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COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 009318
PURCELL KATHRYN
928 HAMIL TON STREET
CARLISLE, PA 17013
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
h~_n__ fold ---------- --------
08104490 I $109.80
ESTATE INFORMATION: SSN: 172-28-8979 I
FILE NUMBER: 2108-0177 I
DECEDENT NAME: PURCELL ALFREDA I
DATE OF PAYMENT: 02/20/2008 I
POSTMARK DATE: 02/20/2008 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 07/13/2007 I
I
TOTAL AMOUNT PAID: $109.80
REMARKS:
CHECK# 1315
INITIALS: CJ
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
~pREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRIS8URG, PA 17128-0601
.oM....
~,
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
NO.21
08104490
02-05-2008
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FILE
ACN
DATE
EST. OF ALFREDA PURCELL
5.5. NO. 172-28-8979
DATE OF DEATH 07-13-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
liJ SAVINGS
D CHECKING
D TRUST
D CERTIF.
ClERr(~ ()~
ORPWL\'( ('(I' J'QT
l 1!"', 'J '._,\..1"_ - ,I
CUtt:":: " r '0(\,
KATHRYN PURCELL
928 HAMILTON ST
CARLISLE PA 17013
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
FRIST NATIONAL BANK OF PENNA has provided the Department with the info....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 information 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.monwealth
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. 540650127
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
PART
[!]
Date 01-29-1992
Established
7,104.37
X 50.000
3,552.19
X .15
532.83
TAXPAYER RESPONSE
To insure proper credit to your account, two
(2) copies of this notice must acco.pany your
pay.ent to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
NOTE. If tax payments are .ade 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.
[CHECK ]
ONE
BLOCK
ONLY
A. [] 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.
B. [] 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. [] The above infor.ation is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
PART
[!I
TAX RETURN - COMPUTATION
If you indicate a different ~x rate~ease stat~our
relationship to decedent: s;L aJ~~ A.,(.h"'I ~
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
1/.2'jnl
~JluLh
OF TAX ON JOINT/TRUST ACCOUNTS
I
2
3
4
5
6
7
8
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
hi/loved
He. ~A ./le
AMOUNT PAID
1I10l,4D
PAYEE
T'~ N.....'lIIfJ", ~
TOTAL (Enter on Line
5 of Tax Computation)
of perjury, I declare that the facts I
~;'fy knowledge and belief.
~~
$
and
DATE