HomeMy WebLinkAbout10-24-07
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*'
NO.
21 07, ql.1 ~ .
07142765
10-17-2007
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
REV..1Sti3 EX AFP C09-00>
"., I.-\r~l C
c. '.'.J. " ..'
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'- ....,
p;, \2: 02
TYPE OF ACCOUNT
o SAVINGS
[iJ CHECKING
o TRUST
o CERTIF.
EST. OF CARMELA M DAVIS
S.S. NO. 181-26-4406
DATE OF DEATH 08-21-2007
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PHYLLIS A DAVIS
512 LAMPOST LN
CAMP HILL PA 17011
COMMUNITY BANKS has provided the Depart.ent with the infoNlation 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 fro. the financial institution, attach a COPY
to this for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co.monwealth
of PennsYlvania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 148005138
Date 05-24-2006
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".
Account Balance
Percent Taxable
Amount SUbject to Tax
Tax Rate
Potential Tax Due
PART
[!J
11,982.01
X 50.000
5,991.01
X .045
269.60
TAXPAYER RESPONSE
NOTE. If tax payments are made within three
(3) months of the decedent's date of death,
you .ay deduct a 5% discount of the tax due.
Any inheritance tax due will beco.e delinquent
nine (9) months after the date of death.
A. r=J The above information and tax due is correct.
I. 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 .ay 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. r=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. r=J The above infor.ation is incorrect and/or debts and deductions were paid bY you.
You must co.plete PART ~ and/or PART ~ below.
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:
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
DESCRIPTION
AMOUNT PAID
$
have reported above are true, correct and
TOTAL CEnter on Line 5 of Tax Computation)
Under penalties of perjury, I declare that the facts
complete to the best of my knowledge and belief.
TAXPAYER SIGNATURE
HOME (
WORK (
TELEPHONE
)
)
NUMBER
~
DATE
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
DAVIS PHYLLIS A
512 LAMPOST LN
CAMP HILL, PA 17011
--.......-- fold
.'--
ESTATE INFORMATION: SSN: 181-26-4406
FIL.E NUMBER: 2107-0962
DECEDENT NAME: DA VIS CARMELA M
DATE OF PAYMENT: 10/24/2007
POSTMARK DATE: 10/23/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 08/21/2007
NO. CD 008845
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
07142765 I $269.60
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: PHYLLIS A OA VIS
CHECK# 1153
SEAL
INITIALS: OM
RECEIVED BY:
REGISTER OF WILLS
$269.60 "
GLENDA FARNER STRASBAUGH-
REGISTER OF WILLS .