HomeMy WebLinkAbout09-12-07
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128.0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
MITTERLlNG ARLA K
115 SKYLINE DRIVE
MECHANICSBURG, PA 17050
-------- fold
ESTATE INFORMATION: SSN: 210-40-1837
FILE NUMBER: 2106-0939
DECEDENT NAME: GROGAN KAY
DATE OF PAYMENT: 09/12/2007
POSTMARK DATE: 08/23/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 10/07/2006
REMARKS:
CHECK#1030
SEAL
ACN
ASSESSMENT
CONTROL
NUMBER
101
TOTAL AMOUNT PAID:
INITIALS: CAJ
RECEIVED BY:
REGISTER OF WILLS
REV.1162 EX(11-96)
NO. CD 008665
AMOUNT
$21.64
$ 21 .64
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS.
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
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INFORMATION NOTICE
AND
':.TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21-()(r(tj3~
06157515
11-22-2006
REV-15'~:_Eit At; !D'~'lIf
TYPE OF
ACCOUNT
iii SAVINGS
o CHECKING
o TRUST
o CERTIF.
ZOG7 SEP 12
KEITH A GROGAN
13430 CATAPULT AVE
BRISTOW VA 20136
CI CRt/ l"\;:
Lc.. f\ Ji
ORPH6Ji'S COURT
C' l~l:-._,"-'-- ,'-.',
vi;'I.
M'IIO: 36EST. OF KAY M GROGAN
S.S. NO. 210-40-1837
DATE OF DEATH 10-08-2006
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLEI PA 17013
MEMBERS 1ST FCU has provided the o.partllent with the inforBation listed below which hu been used in
calculating tha 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 inforeation is incorrect, please obtain written correction frOB the financial institution, attach a copy
to this forB and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the COB~nwealth
of Pennsylvenia. Questions eay be enswer.d by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 103978-00 Date 08-18-1988
EstabUshed
Account Balance
Percent Taxable
AlIOUnt Subject to
Tax Rate
Potential Tax Due
x
961.72
50.000
480.86
.045
21.64
TAXPAYER RESPONSE
To insure proper credit to your account, two
(2) copies of this notice BUst accoBpany your
payeent to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
x
NOTE: If tax payeents are eade within thrae
(3) Bonths of the decedent's date of death,
yOU eay deduct a 5;( discount of the tax due.
Any inheritance tax due will becoee delinquent
nine (9) BonthS after the date of death.
Tax
PART
[!]
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
f\1l The above inforeation and tax due is correct.
~ 1. You Bay choose to reBit pay..nt to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or yOU Bay check box "A" and return this notice to the Register of
Wills and an official assesseent will be issued by the PA Departeent of Revenue.
[] 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.
[] The above inforBation is incorrect and/or debts and deductions IIBre paid by you.
You Bust cOBplete PART ~ and/or PART [!] below.
If you indicate a different tax ratel please state your
relationship to decedent:
PART
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PART
~
TAX RETURN - COMPUTATION OF
LINE 1. Date Established 1
2. Account Balance 2
3. Percent Taxable 3
4. AlIOunt Subject to Tax 4
5. Debts end Deductions 5
6. A.ount Taxable 6
7. Tax Rate 7
8. Tax Due 8
TAX ON JOINT/TRUST ACCOUNTS
x
x
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
perjury I I declare that the facts I
ledge and beUef.
I
$
have reported above are trUBI correct and
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WORK ( ; )
TELEPHON NUMB
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