HomeMy WebLinkAbout09-12-07 (2)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1712B-0601
REV-1162 EX(11-96)
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
NO. CD. 008661
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
06157514 I $203.22
I ,
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK#1029
SEAL
INITIALS: CAJ
RECEIVED BY:
REGISTER OF WILLS
$203.22
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COHKONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
--
'* ~......,..
. ,
, .. ,
...-.... _.
INFORMATION NOTICE
-r,-' . AND
,.TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 '-lJV-CJ37
06157514
11-22-2006
lEV-In, e.x'AFp"':ID?-lq)
KEITH A GROGAN
13430 CATAPULT AVE
BRISTOW VA 20136
TYPE OF ACCOUNT
2007 SEP I 2 AM 10: 3 ~ST. OF KAY M GROGAN 0 SAVINGS
S.S. NO. 210-40-1837 0 CHECKING
CLERr( OF DATE OF DEATH 10-08-2006 0 TRUST
ORPHAN'S COURT COUNTY CUMBERLAND 00 CERTIF.
CUh.~"'; 't " . 01'\ REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
MEMBERS 1ST FCU has provided the Departaent with the inforaation 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 infor..tion is incorrect, please obtain written correction frOll the financial institution, attach a copy
to this fora and return it to the above address. This account is taxable in accordence Nith the Inheritance Tax LaNs of the CoallOnNaalth
of ~cnn=YIYBnia. ~.~tion5"Y be an;w&rad by callinw (717) 787-83Z7.
COMPLETE PART 1 BELOW · · . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 102363-47 Date 06-09-1988
Estllbllshed
Account Balance
Percent Taxable
AItount Subject to
Tax Rate
Potential Tax Due
x
9.032.08
50.000
4.516.04
.045
203.22
TAXPAYER RESPONSE
To insure proper credit to Your account, two
(2) copies of this notice IlUst accoapany Your
payaent to the Register of Wills. Hake check
payable to: "Register of Wills, Agent".
Tax
x
NOTE: If tax payaents are aade Nithin three
(3) aonths of the decedent's date of deeth,
YOU aay deduct a SiC discount of the tax due.
Any inheritance tax due Nill becoae delinquent
nine (9) aonths after the date of death.
PART
[!J
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
I'Iil6The above inforaation and tBlC due is correct.
~l. You aay choose to rllllit payaent to the Register of Wills Nith tNO copies of this notice to obtain
a discount or avoid interest, or YOU ..y check box "A" and return this notice to the Register of
Wills and an official assesSllent Nill be issued by the PA Departaent of Revenue.
If yoU indicate a different tax rate. please state your
relationship to decedent:
r=J The above asset has been or Nill be reported and tax paid Nith the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
r=J The above infor..tion is incorrect and/or debts and deductions Nere paid by YOU.
You aust coaplete PART ~ end/or PART ~ beloN.
PART
[!J
TAX RETURN - COMPUTATION OF
LINE 1. Date Established 1
2. Account Balance 2
3. Percent Taxable 3 X
4. Allaunt SubjBCt to Tax 4
5. Debts and Deductions 5
6. Allaunt Taxable 6
7. Tax Rate 7 X
8. Tax Due 8
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
TAX ON JOINT/TRUST ACCOUNTS
PAYEE
DESCRIPTION
AMOUNT PAID
llf{d-'
facts I
~-;;Erep~rU~ -;ovei~e ?:ue'/~or;i'?t
W~;~EP~ONE N~MBER
and
r-
Z007 SEP 12 M110: 33 _
CLERr( OF
OOFJt-'!If,\:'~-: ("r, 'I !f'lT
I I r ,,'^-, \ ,-, '_ ' -',Jill
"'LIHC RlA
\..J .'j,' I. f'\
"'"
~
crt
:>
I/l
w
-J
--J
::)
o
....
~
~
~
.r...
~
~
i
ti'\
N
r-
r\\
~
CO)
u
j:::
~ c
0
~ ~
X
LU CI)
'" ~
;!: "
w
wen
:::::>>w
z><z 'P'"
w~o ~
>~(jj 9
wc:(- co
a:::::::>>~ ~
LLOO r--
0$>< 'P'"
.... -0 c( ~
Z ....'P'"
w~w~CJ
:ELLOCa::
~Ozrei
<(:::::>>~><en
~c:(-o-
wwa::ma::
oa::~O~
~i.~D.X