HomeMy WebLinkAbout03-06-09COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
RUfl EAU OF INDI VIOUAL TAXES
DEPT. 280601
HARRISBURG, PA 1)128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11-9fi)
NO. CD 011054
THOMAS CONNIE L
2 BOURBON RED
MECHANICSBURG, PA 17050
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
--___ mle
ESTATE INFORMATION: ssN: 200-05-zaoz
FILE NUMBER: 2109-0296
DECEDENT NAME: TITUS BEULAH D
DATE OF PAYMENT: 03/30/2009
POSTMARK DATE: 03/28/2009
COUNTY: CUMBERLAND
DATE OF DEATH: 11/17/2008
REMARKS: JAMES THOMAS
SEAL
CHECK# 758
09118346 ~ 58.57
TOTAL AMOUNT PAID:
INITIALS: WZ
RECEIVED BY:
58.57
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE ~y~q /
BUREAU OF INDIVIDUAL TAXES _. .AND FILE N0. 21 -o7w/-(~~r„
PD Box zea6Bl TAXPAYER RESPONSE ACN 09118346 Y
HARRISBURG PA 1]128-0601
DATE 03-26-2009
PEV-ISLI IX RFP (OB-O B)
- b•_r i , : ,_ ,~ TYPE OF ACCOUNT
EST. OF BEULAH D TITUS ~ SAVINGS
SSN 200-05-2802 ~ ® CHECKING
f~ DATE OF DEATH 11-17-2008 ~ TRUST
l,'RPf"~!~iV~~ C(O~L COUNTY CUMBERLAND ~ CERTIF.
CUP-"'~E~LP~iU C~ REMIT PAYMENT AND FURMS T0:
C ONNIE L THOMAS REGISTER OF WILLS
2 BOURBON RED DR CUMBERLAND CO COURT HOUSE
MECHANICSBURG PA 17050 CARLISLE, PA 17013
PSECU providetl the Department with the information below, which has been usetl in calculati n9 the
potential tax tlue. Records indicate Yhat at the death of the above-named decetl ent, vau were a joint owner/benef ici arv of this account.
If You feel the inf ornation is incorrect, please obtain written correction from the financial institution, attach a copv to This form
and return it to The above adtlre ss. This account is taxable in acco rtlance with The Inheritance Tax laws pf the Comn onw ealth of
Pennsylvania. Flease tali O17) 78]-8327 with questions.
COMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 8404902 473-54 Date 88-27-2003
To ensure proper credit to the account, two
Estab135hetl copies of this notice Host acwnpany
Account Balance $ 1 P 142
22 pays ent to the Register pf Wills. Make check
. payable tp "Register of Wills, Agent".
Percent Taxable X 16.667
Amount Subject to Tax $ 1 9 0.37 NOTE: If tax pave ents are natle within three
months of the tlecadenT's date pf death,
Tax Rata X . 0 45 tleduct a 5 percent discount on the tax due.
Potential Tax Oua $
8.57 Anv Inheritance Tax tlue will become tleli nquant
nine months after the tlate of death.
P
T TAXPAYER RESPONSE
~
r CHECK
I ONE
L BLOCK
ONLY
The above information antl tax due is correct.
Resit payment to the Ramisker of Wills with two copies of this notice to obtain
a tliscoun4 or avoid inks rest, or check box "A" antl return this notice to the Register of
Wills antl an official assessor enk will be issued by the PA Ilepartnent of Revenue.
B. ~ The above assak has been or will be reportetl and tax paitl wikh the Pennsylvania Inheritance Tax return
ko be Filetl by the estate representative.
C. ~ The above inf orna ion is incorrect and/or tlebts antl tletlucti ons were paid.
Com pl ate PART 2~ and/or PART 3^ below.
PART If indicating a differs nt tax rate, please s
relationship to decedent:
TAX RETURN - COMPUTATION
LINE 1. Dat¢ Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts antl Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Dua
PART
3^
DATE PAID PAYEE
OF TAX ON JOINT/TRUST ACCOUNTS
DESCRIPTION
AMOIINT PAT-
v~~
Untler penalties of perjury, I declare that the facts I have reported above are tr//u[e, corre et and
/complete to the befit of my~knowledga and belief. HOME C ~~~~~ ) (a-1~' ~tI~I
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