HomeMy WebLinkAbout05-12-08 (2)
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT 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
BEQUEATH HELEN D
122 KNOCH ROAD
SAXONBURG, PA 16056
__n____ fold
ESTATE INFORMATION: SSN: 184-50-5335
FILE NUMBER: 2108-0523
DECEDENT NAME: KEEBAUGH TIMOTHY M
DA TE OF PAYMENT: 05/12/2008
POSTMARK DATE: 05/09/2008
COUNTY: CUMBERLAND
DATE OF DEATH: 03/12/2008
NO. CD 009705
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
08119005 I $114.20
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$114.20
REMARKS:
CHECK# 7522
SEAL
INITIALS: CJ
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21.. Og ~ 051.?J
08119005
05-05-2008
REV.1543 EX AFP (09.00)
EST. OF TIMOTHY M KEEBAUGH
S.S. NO. 184-50-5335
DATE OF DEATH 03-12-2008
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
D CHECKING
Ii] TRUST
D CERTIF.
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
l"-o.)
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FIRST NATIONAL BANK has provided the Department with the information listed below which has,paiI,gjed irr-- ;'~."<,;Z
calculating the potential tax due. Their records indicate that at the death of the above decedent. you were a j~~~~~r/be~ciar~i~f::,~
this ~ccount. If you fee~ this information is incorr~ct, please. obtain wri~ten correction. from the fin~ncial in~. ..t..l~~. attach a c~py '.~--.).
to th1S form and return 1t to the above address. Th1S account 1S taxable 1n accordance w1th the Inhel'ltance Tax J@~ the '!Q"IIonwealth,',
o~ I'ennsylvania. Questions may be answlOred by c&llinr; (n 7) 787-6327. +.JC ::E -:'.~ - ;'J.-.~~,
COMPLETE PART 1 BELOW If If If SEE REVERSE SIDE FOR FILING AND PAYMENT I~tiUCTI~ ~_:'":;,.4
Account No. 000-0608833 Date 04-27-2000 To insure proper credit to your acco~ two ".<
Established (2) copies of this notice IIuSt accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills. Agent".
DEANNA BEQUETH
122 KNOCH RD
SAXONBURG
PA 16056
x
20,033.63
5.000
1,001.68
.12
120.20
NOTE: If tax payments are made within three
(3) IIonths 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.
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
x
PART
[!]
TAXPAYER RESPONSE
A. ~The above inforllation and tax due is correct.
1. You .ay choose to remit pay.ent 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 assessllent will be issued by the PA Department 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. [] 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 RETURN - COMPUTATION
If you indicate a different tax rate, please state your
relationship to decedent:
OF TAX ON JOINT/TRUST ACCOUNTS
L1NE L Date 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
DESCR I PTI ON
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
$
Under penalties of perjury, I declare that the facts
complete to the best of my knowledge and belief.
6f)~NI~~
have reported above are true, correct and
HOME (?"'Lf) '3 S-d- -- 3 LIt, 4
WORK ( )
TELEPHONE NUMBER
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