HomeMy WebLinkAbout05-18-09COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
GIERLACK DORA F
1338 QUAIL RUN CIRCLE
BETHEL PARK, PA 15102
fold
REMARKS:
SEAL
CHECK# 3926
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ACN
ASSESSMENT
CONTROL
NUMBER
TOTAL AMOUNT PAID:
INITIALS: AJW
RECEIVED BY:
REGISTER OF WILLS
AMOUNT
`77/.88
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REV-1162EXI11-96)
NO. CD 01 1258
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
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REV-1543 IX AFP (OB-OB)
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
~-- ,-. AND FILE N0. 21 ~~ b~S~
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~' ' ;~'A~PAYER RESPONSE ACN 09123970
~: '1 DATE 04-13-2009
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EST. OF DORA E OHARA
SSN 193-14-1910
DATE OF DEATH 03-30-2009
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
DORA F GIERLACK REGISTER OF WILLS
1338 QUAIL RUN CIR CUMBERLAND CO COURT HOUSE
BETHEL PARK PA 15102 CARLISLE, PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
PSECU 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 point 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
Fennsyivania. Please call (717) 767-B327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 8502181095-$4 Date 01-24-2006 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 $ 10,931.08 payable to "Register of Wills, Agent".
Percent Taxable X 16.667
NOTE: If tax payments are made within three
Amount Subject to Tax $ 1 , 821 • 88 months of the decedent's date of death,
deduct a 5 percent discount on the tax due.
Tax Rate X .045 Anv Inheritance Tax due will becowe delinquent
Potential TaX Due $ 81.98 nine months after the date of death.
PART TAXPAYER RESPONSE
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0 ~E~q ~~WIL„L RESULT A ICI L T AbSSE SM .T
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
CHECK Wills and an official assessment will be issued by the PA Department of Revenue.
C ONE
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 were Daid.
Complete PART 2~ and/or PART ~ below.
PART If indicating a different tax rate, Please state
relationship to decedent:
TAX RETURN - COMPUTATION
LINE I. 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 +~
3 X
4 $
5
6
7 X
8
1. a u AAF
PA DEPARTMENT Ofi RE1lENUE
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1
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4
5
A 7
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation) ~
Under penalties of per]ury, I declare that the facts I have reported atbove areptrue, correct and
complete to the best of my knowledge and belief . HOME C 7 ~ a ) O -J f"-3 qs~
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