HomeMy WebLinkAbout06-04-08
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
HUGHES DALE W
591 S 80TH STREET
HARRISBURG, PA 17111-5308
-------- fold
ESTATE INFORMATION: SSN: 195-07-9125
FILE NUMBER: 2107-1006
DECEDENT NAME: HUGHES ZELDA lONE
DATE OF PAYMENT: 06/04/2008
POSTMARK DATE: OS/27/2008
COUNTY: CUMBERLAND
DATE OF DEATH: 10/09/2007
NO. CD 009845
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
08500142 I $152.73
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TOTAL AMOUNT PAID:
REMARKS:
CHECK# 2594
SEAL
INITIALS: CJ
RECEIVED BY:
REGISTER OF WILLS
$152.73
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMK?NWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO BOX 2B0601
HARRISBURG PA 1712B-0601
-~)E1 OFC~~O~;MATfNODN NOTICE
~(" I~),(f'.AYER RESPONSE
REV-IS"A lJ~.?l:o'i,1 [., , ' ! I, .....
FILE
ACN
DATE
NO. 21 07- 1006
08500142
02-13-2008
TYPE OF ACCOUNT
Z008 JUN -4 PH I: 00
EST. OF ZELDA I HUGHES
CLERK OF S . S. NO. 195 - 07 - 9125
~~~~~[?~~T~~~~T~F DEAT~UM~~~~:~~007
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
o SECURITY
[il SEC ACCT
o STOCK
o BONDS
DALE W HUGHES
591 SOUTH 80TH ST
HARRISBURG PA 17111
HARTFORD MUTUAL 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 beneficiary of this asset.
If you feel this information is incorrect, please obtain written correction from the transfer agent, 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 Pennsylvania.
wuestions may oe answer'ad by cai:iing (/17) la/"b~.(:/.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 245878
DOll Valuation
Per"cent Taxable
Amount Subject to Tax
Ta)[ Rate
Potential Tax Due
PART
[!]
x
16,669.95
25.000
4,167.49
.045
187.54
TAXPAYER RESPONSE
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".
x
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. c=JThe 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.
[CHECK ]
ONE
BLOCK
ONLY
B. c=JThe 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. c=JThe above information is incorrect and/or debts and deductions were paid by you.
You must complete PART 0 and/or PART 0 below.
PART If you indicate a different tax rate. please state your
~ relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSETCS)
I
2 X
3
4
5
6 X
7
LINE 1- DOD Valuation
2. Percent Taxable
3. Amount Subject to Tax
4. Debts and Deductions
S. Amount Taxable
(0. Tax Rate
7. Tax Due
PART DEBTS AND DEDUCTIONS CLAIMED
[!]
DATE PAID
PAYEE
=1
DESCRIPTION
AMOUNT PAID
TOTAL {Enter on Line 5 of Tax Computation)
$
perjury, I declare that the facts I
my nowledge and belief.
have reported above are true, correct
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