HomeMy WebLinkAbout08-29-07
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMEN'; OF REVENUE
B.'REAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128.0601
REV-1162 EX(11.96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
BERES LYNN A
55 BLACK WALNUT DRIVE
ETTERS, PA 17319
uu____ fold
ESTATE INFORMATION: SSN: 201-05-9186
FILE NUMBER: 2107-0508
DECEDENT NAME: HENNE RICHARD H
DATE OF PAYMENT: 08/29/2007
POSTMARK DATE: 08/28/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 05/03/2007
NO. CD 008607
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
07500613 I $8,823.66
I
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TOTAL AMOUNT PAID:
REMARKS:
CHECK# 1001
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$8,823.66
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALtH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO.21 07-0508
07500613
07-18 -20i17
REV-lSli3A A.FP (7-00l
'). C !
1: J' ,,' I
EST. OF RICHARD H HENNE
S.S. NO. 201-05-9186
DATE OF DEATH 05-03-2007
'COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SECURITY
[i] SEC ACCT
o STOCK
o BONDS
2~'J7/UG29
n'
LYNN A BERES
55 BLACK WALNUT DRIVE
ETTERS PA 17319
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
VANGUARD GROUP 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 beneficiary of this asset.
If you feel this information is incorrect, please obtain written correction from the transfer agent, attach a copy to this form and
return it to the above address4 This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania.
Duestions may be answered by calling (717) 787-B327.
COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 88009766707
DOD Valuation
Percent Taxable X
Amount Subject to Tax
Tax Rate X
Potential Tax Due
196,081.23
100.00
196,081.23
.045
8,823.66
TAXPAYER RESPONSE
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: IIRegister of Wills, Agent".
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.
PART
[!]
above information and tax due is correct.
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.
[CHECK ]
ONE
BLOCK
ONLY
B. c=JThe 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. c=JThe 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 ABOVE ASSETCS)
LINE
L DOD Valuation
2. Pe I.cent Taxable 2
3. Amount Subject to Tax 3
4. Debts and Deductions 4
5. Amount Taxable 5
6. Tax Rate 6
7. Tax Due 7
X
PART
[ID
DEBTS AND DEDUCTIONS CLAIMED
DATE PAID
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
t
penalties
to t~ best
O~
TA PA ER SIGNATURE
of perjurY, I declare that the facts
of my knowledge and belief.
have reported
HOME or)
WORK C,.,
TELEPHONE
above are true, correct and
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NUMBER
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