HomeMy WebLinkAbout09-22-09COMMONWEALTH 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
DUPLICATE
RUDAWSKI CHERYL L
3 APPOMATTOX COURT
MECHANICSBURG, PA 17050
fold
AMOUNT
09157559 ~ 5332.02
ESTATE INFORMATION: SSN: 131-28-4772
FILE NUMBER: 2109-0882
DECEDENT NAME: GILES RICHARD
DATE OF PAYMENT: 09/22/2009
POSTMARK DATE: 09/21 /2009
COUNTY: CUMBERLAND
DATE OF DEATH: 06/25/2009
ACN
ASSESSMENT
CONTROL
NUMBER
TOTAL AMOUNT PAID:
REMARKS:
SEAL
CHECK# 2180
INITIALS: DM
RECEIVED BY:
5332.02
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REV-1162 EX111-96)
NO. CD 01 1775
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIYIDUAL TAXES AND FILE N0. 21 - ~C~- ~~ ~ .
Po Box zao6ol TAXPAYER RESPONSE ACN 09157559
HARRISBURG PA 17128-0601 DATE 09-11-2009
REV-1543 E% AFP (OB-OB)
TYPE OF ACCOUNT
EST. OF RICHARD GILES ~ SAVINGS
$SjJ 131-28-4772 ® CHECKING
DATE OF DEATH 06-25-2009 ~ TRUST
COUNTY CUMBERLAND ~ CERTIF.
REMIT PAYMENT AND FORMS T0:
CHERYL L RUDAWSKI REGISTER OF WILLS
3 APPOMATION CT CUMBERLAND CO COURT HOUSE
MECHANICSBURG PA 17050 CARLISLE, PA 17013 ~ ~`^~
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CITIZENS BANK OF PA provided the Department with the information below, which has been usx~fi(ly~culat~ the ~._.: ~ j
potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/bene'€-i~giaf~f this accoi}nt•. ,
If you feel the information is incorrect, Dlease obtain written correction from the financial institution, att3cj?CB„icaq/ to ~iFis form.
any! return it to the above address. This ac roust is taxable in accordance with the Inheritance Tax laws of th ~.~ ~onwealt ~ __
Pennsylvania. Please call (717) 787-8327 with questions. --) "~
CDMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTF~CTIDNS ~ri ,
To ensure proper credit to the account, two
Account No. 17050 Date 11-06-1970 `~
Established copies of this notice must accompany
payment to the Register of Wills. Make check
Account Balance $ 15, 532.88 payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to TaX $ 7,766.44 months of the decedent's date of death,
Tax Rate ~( lrj deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due ~` 1,164.97 nine months after the date of death.
PART TAXPAYER RESPONSE
0 FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT
A. ~ The above information and tax due 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
C H E C K Wills and an official assessment will be issued by the PA Department of Revenue.
C ONE
BLOC K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
0 N L Y to be filed by the estate representative.
C. ~ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART ~ and/or PART ~ below.
PART If indicating a different tax ,fat S~p~ea~ state
relationship to decedent: r.
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
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1 -OG- ! d
2 $ lS.s3~.
3 X SO _
4 S ?•7G~
5 '
7 X 0
B s 3yq,y -• too= 33R•
PAD
OFFICIAL USE ONLY ~ AAF
PA DEPARTMENT OF REVENUE
1
3
4
5
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7
s
PART DEBTS AND DEDUCTIONS CLAIMED
3^
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation) s
Under penalties of perjury, declare that the facts I have reported abov-el are true, correc~tj ja~nd
compl a to the est my wledge and belief. HOME C 7 f I ~ ~Z ~~ ' 3 `~~` v~ p
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TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
ZOU9 SE' 22 ~I~ I i ~ 5 7
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