HomeMy WebLinkAbout10-31-07 (2)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128.0601
REV.1162 EXlll.96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
RANGE DENNIS R
1007 CHARLES STREET
MECHANICSBURG, PA 17055
___n___ fold
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 008892
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
07140163 I $11.16
~
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TOTAL AMOUNT PAID:
REMARKS:
CHECK#1057
SEAL
INITIALS: AJW
RECEIVED BY:
REGISTER OF WILLS
" $11.16
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU DF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG, PA 1712B-0601
*'
FILE
ACN
DATE
NO. 21 6'1 6q<b
07140163
10-09-2007
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
REValS43 EX AFP (09-00)
TYPE OF
ACCOUNT
o SAVINGS
[i] CHECKING
o TRUST
o CERTIF.
EST. OF STEPHANIE A RANGE
S . S. NO. 1 62 - 48 - 0 958 ;;:;
DATE OF DEATH ijc37-200~
COUNTY CUM~~~AND~)
g~~AYH~ AND. FORKS TD:
REGIs;r:E;'~~ WH:-LS
CUMBERl'-AW CO COURT HOUSE
CARLI~~~?~fA ::]?1013
~I-
'-''''5
~
SHANE J RANGE
1007 CHARLES ST
MECHANICSBURG PA 17055
N
f')
C-
HEHBERS 1ST FCU has provided the Depart.ent with the infor.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 accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsvlvani!t. QUQstions ma~. be answered by colling (717) 787-8327.
Account No. 204497-11
COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
PART
ill
Date 08-17-2004
Established
To insure proper credit to your account, two
(2) copies of this notice must acco.pany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
1,488.20
X 16.667
248.04
X .045
11.16
TAXPAYER RESPONSE
NOTE: If tax payments are made within three
(3) .onths of the decedent's date of death,
you may deduct a 5% discount of the tax due.
Any inheritance tax due will beco.e delinquent
nine (9) months after the date of death.
[CHECK ]
ONE
BLOCK
ONLY
A. [] The above information and tax due is correct.
1. You may choose to re.it pay.ent 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 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 representative.
C. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
PART
[!]
TAX
If you indicate a different tax rate, please state your
relationship to decedent:
RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4
5
6
7 X
8
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
DEBTS AND DEDUCTIONS CLAIMED
DESCR I PTI 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.
~~~
TAVDAVI::D ~T~"'ATIIDI:'
have reported abov? are
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