HomeMy WebLinkAbout12-28-07
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
SMITH SUSAN J
319 N 24TH STREET
CAMP HILL, PA 17011
-------- fold
EST A TE INFORMATION: SSN: 144-16-2079
FILE NUMBER: 2107-1171
DECEDENT NAME: SMITH JOSEPHINE
DA TE OF PAYMENT: 12/28/2007
POSTMARK DATE: 12/27/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 08/15/2007
NO. CD 009121
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
07149211 I $60.08
I
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TOTAL AMOUNT PAID:
REMARKS: SUSAN J SMITH
CHECK# 6297
SEAL
INITIALS: OM
RECEIVED BY:
REGISTER OF WILLS
$60.08
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
.
..' COMMONWEALTH OF PENNSYlVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
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INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21
ACN 07149211
DATE 11-23-2007
2001 DEe 28 AM": 53
EST. OF JOSEPHINE SMITH
8.S. NO. 144-16-2079
DATE OF DEATH 08-15-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
[i] CHECKING
D TRUST
D CERTIF.
SUSAN
319 N 24TH
CAMP HILL
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J SMITH
ST
PA 17011
REMIT PAYMENT AND FORMS TO:
REGISTERLOF WILLS
CUMBERLA~D CO COURT HOUSE
CARLISLE!, PA 17013
t;t, ~;~07
PNC BAN has provided the DepartMent with the inforaation 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 aay be ans~ered bY r.~11tng <717> 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 5140233677
Date
Established
08-02-1991
To insure proper credit to your account, two
(2) copies of this notice Must aCCOMpany your
paYMent to the keuister of Wills. Make check
payable to: "Register of Wills, Agent".
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
x
2,670.39
50.000
1,335.20
.15
200.28
NOTE: If tax p~yaents are Made within three
(3) Months of t~e decedent's date of death,
YOU aay deduct a 5" discount of the tax due.
Any inherit8nc~ tax due will beCOMe delinquent
nine (9) Months after the date of death.
!
x
PART
[!]
[CHECK ]
ONE
BLOCK
ONLY
The above inforMation and tax due is correct.
1. You May choose to reMit payMent to the Register of Wills with two c~pies 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.
B. c:J The above asset has been or will be reported and tax paid with the Penn$ylvania Inheritance Tax return
o be filed by the decedent's representative.
The above inforMation is incorrect and/or debts and deductions were paid by you.
You MUSt COMPlete PART ~ and/or PART 0 below.
PART If you indicate a different j~X r,te'~/Plea,~_state YOUr
~ relationship to decedent: J !)'~_- a~{"~tCr
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE l. Date Established 1
2. Account Balance 2
3. Percent Taxable 3
4. Amount Subject to Tax 4
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7
8. Tax Due 8
PART
(!]
DATE PAID PAYEE
x
x.tJl{~
; ,"O.Oe
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
.
of perjury, I declare that the facts
of my knowledge and belief.
have reported above are true, correct and
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TELEPHONE NUMBER DATE
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