HomeMy WebLinkAbout06-25-09 (2)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 2 8-060 1
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 01 1403
CLOUSER DOUGLAS G
1875 TOWN HILL ROAD
YORK SPRINGS, PA 17372
fold
ESTATE INFORMATION: ssN: i 84-2s-5048
FILE NUMBER: 2109-0204
DECEDENT NAME: CLOUSER DAVID H
DATE OF PAYMENT: 06/25/2009
POSTMARK DATE: 06/24/2009
COUNTY: CUMBERLAND
DATE OF DEATH: 02/ 20/ 2009
REMARKS:
CHECK# 7736
SEAL
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
09117548 ~ 5321.07
TOTAL AMOUNT PAID:
INITIALS: AJW
REV-1162 EX111-961
5321.07
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AND F I L E
PD sox 2BBCO1 TAXPAYER RESPONSE ACN
HARRISBURG PA 17128-0601
REV-1543 E% 11FP (OB-OB) DATE
N0. 21 09-0204
09117548
03-19-2009
EST. OF DAVID H CLOUSER
SSN 184-26-5048
DATE OF DEATH 02-20-2009
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
r+s
DOUGLAS CLOUSER REGISTER OF WILLS ~
1875 TOWNHILL ROAD CUMBERLAND CO COURT HO~d `i' ~'
YORK SPRINGS PA 17372 CARLISLE, PA 17013 -~ ~ C ~>_
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MEMBERS 1ST FCU ~ ~~~, ~'
provided the Department with the information below, which has been y~~,n calculating the
potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/benef~ary of account'.'`
If you feel the information is incorrect, please obtain written correction from the financial institution, ath a copy toll ~jiis fbrm '.
and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of t Commonweal f
Pennsylvania. Please call (7i7) 7B7-os2i with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 113054-40 Date 12-14-2005 To ensure proper credit to the account, two
Established copies of this notice must accompany
ACCOUnt Balance 85, 622.33 Payment to the Register of Wills. Make check
yQ payable to "Register of Wills, Agent".
Percent Taxable X 8.333
Amount Subject to Tax NOTE: If tax payments are made within three
$ 7, 134.91 months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Potential Tax Due 3 2 1 . 0 7 Any Inheritance Tax due will become delinquent
$ nine months after the date of death.
P~T
~ TAXPAYER RESPONSE
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX A55ES5MENT
A. The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
C H E C K 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.
ONE
B L 0 C K
0 N L Y B. ~ The above asset has been
to be filed by the estate or will be reported and tax paid with the Pennsylvania Inheritance Tax return
representative.
C. ~ The above informs ion is
Complete PART 2~ and/or incorrect and/or debts and deductions were paid.
PART ~ below.
PART If indicating a different tax rate, please state OFFICIAL USE ONLY ~ AAF
relationship to deceden t:
PA DEPARTMENT OF REVENUE
TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
LINE 1. Date Established 1 1
2. Account Balance 2 +fi 2
3. Percent Taxable 3 X 3
4. Amount Subject to Tax 4 $ 4
5. Debts and Deductions 5 5
6. Amount Taxable 6 $
7. Tax Rate 7 X 7
8. Tax Due 8 $ g
PART DEBTS AND DEDUCTIONS CLAIMED
^3
DATE P AID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
lete to the best of my knowledge and belief. HOME C7~ 7 ~
WORK ( ~ c S.~ ~ ~3
YPAV R CTrIJA TIIRF TCI CDUnAIC At11M4CD nwrr
TOTAL (Enter on Line 5 of Tax Computation) $