HomeMy WebLinkAbout01-29-09COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED E=ROME
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11-96)
NO. CD 010831
MITCHELL TOM
1363 HOUCK ROAD
INDIANA, PA 15701
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ESTATE (INFORMATION: ssrv: 207-3o-4s2i
FILE NUMBER: 2109-0092
DECEDENT NAME: MITCHELL MICHAEL P
DATE OF PAYMENT: 01 /29/2009
POSTMAFiK DATE: 01 /27/2009
COUNTY: CUMBERLAND
DATE OF (DEATH: 12/22/2008
REMARKS:
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
09102755 ~ 5515.83
TOTAL AMOUNT PAID:
5515.83
C:HECK# 917
INITIALS: AJW
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU 0
PO BOX 2
NARRISBU
7'OM MITCHELL REGISTER OF WILLS
1363 HOUCK ROAD CUMBERLAND CO COURT HOUSE
INDIANA PA 15701 CARLISLE, PA 17013
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
F INDIVIDUAL TAXES A N D
806D1
RG PA 17128-06D1 TAXPAYER RESPONSE
REV-1543 E% AFP (OB-UB)
EST. OF MICHAEL P MITCHELL
SSN 207-30-4321
DATE OF DEATH 12-22-2008
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS 1.ST FCU 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 joint 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.
COMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 55321-00 Date 05-31-1977
To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 9, 049.66 Payment to the Register of Wills. Make check
Percent Taxable Payable to "Register of Wills, Agent".
X 50.000
Amount Subject to Tax $ 4,524.83 NOTE: If tax payments are made within three
months of the decedent's date of death,
TaX Rate ~( 12 deduct a 5 percent discount on the tax due.
Potential Tax Due $-.~"~S~ ,Q' 542.98 Any Inheritance Tax due will become delinquent
nine months after the date of death.
P~r TAXPAYER RESPONSE
1 r•V,
FAILURE TO RESPOND WILL RESULT IN AN DFFICIAL TAX ASSESS~NT
A. X171 The
~J above information and tax due is correct. 2'~ C~ -.
Remit payment to the Register of Wills with two copies of
a di
t this notice to obk'~
~ ~L~
C HECK scoun
or avoid interest, or check box "A" and return
Wills and an official ..€_
this notice to the+:R~
r of
ONE
~
assessment will be issued by the PA
Department of Revenue
~
B L 0 C K B. ~ The above asset has been or will b ` ~J ~~
O N L Y e reported and tax paid with
to be filed by the estate th r
a Pennsylvania.S~~~t~nce T® return
representative. -
~~ --c-I
C. ~ The
above infor~ms ion is incorrect and/or debts and deductions _
were
id
CJ
~ ~ _
4V
Complete PART u and/or PART ~ below. pa
.
-
--~
'
r s O
~'
MRS -~ -~~~~~a~iny a airrerent tax rate, please state
relationship to decedent:
TAX RETURN - COMPUTATION
LINE 1. Late Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts .and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
2 +~
3 X
4
5
6
7 X
8 +~
PART
PAD
I
2
3
4
5
6
7
8
OFFICIAL USE DNLY ~ AAF
PA DEPARTMENT OF REVENUE
DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation) g
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complet~o, to the b st_ of y knowledge and belief. ~~y) ~/`~_ ~6 ~`
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TAXPAYER STGNATIIRF
F I L E N 0. 21 ! <<, ~~-i-12-.
ACN 09102755
DATE 01-16-2009
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