HomeMy WebLinkAbout05-14-08
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
OHSTROM JOAN B
1454 MAPLEWOOD DRIVE
NEW CUMBERLAND, PA 17070
-------- fold
ESTATE INFORMATION: SSN: 000-00-0000
FILE NUMBER: 2108-0535
DECEDENT NAME: BACKUS MARGARET M
DATE OF PAYMENT: 05/14/2008
POSTMARK DATE: 05/13/2008
COUNTY: CUMBERLAND
DATE OF DEATH: 12/22/2007
NO. CD 009724
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
08116774 I $3.68
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TOTAL AMOUNT PAID:
REMARKS: JOAN B OHSTROM
CHECK# 795
SEAL
INITIALS: WZ
RECEIVED BY:
REGISTER OF WILLS
$3.68
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG, PA 17128-0601
'*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21-00-6S$
08116774
04-18-2008
REV-IS4! EX AFP C09-00)
EST. OF MARGARET M BACKUS
S.S. NO. 109-01-9284
DATE OF DEATH 12-22-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
!iJ CHECKING
o TRUST
o CERTlF.
JOAN B OHSTROM
1454 MAPLEWOOD DR
NEW CUMBERLAND PA 17070
I'-..)
o g
~ B~ has provided the DepartMent with the information listed below Which;t.!)aeen use~ F<~ ;:S~;
ca c. potential tax due. Their records indicate that at the death of the above decedent, you were a:~T~nerAilhefic~f.Y'::.oJ;
this account. If you feel this information is incorrect, please obtain written correction from the financial.-in.. ~Pti:pon, -;.1'tach 10. ciopy"J
to this form and return it to the above address. This account is taxable in accordance with the Inheritance.J~~ of ~ comm~e~h
of Pennsylvania. Questions may be answered by calling {717l 7B7-8327. ~~_crJ~. ~ :~ ctJ
COMPLETE PART 1 BELOW IE IE IE SEE REVERSE SIDE FOR FILING AND PAYMENT 1. QUCT. NS~'
Account No. 513332932
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
PART
[!]
Date 01-15-2002
Established
4,053.65
X 50.000
2,026.83
X .15
304.02
TAXPAYER RESPONSE
:lC_ ~ .__,.:'.,1
To insure proper cre<iit:n your a~nt, t.wo C"J
(2l copies of this n.o;$)ic-;;lmust act~pany ~lI~r"n
payment to the Regi~r of Wills.~ake dheik-)
payable to: "Register of Wills, AllI!)t". '
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.
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 lIay 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.
[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 representative.
C. ~e above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
PART
~
TAX RETURN - COMPUTATION
If you indicate a different ~~a~ Pl~~e state your
relationship to decedent: i1E
LINE 1- Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
S. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
PART
~
DATE PAID
OF
1
2
3
4
5
6
7
8
TAX ON JOINT/TRUST ACCOUNTS
Ol-/~ - ~liotJ
4 0 ~4 . i; ~/"
01-0;2(,. ~3
I q L/ r. 01)
5(.1. Q~
X ~.S-7/):;: 3.' i~S-
X
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCR I PTI ON
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
$
perjury, I declare that the facts I have reported above are true, correct and
y knowledge and belief. HOME (7/7) 77 'I or r 7
WORK ( ) - tJs- - 1/ - rJ1'
TELEPHONE NUMBER DATE .~l
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