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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVEN~
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162 EX!1 '-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
BROWN GALEN
6 PAMELA DRIVE
MECHANICSBURG, PA 17050
-------- fold
ESTATE INFORMATION: SSN: 575-14-8703
FILE NUMBER: 2107-1117
DECEDENT NAME: GELNETT ALICE K
DATE OF PAYMENT: 12/10/2007
POSTMARK DATE: 12/08/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 10/15/2007
NO. CD 009056
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
07149178 I $17.36
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$17.36
REMARKS:
CHECK# 3088
SEAL
INITIALS: WZ
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280&01
HARRISBURG, PA 17128-0601
*'
21 - Of( -1111
07149178
11-23-2007
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO.
ACN
DATE
REV-1543 EX AFP <09-00)
EST. OF ALICE K GELNETT
S.S. NO. 575-14-8703
DATE OF DEATH 10-15-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
[i] CHECKING
D TRUST
o CERTIF.
GALEN BROWN
6 PAMELA DR
MECHANICSBURG PA 17050
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 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 infor.ation is incorrect, please obtain written correction froM 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..onwealth
of Pennsyl\'aniao_ - Questi..ns .ay l!~ -Nlswer9d by .;;al1ing (717) 787-8327.
COMPLETE PART 1 BELOW
Account No. 151139-11
Account Balance
Pe..cent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
PART
[!l
. .
. SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Date 04-27-1995
EstabUshed
To insure proper credit to your account, two
(2) copies of this notice .ust aCCOMPany your
paYMent to the Reuister of Wills. Make check
payable to: "Register of Wills, Agent".
x
2,314.25
16.667
385.72
.045
17.36
x
The above infor.ation and tax due is correct. ~ ~~ :!J
You May choose to re.it paYMent to the Register of Wills with two copi his not... to ~fO:>
a discount or avoid interest, or you .ay check box "A" and return this tice to the 'ltegist,r+~~fTl
Wills and an official assess.ent will be issued by the PA DepartMent of Revenue. I'\) ..., ~ 0
(It '7,
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.
[CHECK ]
ONE
BLOCK
ONLY
C. ~ The above infor.ation is incorrect and/or debts and deductions were paid by you.
You Must COMPlete PART ~ and/or PART ~ below.
OF
1
2
3
4
5
6
7
8
TAX ON JOINT/TRUST ACCOUNTS
PART
[!]
TAX RETURN - COMPUTATION
If you 1nd1cate a different tax rate, please state you~
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
x
x
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
co....ect and
TOTAL CEnte.. on Line 5 of Tax Computation)
.
pe~ju..y, I declare that the facts
my knowledge and belief.
have ..epo..ted above are t..ue.
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