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HomeMy WebLinkAbout05-04-09COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BURKHOLDER JANICE E 319 GLENDALE DRIVE SHIREMANSTOWN, PA 17011 -------- fold ESTATE INFORMATION: ssN: 2o~-is-3s44 FILE NUMBER: 2109-0426 DECEDENT NAME: SHUGHART I R DATE OF PAYMENT: 05/04/2009 POSTMARK DATE: 05/01 /2009 couNTY: CUMBERLAND DATE OF DEATH: 12/19/2008 AMOUNT ACN ASSESSMENT CONTROL NUMBER 09122481 ~ 511.02 TOTAL AMOUNT PAID: REMARKS: SEAL CHECK# 5545 51 1.02 INITIALS: AJW RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS .M.,a REV-1162 EX(11-961 ~'~~" NO. CD 01 1 188 ..,,,,~ .. .~,..,. ~... ~~, REGISTER OF WILLS PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE fn BURG:.i; OF IND'~:IDUAI. 'AXES AND FILE N0. 21 (~ O~IZN PO BOX 280601 TAXPAYER RESPONSE ACN 09122481 HARRISBURG PA 17128-0681 DATE 04-06-2009 REV-1543 E% AFP (O6-UB) JANICE BURKHOLDER 319 GLENDALE DR SHIREMANSTOWN PA 17011 EST. OF I R SHUGHART SSN 201-16-3944 DATE OF DEATH 12-19-2008 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. r.a ~~ ~~ ~_ -.O 4=a ,, ~:t:r ~ '_ _ COMMERCE BANK HARRISBURG NA provided the Department with the information below, which has been user}~~rr~calc ing tt)e .' potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/bene{~sch3rv oft is arcOdgY~ If you feel the information is incorrect, please obtain written correction from the financial institution, attaet± copy ~~.d.._this;fgrm and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of-the-CoplpQonweaYth of __ Pennsylvania. Please call C717) 787-8327 with questions. ,.---., COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRi1~TTONS~ - Account No. 537216996 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART 0 CHECK C ONE BLOCK ONLY Date 01-30-.2006 Established 1,218.89 50.000 609.45 .15 91. X ,~ To ensure proper credjf-'~o the acai nt, kwo copies of this notic~* must accomW7f~y - payment to the Register of Wills ~„~7ake check payable to "Register of Wills, Agent". NOTE: If tax payments are made within three months of the decedent's date of death, deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent nine months after the date of death. TAXPAYER RESPONSE FAILURE TQ RESPOND WILL RESULT IN AN OFFICIAL TAX SE~SF4ENT A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the estate representative. C. The above informs Ion is incorrect and/or debts and deductions were paid. omplete PART 2~ and/or PART ~ below. PART If indicating a different ax rate, p ase state OFFICIAL UStaNLY ~ AAF relationship to decedent: ~~~ f%~+ ~~~''~-~~ PA pEPARTMENT OF REVENUE TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1 . Date Established 1 ~ "" ~ ~~' ~ ~ I 2. Account Balance 2 +fi l~-'~ ~ - ~ 2 3. Percent Taxable 3 X ~ ~v 3 4. Amount Subject to Tax 4 $ l0 0 CJ. 4 5. Debts and Deductions 5 S - 6. Amount Taxable 6 ~ ~ ~~ _ ~ 6 7. Tax Rate 7 X ~._S L~~r , 7 8. Tax Due 8 $ ~~_~~ 8 PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID ~ ~-7 V /v~ / _ /~/~ T IJ ~ T~' n! ~ TOTAL CEnter on Line 5 of Tax Computation) S Under penalties of perjury, I declare that the facts I have reported above are true, c/orre~cjt and complete to the best of my knowledge and belief. HOME C~ ~ 7 ) ~ ~7 L~_7~~ i / m~ ~ ~~~~~Iry ~° ~ ~ J ~. _ ___. N~~ ~~~ J ~ ~ ~~~~~ ~~~ ~- ~. f- x u+ r + ~ ~ i ~- s ~ ~~ ~- © O rn O~ ~ B O A t.:.1 O M G'- N .-- ~0 t{l C7 O b tit ~t ~' ~ O O O t11 Lf1 X47 N .'t' ti- (31 O O fA O CS'1 (T O1 ~4 N N ~i' N M t7~ M *- -~' ,- O O O •-- •-- M ~1 M .-- M r- ~-- ~' N r-- ~ ~D LO •- N x ~, + / ~-. tt1 tS1 N N tT .i' O ' p .t • .- , ~t O ~" N ;,=. ~: ri ~e: ~- ~. _. .~, ys ~+ t~~~_ 1 1 r J -~ :_ '..x. W J 3 ~ ~ (~~ r- 'O ~ \ r.A ~~ ~~ _ ~ ~~ ' .~~ ~ ~ LLJ i`! ~- ~, ~~~ J ~ ~ ~ c_-~ cV ~~ V ~4 v r z ~~ ~_ C~-' ~`J ~ ~4{ ~~~ ~s~ {,'; t~; .~ t,„4 ~•:~