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Home My WebLink About12-18-08COMMONWEALTH OF PENNS'rLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 71 28-060 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) N0. CD 010655 BURTSAVAGE EDWARD M 317 PINEWOOD DRIVE SHIREMANSTOWN, PA 17011 foltl ESTATE INFORMATION: ssN: ~6a-~s-3207 FILE NUMBER: 2108-1265 DECEDENT NAME: BURTSAVAGE HELEN M DATE OF PAYMENT: 1 2/ 1 8/2008 POSTMARK DATE: 12/18/2008 couNTY: CUMBERLAND DATE OF DEATH: 1 1 /01 /2008 REMARKS: ACN ASSESSMENT AMOUNT CONTROL NUMBER 08155448 ~ 599.45 TOTAL AMOUNT PAID: 599.45 CHECK#6501 INITIALS: CJ SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS PENNSYLVANIA INHERITANCE; TAX INFORMATION NOTICE BUREAU OF INDIYIDUAL TAXES _ •_ .._ AND FILE N0. 21 -(~~~Jz(pS Po Box 280601 ~ ~ ' '' TbXRAYER RESPONSE ACN 08155448 HARRISBURG PA 17128-0601 _ ~ DATE 11-24-2008 REV-1543 E% AFP (OB Ue7'~-' '~' ~ "` ` •' TYPE OF ACCOUNT Z~S~O DEC ~ S ~~ ~~~ 23EST. OF HELEN M BURTSAVAGE ® SAVINGS SSN 168-18-3207 ~ CHECKING ~p CLERK ~F ~j--~~• DATE OF DEATH al-O1-2008 ~ TRUST ~1~11~~t l~rV`tiS~ O~~fll~# ROUNTPAYMENT AND M~RM LADND ~ CERTIF. EDWARD M BURTSAVAGE REGISTER OF WILLS 327 SOMERSET DR CUMBERLAND CO COURT HOUSE SHIREMANSTOWN PA 17011-6539 CARLISLE, PA 17013 PSECU provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a point owner/beneficiary of this account. If you feel the information is incorrect, please obtain written correction from the financial institution, attach a coDY 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. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0168183207-S7 Date 03-10-1982 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 4,420.09 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to Tax $ 2, 210.05 NOTE: If 'tax payments are made within three months of +the decedent's date of death, Tax Rate )( .045 deduct a 5 percent discount on the tax due. Potential TaX Due Any Inheritance Tax due will become delinquent $ 99.45 nine month:. after the date of death. P~T TAXPAYER RESPONSE 1 FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX A55ESSMENT A. ~ The above information and tax due is correct. 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 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. BLOC 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 estate representative. [:. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3~ below. PART If indicating a different tax rate, please state relationship to decedent: OFFICIAL U5E ONLY ~ AAF PA DEPARTMENT OF REVENUE TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS pAD LINE 1. Date Established 1 1 2. Account Balance 2 $ 2 3. Percent Taxable 3 X 3 W 4. Amount Subject to Tax 4 $ 4 5. Debts and Deductions 5 - 5 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X ~ 8. Tax Due g $ 8 PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION nMniir.~r- owrn Under penalties of perjury, I declare that the facts I complete to the best of my knowledge and belief. XPAYER SIGNATURE have reported above are true, correct and HOME C 7!7 ~ 76 /° ]!'&~ WORK C ) ~+ ~~ ~~ TELEPHONE NUMBER DAT •-•--- -~••«~ ~~~ ~~„r ~ ur iaz ~omaucauon~ s