HomeMy WebLinkAbout09-08-09COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 011712
PATRICK MARGARET A
356 FUTURITY DRIVE
CAMP HILL, PA 17011
told
ESTATE INFORMATION: ssN: 252-54-3s75
FILE NUMBER: 2109-0839
DECEDENT NAME: MOORE MARY A
DATE OF PAYMENT: 09/08/2009
POSTMARK DATE: 09/03/2009
COUNTY: CUMBERLAND
DATE OF DEATH: 06/ 1 2/2008
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
08156491 ~ 545.41
TOTAL AMOUNT PAID:
REV-1162 EX111-96)
545.41
REMARKS: MARGARET PATRICK
SEAL
CHECK# 406
INITIALS: WZ
RECEIVED BY: GLENDA EARNER STRA~R,nI ir,N
REGISTER OF WILLS
REGISTER OF WILLS
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paid in !`ull tvitlt Visa i~t ±lte amc>utrot of $46.23
Completed 04/08/09
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PENNSYLVANIA INHERITANCE "f
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES /~~ ~ AN D
Po sox zaocol ~'-'~'? ~~ ~='' TAXPAYER RESPONSE
HARRISBURG PA 17128-0601 ~~_~`__, lloi~ h
REV-1543 E% qFP (00-OB)
ACN 08156491
DATE 11-25-2008
zoag s~~ ~-t ~ ~ 3:
EST. OF MARY A MOORE
M c~ii ~;~ SSN 252-54-3875
VL.F r~u~ DATE OF DEATH 06-12-2008
~~~~ 4" `1"'~~ COUNTY CUMBERLAND
CU~!~~r--~ ~"~"`
'•j~'~` -~'+/.. ~ REMIT PAYMENT AND FORMS T0:
MARGARET A PATRICK REGISTER OF WILLS
356 FUTURITY DR CUMBERLAND CO COURT HOUSE
CAMP HILL PA 17011 CARLISLE, PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
COMMERCE BANK HARRISBURG NA provided the Department with the information below, which leas been used in calculating the
potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account.
If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form
and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of
Pennsylvania. Please call (717) 787-8327 with questions. - -
COMPLETE PART I BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 536892656 Date 01-31-2005 To ensure proper credit to the account, two
Established copies of this notice must accompany
payment to the Register of Wills. Make check
Account Balance ~` 2, 910.69 payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax ~` 1 , 455.35 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 $ 218 • 30 nine months after the date of death.
PART TAXPAYER RESPONSE
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSE55MENT
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.
C ONE
B L 0 C 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 2~ and/or PART 3^ below.
PART If indicating a different tax ra e, h~~ ate
Pl OFFICIAL U5E ONLY ~ AAF
relationship to decedent:- r
`' ~
~~1''
PA DEPARTMENT OF REVENUE
TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
LINE 1. Date Established 1 /'- 3/ -SOUS 1
2. Account Balance 2 $ ~ 9~V • ~ ~ 2
3. Percent Taxable 3 X 5~ ddI'~ 3
4. Amount Subject to Tax 4 +fi ~y -SS~ .3~ 4
5. Debts and Deductions 5 ~ ~ 3
y ~ 5
6. Amount Taxable 6 $ l ~ p
Q 7° ~ ~' 6
7. Tax Rate 7 X Dy5 7
8. Tax Due 8 $ ^
~ • y~ 8
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported above c
t and
are true, corr
e
dge and belief.
knowl
e
complete to the best of my HOME C 7~7 p
~
p
) ~7N ~ O 0 7~
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1 q~~~ ( ' ~~f~-?~'PC., WORK C ) -~_p 9
A)PAY R SIGNATU TELEPHONE NUMBER DATE
TOTAL CEnter on Line 5 of Tax Computation) S