HomeMy WebLinkAbout06-15-09COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
SELF CYNTHIA
8 STEPHEN STREET
DILLSBURG, PA 17019
fold
REMARKS:
CHECK# 7635
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ACN
ASSESSMENT
CONTROL
NUMBER
TOTAL AMOUNT PAID:
INITIALS: AJW
AMOUNT
S 15.64
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
REV-1162 EX111-96)
NO. CD 011359
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE FILE N0. 21 ~~~S~IP
AND
BUREAU OF INDIVIDUAL TAXES ACN 09124517
PD Box zaa6ol TAXPAYER RESPONSE
HARRISBURG PA 17126-0601 DATE 04-15-2009
REV-1543 IX pFP (08-OB)
TYPE OF ACCOUNT
EST. OF MARIAN BRUBAKER ~ SAVINGS
® CHECKING
SSN 188-20-8176
DATE OF DEATH 03-24-2009 ~ TRUST
~ CERTIF.
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS TO:~
CYNTHIA SELF REGISTER OF WILLS ~~ ~
CUMBERLAND CO COURT HOBS ~
8 STEPHEN STREET
PA 1 7019 CARLISLE, PA 17013 -j= r :~ -, rj
DILLSBURG m ----
-
-~
i
_ ~
. ;
.~ C -
provided the Department with the information below, which has be~usa~il in calaa3ating`the;'-.-;
ficiarv o~~this accoun$.
MEMBERS 1ST FCU
potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner ne
fs form
th
from the financial institution, attach a cop~~
ti
If you feel the information is incorrect, o
h
on
please obtain written correc
accordance with the Inheritance Tax laws of the Commonw
i
l
and return it to the above address. This n
e
account is taxab
^-arrsslanio. ~ lease call :717) 707-6327
LOW * :iLi~ a..est:ur~s.
SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
COMPLETE PART 1 BE
1 04523-11
N Date 12-01-1988 To ensure proper credit to the account, two
o.
Account copies of this notice must accompany
Established
payment to the Register of Wills. Make check
ce
l
B $ 2, 085 • 51 payable to "Register of Wills, Agent".
an
a
Account
Percent Taxable X 16.667
NOTE: If tax payments are made within three
TaX
t t ~` 347.59 months of the decedent's date of death,
o
Amount Subjec deduct a 5 percent discount on the tau due.
Tax Rate X . 0 4 5
Any Inheritance Tax due will become delinquent
$ 15 • 64 nine months after the date of death.
Potential Tax Due
R RESPONSE
TAXPAYE
PART
AILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT
A. ~ The above information and tax due is correct.
of this notice to obtain
i
Remit es
payment to the Register of Wills with two cop
notice to the Register of
thi
"
"
s
and return
A
a discount or avoid interest, or check box
artment of Revenue.
PA De
h
CHECK Wills p
e
and an official assessment will be issued by t
C ONE
ill be reported and tax paid with the Pennsylvania Inheritance Tax return
B L 0 C K B. ~ The above asset has been or w
0 N L Y to be fil ed by the estate representative.
C. ~ The above infarma ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART ~ below.
n
PART If indicating a different 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
S_ Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4
5
6 '~
7 X
8
PAD
OFF IC iAl. U,~ unt T 1_k P(Hr
PA D£PARTM£NT OF REV£NU£
I
2
3
4
5
6
7
8
DEBTS AND DEDUCTIONS CLAIMED
PART
DATE PAID PAYEE DESCRIPTION
AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation) $
U der penalti s of periury, declare that the facts I have reported ~ ~ nr+y.,,correcp pn~l~
mplete to e b my Howl ge and belief. HOME C ~c O')~ ~~~~/f'-~ -~~
WORK ~ r` ~~
TELEPH E NUMBER TE