HomeMy WebLinkAbout05-27-09 (2)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 2 8-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX111-96)
NO. CD 01 1286
WINTERS CHARLENE
101 LONGVIEW DRIVE
SHIPPENSBURG, PA 17257
fold
ESTATE INFORMATION: ssN: iss-22-7x35
FILE NUMBER: 2109-0489
DECEDENT NAME: WINTERS CHARLES
DATE OF PAYMENT: 05/27/2009
POSTMARK DATE: 05/26/2009
COUNTY: CUMBERLAND
DATE OF DEATH: 03/25/2009
REMARKS:
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
09124520 ~ 513.24
TOTAL AMOUNT PAID:
513.24
CHECK# 5215
INITIALS: AJW
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE T
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AN D
F+ARRISBURG6PA 1712s-0601 TAXPAY E R R E S P O N S E
rsev-isaa Ex avv cae-ae~
FILE N0. 21 ~~~~~
ACN 09124520
DATE 04-15-2009
TYPE OF ACCOUNT
EST. OF CHARLES WINTERS ® SAVINGS
SSN 186-22-7935 ~ CHECKING
DATE OF DEATH 03-25-2009 ~ TRUST
COUNTY CUMBERLAND C7 a ~ CERTIF
.
REMIT PAYMENT AND FORMS TO ~' d
CHARLENE WINTERS
101 LONGVIEW DRIVE REGISTER OF WILLS j`~
SHIPPENSBURG PA CUMBERLAND CO COURT HOUS£~ ~ -'c ,
17257
CARLISLE, PA 17013 ,''^~"j ~
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MEMBERS 1ST FCU provided the Department with the information below, which has been used in calcu~ing the
potential tax due. Records indicate that at the death of the above-named de
d
If
t
1
ce
en
, you were a joint owner/beneficiary of ~i5is account.
you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to thi
and return it to the above address. This account is taxable i
f
'
s
orm
n accordance with the Inheritance Tax laws of the Commonwealth of
rennsYlvania. 'rlease call (7173 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 120626-00 Date 06-01-1991
To ensure proper credit to the account, two
Established
Account Balance copies of this notice must accompany
$ 5$$.52 payment to the Register of Wills. Make check
Percent Taxable X payable to "Register of Wills, Agent".
50.000
Amount Subject to TaX $` 294.26 NOTE: If tax payments are made within three
Tax Rate months of the decedent's date of death,
X
Potential TaX Due . 0 4 5 deduct a 5 percent discount on the tax due.
24 Any Inheritance Tax due will beco
$ 13
d
P
T .
me
elinquent
nine months after the date of death.
~ TAXPAYER RESPONSE
CHECK
C ONE
BLOCK
ONLY
CJ __ _. _ _... _. _,,.,.,,,, o„~ ~~ uue 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.
Complete PART ~2 and/or PART 3^ below.
hRi .~ ~nuica a ng a airrerent tax rate, please state
relationship to decedent:
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
B. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS ~pAD
1
2 +fi
3 X
4 +fi
5
6 +fi
7 X
s $
'OFFICIAL UsE ONLY (~ AAF
PA `bEPARTMENT Ofi REVENUE
i
2
3
4
5
6
7
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rARr
0
DATE PAID PAYEE
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation) g
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowledge and belief.
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