HomeMy WebLinkAbout09-24-08COMMOL1Vt(EALTH CAF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX~11-96)
N0. CD 010306
HALLISEY DENNIS M
95 BARRENS CHURCH ROAD
DILLSBURG, PA 17019
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
fold
ESTATE INFORMATION: ssN: 205-05-2863
FILE NUMBER: 2107-0233
DECEDENT NAME: BOYLE FRANCES
DATE OF PAYMENT: 09/24/2008
POSTMARK DATE: 09/23/2008
COUNTY: CUMBERLAND ~~
DATE OF DEATH: 03/08/2007
REMARKS: DENNIS HALLISEY
SEAL
CHECK# 5530
08004929 ~ 57,302.23
TOTAL AMOUNT PAID:
INITIALS: WZ
RECEIVED BY:
57,302.23
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
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COMMDNWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601 A N D
HARRISBURG, PA 171za-o6gl TAXPAY E R R E S P O N S E
REV-1543 E% AFP (09-00)
FILE N0. 21 07-0233
ACN 08004929
DATE 09-11-2008
EST. OF FRANCES BOYLE
S.S. N0. 205-05-2863
DATE OF DEATH 03-08-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
REMIT PAYMENT AND FORMS TD:
DENNIS HALLISEY REGISTER OF WILLS
95 BARENS CHURCH RD CUMBERLAND CO COURT HOUSE
DILLSBURG PA 17019 CARLISLE, PA 17013
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AMERICAN SKANDIA ANNUITY has provided the Department with the information listed below which ha's b(e~m used>>7n
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a.jpit~t owner,c6e'neficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach ~ c,opy-,
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tam #~ of tli8 Commonwealth
of Pennsvlvania. Questions may be answered by calling (717) 787-8327. ~-- _i;..
-
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FI _
LING AND PAYMENT IFf~TRUCT~L.pNS ~-.
Account No. E0361267 Date 03-08-2006 !-3
L'
To insure proper credit to your ac~/~QQ{{~~nt, two
Established C2) copies of this notice must acc~'mpany your
Account Balance 48
681
50 payment to the Register of Wills. Make check
"
,
. payable to:
Register of Wills, Agent".
Percent Taxable X 100.00
Amount Subject to Tax 48
681
50 NOTE: If tax payments are made within three
'
,
. (3) months of the decedent
s date of death,
Tax Rate X 1Fj you may deduct a 5% discount of the tax due.
Potential Tax Due 7,302.23 Any inheritance tax due will become delinquent
nine C9) months after the date of death.
P
T TAXPAYER RESPONSE
~
1
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT BASED ON THIS NOTICE
A. The above information and tax due is correct.
1. You nay choose to remit payment to the Register of Wills with two copies of this notice to obtain
C H E C K a discount or avoid interest, or you may check b ox "A" and return this notice to the Register of
C 0 N E ~ Wills and an official assessment will be issued by the PA Department of Revenue.
B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
0 N L Y 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 2^ and/or PART 3^ below.
PART If you indicate a different tax rate, please state your OFFICIAL USE ONLY ~ AAF
relationship to decedent:
PA DEPARTMENT OF REVENUE
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNT S PAD
LINE 1. Date Established 1 1
2. Account Balance 2 2
3. Percent Taxable 3 X 3
4. Amount Subject to Tax 4 4
5. Debts and Deductions 5 - 5
6. Amount Taxable 6
7. Tax Rate 7 X 7
8. Tax Due 8 g
PART DEBTS AND DEDUCTIONS CLAIMED
0
TOTAL (Enter on Line 5 of Tax Computation) 8
r pe al ies of perjury, I declare that the facts I have reported abov=e/are true, correct and
co let he best of my knowledge and belief. HOME (7~7 ) 7~oZ ~'~'(~~~
WORK ( ~ ) ~ -U6/D 9 ~, ~:~~
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TA R SIGNATURE TELEPHONE NUMBER DATE
DATE PAID PAYEE DESCRIPTION AMOUNT PAID