HomeMy WebLinkAbout07-07-09 (2)REV-1162 EX(11-96)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
HINTON HAROLD H
815 ACRI ROAD
MECHANICSBURG, PA 17050
fold
ESTATE INFORMATION:
FILE NUMBER:
DECEDENT NAME:
DATE OF PAYMENT:
POSTMARK DATE:
COUNTY:
DATE OF DEATH:
SSN: 159-20-0919
2109-0627
HINTON HAROLD H
07/07/2009
07/06/2009
CUMBERLAND
01/13/2009
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 642
SEAL
INITIALS: CJ
RECEIVED BY:
NO. CD 01 1457
$564.14
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
ACN AMOUNT
ASSESSMENT
CONTROL
NUMBER ________
-_
__
PENNS NFORMATIONH NOTICECE T
I
BUREAU OF INDIVIDUAL TAXES
p0 BOX 280601 17128-0601
HARRISBURG PA
{ r•. AND
•';T~XPAYER RESPONSE
Y Y 4~
REV-1543 EX 11FP (a6"VB)
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HAROLD N HINTON
815 ACRI RD PA 17050-2231
MECHANICSBURG
FILE N0. 21 -~-Q(p27
ACN 09117313
DATE 03-18-2009
EST. OF HAR0159H2OI09019
SSN
DATE OF DEATH 01-13-2009
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
CUMBERLAND CO i0U0R3 HOUSE
CARLISLE, PA
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
provided the Department with the information below, which has been used in calculating
to this form
th of the above-named decedent, You were a joint owner/beneficiary of this account.
financial institution, attach a copy e
0
PSECU
potential tax due. Records indicate that at the dea
This account is taxable in accordance with the Inheritance Tax laws of the Commonwea
If you feel the informbpyenaddress rrect, please obtain written correction from the f ENT INSTRUCTIONS
and return it to the a
Pennsylvania. Please call C717i 767-d327 with questions.
COMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AND PA
Og_29-2005 To ensure proper credit to the account, two
Date copies of this notice must accompany
Account No. 0159200919-57 Established payment to the Register of Wills. Make check
25,072.91 payable to "Register of Wills, Agent".
Account Balance X 50 • ~~~ NOTE: If tax payments are made within three
Percent Taxable 12,536.46 months of the decedent's date of death.
. 0 4 5 deduct a 5 percent discount on the tax due.
Amount Subject to Tax X Any Inheritance Tax due will become delinquent
TaX Rate 564.14 nine months after the date of death.
Potential Tax Due
TAXPAYER RESPONS
1 FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT
PART
^ The above information and tax due is correct• and return this notice to the Register of
A.
Remit payment to the Register of Wills with two cop the PA Department ofoRevenue.
a discount or avoid interest, or check box "A"
CHECK Wills and an official assessment will be issued by
0 N E The above asset has been or will be reported and tax Paid with the Pennsylvania Inheritance Tax return
BLOCK ~ B' the estate representative.
C ONLY ~ to be filed by
C ~ The above information is 1PARTre~ below. debts and deductions were paid.
Complete PART 2~ and/or USE ONLY ~ }+~^'
OFFICIAL
different tax rate, please state
PA DEPARTMENT OF REVENU
PART a
If indicating
to decedent:
relationship
X ON JOINT/TRUST ACCOUNTS
PA
COMPUTATION OF TA 1
TAX RETURN - 1 2
LINE I. Date Established 2 $ ~
2, Account Balance X 4
3
3_ Percent Taxable $ 5
Amount Subject to Tax 4
y
,
5. Debts and Deductions 6
$ 6
7
6, Amount Taxable X 8
7
7. Tax Rate
B
g, Tax Due
DEBTS AND DEDUCTIONS
CLAIME
PART
0
PAYEE
DATE PAID
DESCRIPTION
AMOUNT PAID
s
TOTAL (Enter on Line 5 of Tax Computation)
I declare that the facts L have reported(above~~e tr;e~ corre~ and `
Under penalties of perjury, HOME 11 7 6 3~~ ~3 ~ ~ ~
comp ete to the best of /~"y./.k/1nowledge and belief . WORK ~ ~ ~ ~ •
•^L TELEPHONE NUMBER
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