HomeMy WebLinkAbout10-29-07
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
ANDERSON JOHN R
12045 GERALD AVENUE
GRANADA HILLS, CA 91344-2602
___nn_ fold
ESTATE INFORMATION: SSN: 160-1 6-8651
FILE NUMBER: 2107-0552
DECEDENT NAME: WALLOWER EVA
DATE OF PAYMENT: 10/29/2007
POSTMARK DATE: 10/24/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 02/28/2007
ACN
ASSESSMENT
CONTROL
NUMBER
07119695
TOTAL AMOUNT PAID:
. REMARKS:
\,.....,...",
CHECK# 5267
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INITIALS: CJ
RECEIVED BY:
SEAL
REGISTER OF WILLS
REV-1162 EX(11-96)
NO. CD. 008867
AMOUNT
$10.17
r
"$10.17
GLENDA FARNERSTR-,t...SBAUGH .
REGISTER OF WILLS.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG, PA 17128-0601
*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21-07.55;2..
07119695
05-03-2007
REv1.t54!D: AFP (ott. 00)
ZOOl OCT 29
p;; \2: 22
EST. OF EVA WALLOWER
S.S. NO. 160-16-8651
DATE OF DEATH 02-28-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
iii CHECK I NG
o TRUST
o CERTIF.
ro.n\ it,
l/t~l~ I'
('I I" '
'.......\...'
JACQUELIN ANDERSON
12045 GERALD AVE
GRANADA HILLS CA 91344
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 info,..ation 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 eccordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Questions .9Y be answercd by c311i~G (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 6050-11
Date 03-15-2000
Established
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".
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
1,356.25
X 16.667
226.05
X .045
10.17
TAXPAYER RESPONSE
NOTE, If tax payments are made within three
(3) months of the decedent's date of death,
you may deduct a 5X discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
PART
[!]
[CHECK ]
ONE
BLOCK
ONLY
A. ~The above information and tax due is correct.
~l. 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 assess.ent will be issued by the PA Depart.ent 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 representetive.
C. [] The above infor.ation is incorrect and/or debts and deductions were paid by you.
You .ust co.plete PART ~ and/or PART ~ below.
LINE l. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
PART
[!]
DATE PAID PAYEE
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4
5
6
7 X
8
PART
@]
TAX RETURN - COMPUTATION
If you indicate a different tax rate, please state your
relationship to decedent:
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
.
facts I have reported above are true, correct and
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