HomeMy WebLinkAbout10-31-07
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
RANGE DENNIS R
1007 CHARLES STREET
MECHANICSBURG, PA 17055
--~----- told
ESTATE INFORMATION: SSN: 162-48-0958
FILE NUMBER: 2107-0985
DECEDENT NAME: RANGE STEPHANIE A
DA TE OF PAYMENT: 10/31/2007
POSTMARK DATE: 10/31/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 07/27/2007
NO. CD 008893
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
07140161 , $142.46
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I
I
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TOTAL AMOUNT PAID:
REMARKS:
CHECK# 1058
.SEAL
INITIALS: AJW
RECEIVED BY:
REGISTER OF WILLS
$142.46
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRIS8URG, PA 17128-0601
'*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 b~ (),\~c;'
07140161
10-09-2007
REV-lS43 EX AFP (09-00)
EST. OF STEPHANIE A RANGE
5.5. NO. 162-48-0958
DATE OF DEATH 07-27-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
!iJ SAVINGS
o CHECKING
o TRUST
o CERTIF.
REMIT PAYMENT AND FORMS TO:
REGISTER OF .~ILLS ;.::::
CUMBERLAND E~~OURT WUSE
CARLISLE, PA~::17013 <:::)
..~ :::u () ('")
D'~'- -j
.~ 8;~~ w
;.) C~ -0
MEMBERS 1 ST FCU has provided the Department with the information listed below which.:ba';,d>e\!h usel!:ln
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were .:..-:i.~t owner/benefic1a-f-YC o.t
this account. If you feel this information is incorrect, please obtain written correction from the financiaf.,i.p5'ti tution, f)1tach a copi/.
to this form and return it to the above address. This account is taxable in accordance with the Inheritance~4X Laws of ~ Commonwealth
of Pennsylvania. Questions may b~ dflSWtH"et.i Olt l,;dl11n3lJ (717) "i57-a527. ~ 1
COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
SHANE J RANGE
1007 CHARLES ST
MECHANICSBURG PA 17055
Account No. 204497-00
Date 04-26-2001
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
18,994.00
X 16.667
3,165.73
X .045
142.46
TAXPAYER RESPONSE
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
ill
A. c=J The above information and tax due is correct.
1. 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 assessment will be issued by the PA Department of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
B. c=J 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.
C. c=J The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
LINE 1- 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
I
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
DESCR I PH ON
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
$
Under penalties of perjury, I declare that the facts
complete to the best of my knowledge and belief.
~ -1(,~
have reported above are
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DATE