2) copies of this notice IIUSt aCCOllpany your
paYllent to the Register of Wills. Make check
payable to. "Register of ~i.!:ls, Agent".
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
10,882.55
X 16.667
1,813.79
X .12
217.65
TAXPAYER RESPONSE
NOTE. If tax paYllents are lIade 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) 1I0nths after the date of death.
PART
[!]
[CHECK ]
ONE
BLOCK
ONLY
A. ~ The above inforllation and tax due is correct.
1. You lIay choose to rellit paYllent to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you lIay check box "A" 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 inforllation is incorrect and/or debts and deductions were paid by you.
You IIUSt cOIIPlete PART 0 and/or PART ~ below.
X
PART
~
TAX RETURN - COMPUTATION
If you indicate a different tax rate, please state your
relationship to decedent:
OF TAX ON JOINT/TRUST ACCOUNTS
LINE l. 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
~
DATE PAID PAYEE
X
DEBTS AND DEDUCTIONS CLAIMED
DESCR I PTI ON
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
t
of perjury, I declare that the facts
f know edge and belief.
have reported above are true, cor~~ and
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