HomeMy WebLinkAbout11-05-07
COMMONWEAL TH 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- 0737
07145644
10-25-2007
REY~15li:S EX AFP (09-00)
'\' ~ "
LI i: k9
TYPE OF ACCOUNT
D SAVINGS
[i] CHECKING
D TRUST
D CERTIF.
'-~
EST. OF SARA E SHAY
S.S. NO. 185-03-3704
DATE OF DEATH 07-24-2007
COUNTY CUMBERLAND
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REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
DONALD L SMITH
APT 19
660 GREGS DR
HBG PA 17111
PNC BANK has provided the Department with the information 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 Pennsylvania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 5004050155
Date 01-05-2004
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
PART
[!]
3,109.27
X 50.000
1,554.64
X .045
69.96
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.
A. F{1 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. [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. [J The above inforMation is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
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
PART
~
TAX
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
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
$
TOTAL (Enter on Line 5 of Tax Computation)
co
perjury, I declare that the facts I
my knowledge and belief.
have reported above are true, correct and
HOME (~l"') Sc..c, -'\OS-O ff- 2..-ol
WORK ( )
T~I ~PWONE 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
NO. CD 008913
DUPLICA TE
SMITH DONALD III
660 GREGS DRIVE
APT 1 9
HARRISBURG, PA 17111
-------- fold
ESTATE INFORMATION: SSN: 185-03-3704
FILE NUMBER: 2107-0737
DECEDENT NAME: SHA Y SARA E
DATE OF PAYMENT: 11/05/2007
POSTMARK DATE: 11/02/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 07/24/2007
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
07145644 I $69.96
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TOTAL AMOUNT PAID:
REMARKS:
CHECK# 3456
SEAL
INITIALS: AJW
RECEIVED BY:
REGISTER OF WILLS
$69.96
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
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