HomeMy WebLinkAbout08-15-07
r~ OF PENNSYLVANIA
171
fiEV-1162 EX( 11961
R[CE~VED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
LEBLANC WENDY L
9 SILKWOOD LN
CARLISLE, PA 17013
i cST A TE INFORMATION: SSN: 196-18-5526
-
FII_E NUMBER: 2107-0770
DECEDENT NAME: CLINE BETTY J
DA TE OF PA YMENT: 08/15/2007
?OSTMARK DATE: 08/14/2007
.-
OUNTY: CUMBERLAND
.
DA TE OF DEATH: 04/30/2007
------------
NO. CD 008546
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
07125512 I $17.10
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARI<S: WENDY L LEBLANC
CHECK# 2457
SEAL
INITIALS: OM
RECEIVED BY:
REGISTER OF WILLS
$17.10
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRIS8URG, PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO.21
07125512
06-08-2007
REV.1543 EX AFP (09-00)
i.. j;! [: :: J
EST. OF BETTY J CLINE
S.S. NO. 196-18-5526
DATE OF DEATH 04-30-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
liJ CHECKING
o TRUST
o CERTIF.
WENDY LEBLANC
9 SILKWOOD LN
CARLISLE PA 17013
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MEMBERS 1 ST FCU has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pcnn~ylv~nia. Qu~sticns may be an$werod by c~lling (717) 7e7-2!27.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 226890-11
Date
Established
02-12-2003
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
759.86
50.000
379.93
.045
17.10
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.
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
x
PART
[!]
[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 "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 information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
x
PART
~
TAX
If you indicate a different tax rate, please state your
relationship to decedent:
RETURN - COMPUTATION 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
PAR"
@]
DATE PAID PAYEE
x
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
$
penalties of perjury, I declare that the facts
he) be(1~~\~(:_:nOjedge and belief.
have reported above are true, correct and
HOME (Ill) '2..L~1- Cp, 4-4-
WORK (III) 2L\J~-G\l~)4- ICCL-,-> <:.:.7
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