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r COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE .~. BUREAU OF COUNTY COLLECTIONS HARRISBURG 17127 RCC-43 (4-71) NOTE: TO BE SUBMITTED IN TRIPLICATE REPORTING FINANCIAL INSTITUTION ADDRESS Dauphin Deposit 8enk i Trast I~o. 213 Merkat :araet HarrieburQ, Penney van a GIP CODE 17105 Pennsylvania Department of~Revenu~~ Bureau of County Collections Gable Building, 3rd, Floor 41'1 S. Second Street Harrisburg, Pennsylvania 17127 Pursuant to Section 742, Pennsylvania Inheritance and Estate Tax Act of 1961, we herewith submit the following rE~port: ACCOUNT N0. OF JOINT, TRUST OR INVESTMENT DEPOSIT ~ c~ ~ 8 NAMES ON ACCOUNT OR INVESTMENT Mer Bret F. Walsh or Rite F. Caapbell DATE OF DEATH JY1 ~~ ~ DECEASED JOINT DEPOSITOR, TRUSTEE OR INVESTOR Rlta F. t~pboll H - ADDRESS 4 S{,~lt Street COUNTY ZIP CODE SURVIVING DEPOSITOR, BENEFICIARY OR INVESTOR Mer>Darat F. Welsh ADDRESS RELATIONSHIP TO DECEDENT DATE DEPOSIT OR INVESTMENT WAS ESTABLISHED BALANCE, INCLUDING INTEREST DUE, AT DATE OF DEATH $ ~~ ~ , s" ~~J ~ll~/vf ~ ~~ Sister X1148.95 Signature TITLE ~+ Ann ~:. stover Accotmt Service ©fllcer Deposit Accost Services K~C /'ItV-0YJ I1 V-/o/ OFFICIAL NOTICE OF INHE COMMONWEALTH OF PENNSYLVANIA ,rte APPRAISEMENT AND ASSESSMENT DEPARTMENT OF REVENUE BUREAU OF FIELD OPERATIONS OF ASSETS NOT SUBJECT INHERITANCE TAX DIVISION TO ADMINISTRATION T0: IIM-tc~atcsi >E. iitlal~ Date: 43S gy~~ ,~~ County ~~~ paw 1~q,3 County File No Bureau File No. tits E. t~apMil We have r~c~~ive$ notice that, as a result of the death of on ~ '19~$_, you came into ownership of certain property through ri ht of survivorship, which was formerly owned by the decedent. Under the Inheritance and Estate Tax Laws of the Commonwealth of Pennsylvania and the liability for the payment of the inheritance tax due is imposed upon you, as transfer The property on which tax is hereby assessed consists of: ~D1~*~ i ~ st ~ t 3a air odE ~ ~• ilalsY os sita- ~. Cia~p>b~ transfers are taxable ~t Co. ascabliai~ld 5-31-i2 appraised by the Commonwealth, as of the date of death, at $~ -~~-,~ ~ °i° of this amount is taxable at the rate of ~ °~° ORIGINAL ASSESSME~ DATE OF ASSESSMENT TAXABLE AMOUNT LESS: ALLOWED DEBTS NET TAXABLE AMOUNT AMOUNT OF TAX DUE If you pay the above amount within three (3) months of the date of death of the decedent, or on or before 19 ., you may deduct a discount of 5 % of the amount of tax due, or This tax became delinquent nine (9) months after death (one year if death occurred prior to December 22, 1965 and fifteen months if death occurred on or after December 22, 1965 but prior to June 17, 1971) and in addition to the tax, statutory interest at the rate of 6°i° of the tax per annum is also due as of.' ~-~ 19~--- in the amount of ~' -' ~~;-~,;~ ~~~ ~~,,, ~~ , * If the tax is not paid by the above date additional interest is due at the rate of 6°i° per annum until paid TOTAL AMOUNT DUE 11q Z!, 1!>i~Q $ ~~"°r"` - ~, ~' 7~, '/ c .~ ~'~~ ~ I „' ri,h; j,r ~ /~ ~ ~r ~r_ ~~~~SSESSED BY: APPRAISED BY: i`.~ ~+ (Inheritance Tax Appraiser) Make checks or money orders payable to: ~~ I /D~ INSTRUCTIONS TO TAXPAYERS AMENDED ASSESSMENT To insure roper credit to your account this Offici Notice must accompany your pay ent. Mail or bring it to: NOTE: Any party in interest who is aggrieved by this notice may object thereto with n sixty days after receipt of said notice as provided by Section 1001 of the Inheritance and Estate Tax Act of 1961, 72 P.S. 2485-1001. TRIPLICATE-MAIL TO THE SECRETARY OF REVENUE IF THE TRANSFEREE CLAIMS DEBTS AND DEDUCTIONS.