HomeMy WebLinkAbout08-29-07
REV-1162 EX( 11-96)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B060 1
HARRISBURG. PA 17128-0601
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 008604
RECEIVED FROM:
WOOTEN SHARON
2118 ARBOR COURT
MECHANICSBURG, PA 17055
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
-------- fold
07123127
$105.04
ESTATE INFORMATION: SSN: 168-14-1265
FILE NUMBER: 2107-0804
DECEDENT NAME: BELFORD JEAN G
DATE OF PAYMENT: 08/29/2007
POSTMARK DATE: 08/09/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 04/01/2007
TOTAL AMOUNT PAID:
$105.04
REMARKS:
CHECK# 1335
INITIALS: CAJ
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
SEAL
REGISTER OF WILLS
c.Y.. \;~S COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*;
FILE
ACN
DATE
NO. 21-07-0804
07123127
05-31-2007
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
R['j--1543" EX 'MP' (09-00)
7f'-J'7I..UG "9
L ,,' "I C.
TYPE OF ACCOUNT
o SAVINGS
IiJ CHECKING
o TRUST
o CERTIF.
Pt'! 12: 37
EST. OF JEAN G BELFORD
5.5. NO. 168-14-1265
DATE OF DEATH 04-01-2007
COUNTY CUMBERLAND
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REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
SHARON WOOTEN ,,-r-
9 [HL 'ftl Ltt .;z It g ARBDft COU" I
MECHANICSBURG PA 17055
MEMBERS 1ST FCU has p..ovided the Depa..tunt with the info....ation listed below which has been used in
calculating the potential tax due. Thei.. ..eco..ds indicate that at the death of the above decedent, you we..e a joint owne../beneficiar-y of
this account. If you feel this info...ation is inco....ect. please obtain w..itten co....ection f..om the financial institution. attach a copy
to this fo... and ..etu..n it to the above add..ess. This account is taxable in acco..dance with the Inhe..itance Tax Laws of the Co..onwealth
of Pennsylvania. Questions may be answe..ed by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 37390-11
Account Balance
Pe..cent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
PART
[!]
Date 04-12-1984
Established
To insure proper credit to your account, two
(2) copies of this notice must accompany you..
payment to the Registe.. of Wills. Make check
payable to. "Registe.. of Wills. Agent".
14,005.15
X 16.667
2,334.24
X .045
105.04
TAXPAYER RESPONSE
NOTE. If tax pay.ents a..e .ade within th..ee
(3) months of the decedent.s date of death.
you .ay deduct a 5X discount of the tax due.
Any inhe..itance tax due will beco.e delinquent
nine (9) .onths afte.. the date of death.
A. f'J\ The above info...ation and tax due is co....ect.
~l. You .ay choose to ..e.it pay..ent to the Registe.. of Wills with two copies of this notice to obtain
a discount 0.. avoid inte..est. 0.. you .ay check box "A" and ..etu..n this notice to the Registe.. of
Wills and an official assessment will be issued by the PA Depa..tment of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
B. [] The above asset has been 0.. will be ..epo..ted and tax paid with the Pennsylvania Inhe..itance Tax ..etu..n
to be filed by the decedent's ..ep..esentative.
C. [] The above info...ation is inco....ect andlo.. debts and deductions we..e paid by you.
You must complete PART ~ andlo.. PART ~ below.
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4
5
6
7 X
8
PART
~
TAX RETURN - COMPUTATION
If you indicate a diffe..ent tax ..ate. please state you..
..elationship to decedent:
LINE 1- Date Established
2. Account Balance
3. Pe..cent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
PART
[!]
DATE PAID PAYEE
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
TOTAL CEnte.. on Line 5 of Tax Computation)
.
have ..epo..ted above a..e t..ue, co....ect and
HOME (71'1) bq1- q3~()
WORK ( )
TELEPHONE NUMBER DATE
Unde.. penalties of pe..ju..y, I decla..e that the facts I
complete to the best of my knowledge and belief.
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TAXPAYER SIGNATURE
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