HomeMy WebLinkAbout01-27-09COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBIJ RG, PA 1 7 1 28-0601
RECEIVED IFROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11-96)
NO. CD 010822
SIPE BETTY M
16 WEST MAIN STREET
P O BOX 75
NEWBURG, PA 17240
-------- fold
ESTATE INFORMATION:
FILE NUMI3ER: ssrv: ~ s3-44-o4i $
2109-0086
DECEDEN,~r NAME: BLACK DEBORAH A
DATE OF PAYMENT: 01 /27/2009
POSTMARK DATE: 01 / 1 6/2009
couNTY: CUMBERLAND
DATE OF DEATH: 09/ 1 4/2008
REMARKS:
CHECK# 6923
DUPLICATE
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
TOTAL AMOUNT PAID:
INITIALS: AJW
S 12.69
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE T
INFORMATION NOTICE
BUREAU 01= INDIVIDUAL TAXES AN D
HARRISBURG6PA I71z8-o6ol TAX PAYE R R E S P O N S E
REV-1543 EX AFP (OB-09)
FILE N0. 21 1361 UvO~J
ACN 08160342
DATE 12-11-2008
BETTY M SIPE
16 W MAIN ST
NEWBURG PA 17240
EST. OF DEBORAH A BLACK
SSN 163-44-0418
DATE OF DEATH 09-14-2008
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS TD:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
ORRSTOWN BANK 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 ioint owner/beneficiary of this account.
If you feel the 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. Please call (717) 787-8327 with questions.
COMPILETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 450181 Date 12-01-2000
To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 564.0 ~ payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 50.000
Amount Subject to Tax $ 282 00 NOTE: If tax payments are made within three
months of the decedent's date of death,
Tax Rate ~( 15 deduct a 5 percent discount on the tax due.
Potential Tax DUe $ 42.30 Any Inheritance Tax due will become delinquent
nine months after the date of death.
P~r TAXPAYER RESPONSE
1 FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASS>ES,rSAENT
*_~
A. ^ The above information and tax due is correct. '7 `~
Remit payment to the Register of Wills with two copies of this notice to d ,a" ~'
CHECK a discount or avoid interest, or check box "A" and return this notice to the ide~ster--"`f 5
0 N E Wills and an official assessment will be issued by the PA Department of Revenue; i\,)
B L 0 C K ~ B. ~ The above asset has been or will be reported and tax paid with the Pen ~-.t r ~,
O N L Y to be filed by the estate representative. nsvlvan ~i_~Inheritance Tax return`
~ L
C. The above informs ion is incorrect and/or debts and deductions were paid ~ .j
t
Complete PART 2~ and/or PART ~ below. -L _"'~ '-'^-
a
PART If` indicating a different tax rate, plea a state ~~~
relationship to decedent: D-/~ r~ -~+~ p /~' OFFICIAL USE~NLY ~ AAF
TAX RETURN - COMPUTATION OF TAX O~~NI1JOINT/TRUST ACCOUNTS PAD PA DEPARTMENT OF REVENUE
LIN'c I . ^uate Established 1 ~ o[- ~ ~ ~''rp1OC~0 I
2. Account Balance 2__ $ (p T O C 2
3. Percent Taxable 3__ X '-p 3
4. Amount Subject to Tax 4 $ ~, $' 01 , 8 Q 4
5. Delbts and Deductions 5 - -- O -~ ~
6. Amount Taxable 6 $ o~ . O p 6
7. Ta:K Rate 7 X (~,. S'o d 7
8. Ta;[ Due 8 $ ~ a p 8
PART DEBTS AND D/EDUCTIONS CLAIMED
0
DATE PA I1) PAYEE DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation) g ~ p
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowledge and belief.
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