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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. CO 009433
MCCANNA JAMES C
606 COPPER CIRCLE
CARLISLE, PA 17013
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
~-~----- fold ---------- --------
08107788 I $1,709.57
ESTATE INFORMATION: SSN: 185-18-5088 I
FILE NUMBER: 2108-0313 I
DECEDENT NAME: MCCANNA MARY M I
DATE OF PAYMENT: 03/20/2008 I
POSTMARK DATE: 03/12/2008 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 12/10/2007 I
I
TOTAL AMOUNT PAID: $1,709.57
REMARKS:
I
CHECK# 200
INITIALS: CJ
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRIS8URG, PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 --()(,03/3
08107788
03-04-2008
REY-1543 EX AFP (09.00)
~,' 0 ,
\ l_ ,. ~ 1 "
EST. OF MARY M MCCANNA
S.S. NO. 185-18-5088
DATE OF DEATH 12-10-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
[X] CHECKING
o TRUST
o CERTIF.
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
JAMES C MCCANNA
606 COPPER CIR
CARLISLE PA 17015
MEMBERS 1ST FCU 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 Ppnnsvlvania. Qu~~tions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 210777-05
Date 08-26-2003
Established
To insure proper credit to your account, two
(2) copies of this notice must accompanv your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agentll.
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
75,980.75
X 50.000
37,990.38
X .045
1,709.57
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.
PART
[!]
A. ~ The
1.
above information and tax due is correct.
You may choose to remit payment to the Register of Wills with two copies of this
a discount or avoid interestt or you may check box "A" and return this notice to
Wills and an official assessment will be issued by the PA Department of Revenue.
notice to (Jlbtain
the Relliste<r of
[CHECK ]
ONE
BLOCK
ONLY
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 representative4
c. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
X
PART
~
TAX
If you indicate a different tax rate, please state your
relationship to decedent:
RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LIHC . . Data Established
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
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation)
t
Under penalties of perjury, I declare that the facts
complete to the best of my knowledge and belief.
have reported above are true, correct and
()
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