HomeMy WebLinkAbout04-15-08
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INOIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYL VANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 009564
HAFFNER WALLACE
215 N 33RD STREET
CAMP HILL, PA 17011
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold ---------- --------
08114391 I $190.64
ESTATE INFORMATION: SSN: 189-07-8665 I
FILE NUMBER: 2108-0429 I ,
I
DECEDENT NAME: CHRISTIAN MARY K I
DATE OF PAYMENT: 04/15/2008 I
POSTMARK DATE: 04/14/2008 I I
COUNTY: CUMBERLAND I
DATE OF DEATH: 01/21/2008 I
I
TOTAL AMOUNT PAID: $190.64
REMARKS:
CHECK# 2247
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
HARRISBURG. PA 1712B-0601
fif~. '. .f-.1- rF ;{NFORHATlNODN NOTICE
!~ I ....J ,~~TAXPAYER RESPONSE
'- ,,~, '....' .......1 I ......';
FILE
ACN
DATE
NO. 21 ,a'o~~,
08114391
04-10-2008
REY-1543 EX AFP (09-00>
2008 APR 1 5 PM 12: 5 I
EST. OF MARY K CHRISTIAN
S.S. NO. 189-07-8665
DATE OF DEATH 01-21-2008
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
[i] CHECKING
o TRUST
o CERTIF.
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REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
WALLACE HEFFNER
215 N 33RD ST
CAMP HILL PA 17011
NORTHUMBERLAND NATl BANK 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 fro.. 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 Commonwealth
of Pennsylvania. Questions may be answered by colling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0031988001
Account Balance
Percent Taxable
Amount SUbject to Tax
Tax Rate
Potential Tax Due
PART
[!]
Date 09-27-1999
Established
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
2,675.72
X 50.000
1,337.86
X .15
200.68
TAXPAYER RESPONSE
NOTE. If tax pay.ents 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.
[CHECK ]
ONE
BLOCK
ONLY
A. 'I'Ilii'I The above inforllation and tax due is correct.
~ 1. You may choose to re.it 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 inforllation is incorrect and/or debts and deductions were paid by you.
You .ust cOIIPlete PART ~ and/or PART ~ below.
1
2
3 X
4
5
6
7 X
8
PART
~
TAX
If you indicate a different tax rate, please state your
relationship to decedent:
RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
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
DEBTS AND DEDUCTIONS CLAIMED
DESCR I PTI ON
AMOUNT PAID
TOTAL (Enter on line 5 of Tax Computation)
*
Under penalties of perjury, I declare that the facts I
complete to the best of my knOWledge and belief.
TA~~U~
have reported above are true, correct
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