HomeMy WebLinkAbout08-01-07 (2)
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
GILBERT JACK N
150 TIMBER CREST DRIVE
YORK, PA 17408
-------- fold
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 008488
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
07130598 I $1,217.36
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TOTAL AMOUNT PAID:
$1,217.36
REMARKS:
CHECK#1560
SEAL
INITIALS: AJW
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
'*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO.21 07-0542
07130598
07-06-2007
REV-1S43 EX AFP (09-00>
EST. OF SHARON A KEEFE
5.5. NO. 207-34-6322
DATE OF DEATH 05-17-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
Ii] SAVINGS
o CHECKING
o TRUST
D CERTIF.
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 1ST FCU has provided the Depal"t.ent with the infol".ation listed below which has been used in
calculating the potential tax due. Theil" records indicate that at the death of the above decedent. you were a joint owner/beneficiary of
this account. If you feel this infol".ation is incorrect. please obtain written correction fro. the financial institution. attach a copy
to this for. 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) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 100762- 05
Date
Established
11-12-1993
To insure propel" credit to your account. two
(2) copies of this notice .ust acco.pany your
pay.ent to the Register of Wills. Make check
payable to. "Register of Wills, Agent".
x
60,866.55
16.667
10,144.63
.12
1,217.36
NOTE. If tax pay.ents are .ade within three
(3) .onths of the decedent's date of death.
you .ay deduct a 5X discount of the tax due.
Any inheritance tax due will beco.~elinquent
nine (9) .onths afte he date of daath.
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
x
PART
[!]
~ The above infol".ation and tax due is correct. . ,~. ~ .
1. You.ay choose to I"e.it pay.ent to the Register of Wills with two copies o~..t~~otice to obt.in
a discount 01" avoid interest. 01" you .ay check box "A" and return this no~iCi~e ReABtel" of
Wills and an official assess.ent will be issued by the PA Depal"t.ent of Rev.. ..... ...
-::0 N
B. c=l The above asset has been 01" will be reported and tax paid with the pennSYlvani<<JI~el"itance"rax return
to be filed by the decedent's representative. 1? N
(j"I
c. c=l The above infol".ation is incorrect and/or debts and deductions were paid by you.
You .ust co.plete PART ~ and/or PART ~ below.
[CHECK ]
ONE
BLOCK
ONLY
x
PART
~
TAX RETURN - COMPUTATION
If you indicate a different tax rate. please state your
relationship to decedent:
OF TAX ON JOINT/TRUST ACCOUNTS
LINt!!: 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
[!]
DATE PAID PAYEE
x
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
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