HomeMy WebLinkAbout05-18-09 (2)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE REV-1162 EX111-96)
BUREAU OF INDIVIDUAL TAXES
DEPT. 280801
HARRISBURG, PA 1 J128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 01 1256
GIERLACK DORA F
1388 QUAIL RUN CIRCLE
BETHEL PARK, PA 15102
------- IuIE
ESTATE INFORMATION: SSN: i93-t4-t 91o
FILE NUMBER: 2109-0457
DECEDENT NAME: OHARA DORA E
DATE OF PAYMENT: 05/18/2009
POSTMARK DATE: 05/14/2009
COUNTY: CUMBERLAND
DATE OF DEATH: 03/30/2009
REMARKS: DORA GIERLACK
CHECK# 3927
SEAL
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
09123972 ~ 5721.24
TOTAL AMOUNT PAID:
INITIALS: WZ
RECEIVED BY:
REGISTER OF WILLS
5721.24
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
~.
EST. OF DORA E OHARA
SSN 193-14-1910
DATE OF DEATH 03-30-2009
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
INFORMATION NOTICE
~ n_--~ ,
BUREAU OF INOIVIDIWL TAXES ~ ~/~ ,~ AND FILE ND
PO BOX 290601
WIRRISBUR6 PA 17128-0601 t. ~;- ~ TgXPAYE R RESPONSE ACN
av-:ec{ sx. r soa-es: DATE
21 -`-/ /- ~~(
09123972
04-13-2009
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
PSE CU provided the Deparkaent with the inforaation below. which has been used in ealculatinp the
potential tax due. Racortls indicate that at the death of the above-n ned tleeedenk, you were a joint owner/beneficiary of 4hia account.
If you feel the inforaation is incorrect, please obtain written correction frpa the fin aneiel institution, attach a copy to this fon
and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of khe Coaaomre slkh of
Pennsylvania. Please cell 017) 787-8327 with questions.
COMPLETE PART 1 BELOW a SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 8502181095-57 Date 07-21-2006
OORA F GIERLACK
1338 pUAIL RUN CIR
BETHEL PARK PA 15102
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
CL~•~;K OF
'Jf~PHr~a"\~~ ~i~~.Rr
Eatah lashed
$ 101,224.33
X 16.667
S 16,871.06
X .045
S 759.20
To •nsu re proper credit to the account, two
copies of this notice oust eecaaps,N
payaent to the Register of Wills. Make cheek
pwable to "Repistsr of Wills, Apant^.
NOTE, If tax pavaents are satle within three
apnths of the tlecatlent's date of death.
deduct a 5 pe reent discount an the tax due.
AnY Inheri tanc• Tax due will becoae delinquent
nine aanths after the data of death.
A• Tha shove inforaation end taz tlue is correct.
Resit payaen4 to the Repistsr of Wills with two eppiea of khis notiea to obtain
r CHECK ~7 a discount or avoid interest, or chock box •'A" and return this notiea to the Rapi star of
I ONE I Wills and sn off ieial asses went will be issued by the PA Departaent of Revenue.
L BLOCK J
ONL Y B. ~ Tha above aasat has been or will ba reported and 4ax paid with the Pennsv lvania Inherit
T
to Oa filed by the estate rap resentativa. ance
ax ratu rn
C. ~ Tha above infor a ion is incorrect and/or debts and deductions were paitl
Coaplete PART ~2 and/or PART 3^ below. .
PART If Indicating a different tax rate, please state
relationship to decadent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Oats Established 1
2. Account Balance 2
3. Percent Taxable 3 X
4. Amount Subject to Tax 4 S
5. Debts antl De tluetions 5
a. Amount Taxable 6 S
7. Tax Rate 7 X
8. Tax Due 9
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
r on Line 5 of 7sx Computation
Untler pane ltles of perjury, I declare that the facts I hav reportetl above era true, corre et and
/e~oomplet• t~o'7th~•c/best~ of my knoWletlpa antl belief. ~
d~T~-T i~e.X~-c~ HDME ( l a() ..3 ~ ~~J.S
WORK ( ) '/3-O
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
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