HomeMy WebLinkAbout10-07-08 (3)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU DF INDIVIDUAL rAxes INFORMATION NOTICE //~~-~
DEPT. 280601 AND FILE N0. 21 °--U~~1lJ~-tX
HARRISBURG, Pa 1712a-0601 ~'_ - TAXPAYER; RESPONSE ACN 08133800
REY-1543 E%AFP (09-00) ~-, ~ DATE 07-24-2008
~~.'.lr, (',J ~ _, '~~~+ ° 0~ JOSEPH G SEMANCIK TYPE OF ACCOUNT
SAVINGS
S.S. N0. 188-38-9627
,~, r ®CHECKING
-_ ~'~ATE OF DEATH o7-12-2008 ~ rRUSr
G ~ :e
Q~A1~I'Y CUMBERLAND
(~~ gyp;-. ~~ _ _ ~ CERTIF.
CHRISTOPH J SEMANCIK ~ t REMIT PAYMENT AND FORMS T0:
4943 WATERFALL DR REGISTER OF WILLS
MACUNGIE PA 18062 CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
HARLEYSVILLE NB & TC 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 joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, 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. puestions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW ~( * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 2399 Date
11-29-1991
To insure proper credit to your account, two
Established (2) copies of this notice must accompany your
ACCOUnt Balance payment to the Register of Wills. Make check
Percent Taxable 8, 127 • 21
X payable to: "Register of Wills, Agent".
Amount Subject to Tax 16.667
1 , 354.56 NOTE: If tax payments are made within three
Tax Rate X (3) months of the decedent's date of death,
Potential Tax Due ' 15 you may deduct a 5i discount of the tax due.
2 0 3. 1 8 Any inheritance tax due will become delinquent
PART nine (9) months after the date of death.
1 ;;;;;;;,;;;;,;,;,;,,, ,; ,, TAXPAYER R E S P O N S E
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
C CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of
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
0 N L Y ~/to be filed by the decedent's representative, paid with the Pennsylvania Inheritance Tax return
C• Ik( The above information is incorrect and/or debts and deductions were paid by you.
7`~ You must complete PART 2^ and/or PART 3^ below.
PART If you indicate a different tax rate, please state
your :::::::::::::::::~ ::: ~:::: ~:::::::: _ ::~ ~~:~:.:::::::~ ::;:::::;:::<::::,::::::;::~ ~::::::::::::: ~:::: ~:::::.,.,.,.................
relationship to decedent: ""'"""""°°°'°°=~' °~~ '"
i''i:'iti~~ii'iii[=is~i~~i!'s;::_;:;:::~:;::: :€i'i;...:'€:':'`':'iii'i€::;:;:::'i'i'
ION ~_~<i€i=~~';~4€~~~' .: ;:~: _;~ ~ '`' :.. ..........:....:'i
TAX RETURN - COMPUTAT ~~~~~~~~'~~`~~~
OF TAX ON J0 NT/ :-:....;,::,::~::~::::::: ~::~~::::::::::::€:;:~;:~:;:::;::::~:~`:::::~fls1E::::
RUST ACCOUNTS =; :.:•::::°::::::~ :::::::::::::::-::~:,:::::~::;::::::::~;,:::::::::;::::::;~:;:_::::;:::;:::::=::;:::~::::~:
LINE 1 . Date Established l 11 / ~ ii ~~~:~ :::__ ...:........:.. r::.,.,.:.:.:.;.,.,.,.,.::, :,:; ,,;;; ,:; ~:;:::;,:; ~:::~ :i:~ € ~€"i=_=_"ii€i
;i:;: ass. is ; ~~ €~;: ~::'::::i.`i'i.`f:E:i'.CE'.5.::;:i;5i~i:s5iPE2;E; ~EiFi:SiEicii=_::~ :~ ~ :: EEiESEiiiiPi°p:SSii
2 . Account Balance ::::::::.:::::::::~ ;: .: .:.....: _:.:.:.::::.::.,.,.:::.-::;:_.:::::::,• ;:;:;;;:::~ i::€;;;i ' i '€
3. Percent Taxable ':is~i;is?ssi:~~ :::...:.::..:...............:::::.::::.:::•:::,:~;:,:~:~€;;:€:;::~:::`ii:€:?iii€si~;:;::::::::`t~i€:
4. Amount Subject to Tax " "
Debts and Deductions 5 _ """ °' °°' '`
::::::::::::::::::
Amount T a x a b 1 e 6 ~ ~ ::; :::::::: :.:....::......................................:.............:.:.:.:.:.:.:.: °.:.:. °..::`:::::::, :: ,:;:::;:;:~ ;:; ~:;
..
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:~:~:~;: ~;;: ~:;: ~: ~;~ ~ Eii:=;:~ ;:~':::;:~ [:'i:`s~=;s;:~ ;:~'::~ ; ~;'p€;;€;€;i ~;~ _ [i ~ iii'~it~[?~ t'i6i:'i'i~i=ii€ssE:.
:::
a x Rate ....... ..:: :.. . ..........::: r;:::,, :,::::::::,:,:,;:,:,:::::>;,; .; ~:;:; ~:;:::~ :s:;:;;;~ €
° 7 Q iissi~iz~i~ii=i'i4ii:'i'i;€ ~ii:i!`is:;:;::::=_:s:;~ ~ ::~ ~ :::;;_::::::::~ ::::~ ::: ~ :::.........................
:a::s::a=_::[:::s:.: ;::::is _s:= ~::~ si:'si~ ~ ~~i€iii ~:;:::i:€[9iis ~i€i?ifi?i ~;::;: viii€iiii€ ~;;:;:~ ississsi€i`iii€i€:; ~:::
8. Tax Due iii;~i:`i'itii::.:.:.' ..:.:.......:......::......:.:.::............:. ::::;,::; ,~::: ;:;:;:q:¢;:~:;:~::si['i
B ~~ ;~ si€~ s':i€[ f::;'ii'ii~€si:;:;`:€=iii`i'iii€i'i:'::;:::t:::s:::::::::s::~;:,:::~::::::::~ _ ::: ~ ..............................
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_ €~€~i a;i~i?:~ 4ssi _ ii~iiit~;i~i~i€iiiiai€s; ~ ~;~silii;iii~i€~ ;i€ ~i~i ~ ~i;_ ~€i~ 4~~;~i€i;iii ~i
PART - SGC~Z>!~J
~ ~o. pax ~
DATE PAID
~~7- ~~^5
~1 ~-I
PAYEE
DESCRIPTION
TOTAL (Enter on Line 5 of Tax Computation)
Under 8
penalties of perjury, I declare that the facts I have reported above are true, correct and
comp ete to the best of my knowledge and belief.
'- I HOME C 1~ ) ELI ~ ~V
TAXPAYER IG TURE WORK ( ~ OG~ ~ ~~
TELEPHONE NUMBER DATE
DEBTS AND DEDUCTIONS CLAIMED
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
SEMANCIK CHRISOPHER
4943 WATERFALL DRIVE
MACUNGIE, PA 18062
-------- fold
ESTATE INFORMATION: SSN: ~ 88-38-9627
FILE NUMBER: 2108-1002
DECEDENT NAME: SEMANCIK JOSEPH G
DATE OF PAYMENT: 10/07/2008
POSTMARK DATE: 10/06/2008
COUNTY: CUMBERLAND '"
DATE OF DEATH: 07/12/2008
REV-1162EX111-96)
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 010383
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
08133800 ~ 557.91
TOTAL AMOUNT PAID:
REMARKS: CHRISTOPHER SEMANCIK
CHECK# 9107
557.91
INITIALS: WZ
sEaL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS