HomeMy WebLinkAbout09-28-09COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 2 8-0 601
RECEIVED FROM:
SKELTON CLAUDE
88 COURTYARD DRIVE
CARLISLE, PA 17013
fold
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ESTATE INFORMATION: ssN: 175-48-2957
FILE NUMBER: 2109-0906
DECEDENT NAME: SKELTON MICHAEL
DATE OF PAYMENT: 09/ 28/ 2009
POSTMARK DATE: 09/25/2009
COUNTY: CUMBERLAND
DATE OF DEATH: 08/03/2009
REV-1162 EXI11-961
NO. CD 01 1808
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
09154756 ~ 57.44
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 1088
SEAL
INITIALS: JN
RECEIVED BY:
57.44
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES ,." AND FILE N0. 21 (~~ C7c10~
Po Box zeocol "- TAXPAYER RESPONSE ACN 09154756
HARRISBURG PA 17128-0601 ~-.
DATE 08-27-2009
REV-1543 E% AFP (48~®dL' : _. ~ ''~'~ ~...- ~-
20~~ SEP 28 ~~ {2~ 42
CLAUDE SKELTON
88 COURTYARD DRIVE
CARLISLE PA 17013
EST. OF MICHAEL SKELTON
SSN 175-48-2957
DATE OF DEATH 08-03-2009
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
MEMBERS 1ST FCU provided the Department with the information below, which has 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 rsturr, it to the above address. This asco~nt is taxsble ir. accor3ance with the Inheritance Tax laws cf the Co,:~morwealth of
Pennsylvania. Please call (717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 53708-11 Date 12-31-1979 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 ~` 992 .60 payable to "Register of Wills, Agent".
Percent Taxable X 16 .667
NDTE: If tax payments are made within three
Amount Subject to Tax $ 165 .44 months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Anv Inheritance Tax due will become delinquent
Potential Tax Due $ 7 • 44 nine months after the date of death.
PART TAXPAYER RESPONSE
FAILURE TU RE SPOND WILL RESUL T IN AN OFFI CIAL TAX ASSESSMENT
A. fi(The above information and tax due is correct.
uu 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 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 information is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART 3~ below.
PART
a
TAX
If indicating a different tax rate, please state
relationship to decedent:
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
2 $
3 X
4
5
6 $
7 X
8
PAD
OFFICIAL USE DNLY ~ AAF
PA DEPARTMENT OF REVENUE
1
2
3
4
5
6
7
8
PART DEBTS AND DEDUCTIONS CLAIMED
^3
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
HONE NUMBER
DATE
TOTAL CEnter on Line 5 of Tax Computation) S
Under penalties of perjury, I declare that the facts I have reported above are true, correct an
comp to to the b~elst my knowledge and belief. HOME C ~ ~ ~ ) JU.~ ?~~'
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