HomeMy WebLinkAbout04-15-09 (2)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ZOOK BETTE J
24 GUNPOWDER ROAD
MECHANICSBURG, PA 17050
fold
ESTATE INFORMATION: ssN: Asa-i2-4380
FILE NUMBER: 2109-0351
DECEDENT NAME: DAWSON VIVIAN R
DATE OF PAYMENT: 04/15/2009
POSTMARK DATE: 04/ 14/2009
COUNTY: CUMBERLAND
DATE OF DEATH: 09/21 /2008
REV-1162 EX111-96)
NO. CD 01 1 1 12
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
09100569 ~ 5355.91
09100570 ~ 512.58
TOTAL AMOUNT PAID:
REMARKS:
SEAL
CHECK#1009
INITIALS: CJ
RECEIVED BY:
5368.49
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
PENNSYLVANIA INHERITANCE T
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AN D
PD Box zao6ol r`;- ~ !~;' f', '='~';~~(PAYER RESPONSE
HARRISBURG PA 17128-0601 '"
REV-1543 EX AF'R {.yb.p~}-- i ELI - ,,....
ACN 09100572
DATE 01-02-2009
2004 APR I S PM 12~ 27
CLEF ~~{ (Jf=
n Of~3Pf-f?a~1'S uOURtn
CUf,~~~r.. ,stn ..~ PA
_ 'i_ ,
HARRY H DAWSON
21 BENT CREEK BLVD
MECHANICSBURG PA 17050
EST. OF VIVIAN R DAWSON
SSN 188-12-4380
DATE OF DEATH 09-21-2008
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
M&T 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 rail (717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 27623858 Date 05-24-2004 To ensure proper credit to the account, two
Established copies of this notice must accompany
payment to the Register of Wills. Make check
Account Balance $ 3, 354.65 payable to "Register of Wills, Agent".
Percent Taxable X 8.333
NOTE: If tax payments are made within three
Amount Subject to Tax $ 279 • 54 months of the decedent's date of death,
~( 0 0 deduct a 5 percent discount on the tax due.
Tax Rate , Any Inheritance Tax due will become delinquent
Potential Tax Due $` • 00 nine months after the date of death.
PART TAXPAYER RESPONSE
^ ..
u
TAX RETURN - COMPUTATION
LINE 1. Date 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 $
s X
4
5
6
7 X
8
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported above correct and
are true,
wlgdge and belief.
complete to the best of my kno HOME C`~(ti~ (~yy
) (Q'11"~"1~~
`
~ ~ ~~1t \\\7"Q'~_ r WORK C ~ LI'~~I'O
TAXPAYE SIGN/~,~1RE T DO~Se~-~ TELEPHONE NUMBER DATE
TOTAL (Enter on Line 5 of Tax Computation) s
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE ~7
BUREAU OF INDIYIDUAL TAXES ~ i,jrr_ ~C ^`' AND FILE N0. 21 "C~"I-Q~,~~
Po eox 280601 ~ ~' ~ ~'~'A7CPAY~R RESPONSE AcN 09100569
HARRISBURG PA 17128-0601 --- i~l'. ~ ~~ DATE 01-02-2009
_r ~ ~,
`~I,) ~~~ _J1
REV-1543 EX pFP'2 dR,~0~) ~ - .~~
TYPE OF ACCOUNT
20~g ~~~ ~ ~ P!1 IZ~ 27 $ST. OF VIVIAN R DAWSON ^ SAVINGS
$$N 188-12-4380 ® CHECKING
CLE~?K G~ DATE OF DEATH 09-21-2008 ^ TRUST
'~ ~~UI~1
QRPHP.N ~ IJ COUNTY CUMBERLAND ^ CERTIF.
C~~,,R~~-r~';L_r ~`~~1 r%Ci , rM REMIT PAYMENT AND FORMS T0:
BETTE J ZOOK REGISTER OF WILLS
24 GUNPOWDER RD CUMBERLAND CO COURT HOUSE
MECHANICSBURG PA 17050 CARLISLE, PA 17013
M&T 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 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. ?lease coil t7.i7 787-SS27 ::it.. quasticn s.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
TOTAL CEnter on Line 5 or lax compucau on,
Under penalties of perjury, I declare that the facts I have reported a-byov^e~are true, c(~orrect and
eo e to th~t of m knowledge and belief. HOME C 1 ~ I ) ~Q'^ I "{~
WORK , y,~~I-G~1
TAXPAYER SIGNATUR TELEPHONE NUMBER DATE
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES ~:{..f~.._ ,.,ti-_ AND FILE N0. 21-(~-Q~,S~
Po Box ZBOSOI ? !. TAXPAYER RESPONSE ACN 09100570
HARRISBURG PA 1 7128-0601 r~ 1~„ ~. '•, ~, ~~~~ ;., ~ DATE 01-02-2009
REV-35k~'E7i"~F7 tbH'OB)" ti r.i ~_. .. '
2009 APR 1 S PP112~ 27
CLER~t CF
oRpy~a~.~~s C~CURT
P~^z_~ ,,~, ,`~~
CU _ ~~:.., ~, PA
BETTE J ZOOK
24 GUNPOWDER RD
MECHANICSBURG PA 17050
EST. OF VIVIAN R DAWSON
SSN 188-12-4380
DATE OF DEATH 09-21-2008
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
M&T 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 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. rlease tali iTi7i 787-63er with gaasi:.rs.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 27,623858 Date 05-24-2004 To ensure proper credit to the account, two
Established copies of th15 notice must accompany
Account Balance 3, 354.65 payment to the Register of Wills. Mako check
payable to "Register of Wills. Agent".
Percent Taxable X 8.333
Amount Subject to TaX 2 7 9.54 NOTE: If tax payments are made within three
months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Potential Tax Due 1 2.5 8 Anv Inheritance Tax due will become delinquent
nine months after the date of death.
P~T
1 TAXPAYER RESPONSE
A. The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
CHECK a discount or avoid interest, or check box "A" and return this notice to the Register of
C 0 N E ~ Wills and an official assessment will be issued by the PA Department of Revenue.
B L 0 C 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.
C. ~ The above informs ion is incorrect and/or debts and deductions ware void.
Complete PART ~2 and/or PART 3~ below.
PART If indicating a different tax rate, please state
relationship to decedent:
TAX RETURN - COMPUTATION
i.INE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
B. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
2 +~
3 X
4 +~
5
6
7 X
8
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of per~ury, I declare that the facts I have reported above are true, co(Ar~re~c7t and
complete to the best o my knowledge and belief . HOME C ~ (~ .) Coq ~ ~~ vY ( C~
woRK c ----~ -i4-Oq
TAXPAYER SIGNAT TELEPHONE NUMBER DATE
.,j
~j~'~f~
~`
~Z
j?
~. _ -
W
;+ri ?+s+
~.~
b
;~, ;.:i
._ ,_
~ ~ ~'r
~'' ~ ~;
k•
~.
`a
G ids
• ~
IY1
,
»~' ~F ~ 1
~
F w _~
!k`f ~~ ~ r
l
;. 3
~: ~
~~
~
n
~ ~
a
:~ ~
-~ ~ ~ ~
~~-
LjG~
~
~.
N
~
~
h
r
Vii.
~ '~ ~
:
_ ~-a j
`L
~ x P
_ ~
c~, c~ n v ~'-'
C .:, Lx..t
t.Lt C2. _
4 ~ ~?
.c.
~~ C
d O ~
U
a
u r
r~
~a
u
~,
a
a
~~
,=
r
T
...:
i~
l~
f
~~,