HomeMy WebLinkAbout10-07-09COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11-96)
N0. CD 01 1837
SUTA JACOB A
41 SHADY RD
NEWBURG, PA 17240
fold
ESTATE INFORMATION: ssN: ~4s-2E-5417
FILE NUMBER: 2109-0942
DECEDENT NAME: SUTA STELLA
DATE OF PAYMENT: 10/07/2009
POSTMARK DATE: 10/05/2009
COUNTY: CUMBERLAND
DATE OF DEATH: 07/16/2009
REMARKS:
CHECK#216
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
09150246 ~ 5696.82
TOTAL AMOUNT PAID: 5696.82
INITIALS: DM
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
FARMERS 8 MERCHANTS TRUST CO 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 point 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
Pennsvlvania. Please call (71.7) 767-8377 with questions.
COMPLETE PART I BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21- C~ - (~~~
Po Box 280601 TAXPAYER RESPONSE ACN 09150246
HARRISBURG PA 17128-6661
DATE 08-06-2009
REV-1543 E% AFP (OB-OBl
TYPE OF ACCOUNT
EST. OF STELLA SUTA ® SAVINGS
SSN 146-28-5417 ~ ~ ^ CHEC~K,ING
-^-
DATE OF DEATH 07-16-2009- ~^? `° ^TR+us71
COUNTY CUMBERLAND .?._., ~ ^ ~ERI~.
' ---~ t f
REMIT PAYMENT AND FORMS T0: ~_ ~
JACOB A SUTA REGISTER OF WILLS "-~ ~'- -~?
41 SHADY RD CUMBERLAND CO COURT HOUSE - - r
NEWBURG PA 17240-9394 CARLISLE, PA 17013 ~ ~~
,~_-i ~ -
L fV .. -.
W
Account No. 71-33510 Date 0$-09-2007
To ensure proper credit to the account, two
Established copies of this notice must accompany
AccOUnt Balance $ 9,779.87 payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 50.000
Amount Subject to Tax NOTE: If tax payments are Dade within throe
4,889.94
months of the decedent's datm of death.
Tax Rate ~( 15 deduct a 5 percent discount on the tax due.
Potential Tax Due Any Inheritance Tax due will become delinquent
$ 733.49
nine months after the date of death.
PART TAXPAYER RESPONSE
0
FAILURE Tq 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
C H E C K
0 N E 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.
[ B L 0 C K ~ B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
O N L Y o 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 3LJ below.
PART It indicating a different tax rate, please state
relationship to decedent:
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 O/N JOINT/TRUST ACCOUNTS
1 f~/ ~ ~~
2-~7~7 t~ ~i 7
3X S~'y:c'~_
4 $ Y'~SR
5
6 $ ~ ~ r
7 X 5 ~ =3G.v~
PAD
OFFICIAL USE ONLY ^ AAF
PA DEPARTMENT OF REVENUE
1
2
3
4
6
7
8
PART DEBTS AND DEDUCTIONS CLAIMED
3^
DATE PAID PAYEE DESCRIPTION eMniiNr pern
Under penalties
complete to t e
,
~ of perjury, I declare that the facts I
bes of my knowledge and belief. have reported above
HOME ( '7/ ~ are true, correct and
/
) .~{- 23 "G ~ I ~
~ ~v WORK ( ) /y ~__ p 5~ 5
PAYER SIGNATURE TELEPHONE NUMBER AO TE
IVIHL itnter on Line 5 of Tax Computation) $
r = ~ {.~
f m ~
3 ~mtf#
»m~ ~#
~ a C r
z
~3
N y
3° #
w
~~
`o
. ~ 't
~. ai.
h^•
...~
{~ 1
t-
It~ q S
~i
~~}
1t1
~~l
nV
V
1 y~
~` r(~I
V A`° v
iJ `;, ~,l, u~
~~~~0~ 5.P !`
_ `y .I
~~ / 1 _.
r
'i
I
r
~~
~~
r
_~
g
'xin~i ~
Y~
vsn