HomeMy WebLinkAbout06-08-09COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PREVOST LORI A
346 RUTH RIDGE DRIVE
LANCASTER, PA 17601
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PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ESTATE INFORMATION: SSN: 202-36-s326
FILE NUMBER: 2108-0942
DECEDENT NAME: POWELL JANET M
DATE OF PAYMENT: 06/08/2009
POSTMARK DATE: 06/08/2009
couNTY: CUMBERLAND
DATE OF DEATH: 09/ 1 5/2008
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
08501498 ~ 52,096.72
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 2607
SEAL
INITIALS: AJW
RECEIVED BY:
52,096.72
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REV-1162 EX111-96)
NO. CD 01 1329
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT DF REVENUE INFORMATION NOTICE FILE N0. 21 08-0942
BUREAU OF INDIVIDUAL TAXES AN D
PD cox zao6ol TAXPAYER RESPONSE ACN 08501498
HARRISBURG PA 17128-0601
DATE 11-28-2008
REV-15438 I1FP (7-007
LORI A PREVOST
346 RUTH RIDGE ROAD
LANCASTER PA 17601
TYPE OF ACCOUNT
EST. OF JANET M POWELL ^ SECURITY
S.S. N0. 202-36-8326 X^ sEC ACCT
DATE OF DEATH 09-15-2008 ^ srocK
COUNTY CUMBERLAND ^ soNDs
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
FIDELITY INVESTMENTS has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a beneficiary of this asset.
If you feel this information is incorrect, please obtain written correction from the transfer agent, attach a copy to this farm and
return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania.
Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 243995355 To insure proper credit to your account, two
(2) copies of this notice must accompany Your
payment to the Register of Wills. Make check
DOD Valuation 46,593.75 payable to: "Register of Wills, Agent".
Percent Taxable X 100.00
NOTE: If tax payments are made within three
Amount Subject to Tax 46,593.75 (3) months of the decedent's date of death,
TaX Rate X .045 You may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
Potential TaX Due 2, 096.72 nine C9) months after the date of death.
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PART TAXPAYER RESPONSE n
.~ ,
FAILURE TO RESPOND WILL RESULT IN AN OFFI,~G4IAL TAX ASS ESSMFENT BASED ~ IS NICE;:
y:..
A. The above information and tax due is correct. ' ``i~ """~ ~
1. You may choose to remit payment to the Register of Wills with two copies of thiST~ce to,,...~,,QQbtain
CHECK a discount or avoid interest, or you may check box "A" and return this notice to j-ieRegis`ttir of
0 N E Wills and an official assessment will be issued by the PA Department of Revenu~.~-~.~.. "C
[ B L 0 C K B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tom"return
0 N L Y to be filed by the decedent's representative. ~ E~J
C. ^ The above information is incorrect and/or debts and deductions were paid by you. T" v
You must complete PART 2^ and/or PART '^3 below. r-~
PART If you indicate a different tax rate, Please state your 0F~'ICIAL USE f}NLY ^ AAF
relationship to decedent: PA DEPARTMENT OF REVENUE
TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSET(S) PAD
Li~iE i. D^uD 'raiuaiiun i 1
2. Percent Taxable 2 X 2
3. Amount Subject to Tax 3 3
4. Debts and Deductions 4 - 4
5. Amount Taxable 5 5
6. Tax Rate 6 X 6
7. Tax Due 7 7
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation) 6
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to t~e ¢est o~ ~ kno~~ and belief. HOME C'7/7 ) S6 ~ ` ~0 41
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