HomeMy WebLinkAbout12-10-07 (3)
..,
COMMONWEALTH OF PENNS~VANIA ~ REV-1162 EX(11-96)
/ DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERIT ANCE AND EST A TE TAX
OFFICIAL RECEIPT
NO. CD 009057
BROWN GALEN
6 PAMELA DRIVE
MECHANICSBURG, PA 17050
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
___n_n fold ---------- --------
07149177 I $17.36
ESTATE INFORMATION: SSN: 575-14-8703 I
..
FILE NUMBER: 2107-1117 I
DECEDENT NAME: GELNETT ALICE K I
DA TE OF PAYMENT: 12/10/2007 I
POSTMARK DATE: 1 2/08/2007 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 10/15/2007 I
I
TOTAL AMOUNT PAID: $17.36
REMARKS:
CHECK# 3091
SEAL
INITIALS: WZ
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONllEAlTH OF PENNSYlVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280'01
HARRISBURG, PA 17128-0'01
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21~01rOJU1
ACN
DATE
07149177
11-23-2007
REV-1543 EX AFP <09-00>
EST. OF ALICE K GEL NETT
S.S. NO. 575-14-8703
DATE OF DEATH 10-15-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
[i] CHECKING
D TRUST
D CERTIF.
CAROLYN SIMPSONBROWN
6 PAMELA DR
MECHANICSBURG PA 17050
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MEMBERS 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 infor.ation is incorrect, please obtain written correction fro. the financial institution, attach a copy
to this fo~ and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Co..onwealth
of Pennsylvania. Questions .ay be answered bY calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 151139-11
Date 04-27-1995
EstabUshed
To insure proper credit to your account, two
(2) copies of this notice .ust acco.pany your
pay.ent to the Regi~r of Wills.~ake check
payable to: "Reg.l.Ii.~...WillS' /Celt".
~ ~ ::J'..' ~.~~
NOTE I If tax pay..fij .ade ain titrlt.-. ~..'8i':.--'").'
(3) .onths of the datMf dea[ij!/ C)
you .ay deduct a 5 . of l!!!t tax .~. .. eg
Any inheritance t tr)~ be~ del~~
nine (9) .onths af(i) t;Oate oTdeath..:t1 C:':;
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
2,314.25
X 16.667
385.72
X .045
17.36
PART
[!]
The above infor.ation and tax due is correct. I\) C,:)<~=>
1. You.ay choose to re.it pay.ent to the Register of Wills with two copies of this no"'e to obt;ih1
a discount or avoid interest, or you .ay check box "A" and return this notice to the Register of
Wills and an official assess.ent will be issued by the PA Depart.ent 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 infor.ation is incorrect and/or debts and deductions were paid by you.
You .ust co.plete PART ~ and/or PART ~ below.
6
7
8
x
If you indicate a different tax rate, please state your
relationship to decedent:
PART
[!]
TAX RETURN - COMPUTATION
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
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3
4
5
x
PART
[!]
DEBTS AND DEDUCTIONS CLAIMED
DATE PAID
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
.
Under penalties of perjury, I declare that the facts
to the best of my knOWledge and belief.
have reported above are true, correct and
HOME ~lr
\'1 \11---":':"'.'1
1"'i
t"'.
~
<
0..
t:J
C't
:J
cO
Vi
.....
Ci
ct
((
:t
r-
~
...
-
...
-
-
-
-
-
-
-
-
t
0..
t"..
8
t-.I
U
UJ
o
~
l
J
.~n
~ ~
....
j
e:tJ
In
it)
,"':'
+
i')
.,..,
()
"-
.;001
"