HomeMy WebLinkAbout10-29-09COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
BUXTON PATTI M
725 S MAIN STREET
MARYSVILLE, PA 17053
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PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ESTATE INFORMATION: ssrv: 179-i4-s711
FILE NUMBER: 2109-0736
DECEDENT NAME: BRUDOWSKY MARIAN L
DATE OF PAYMENT: 10/29/2009
POSTMARK DATE: 10/29/2009
CouNTY: CUMBERLAND
DATE OF DEATH: 07/ 24/ 2009
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
09163771 ~ 533.72
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 4137
SEAL
INITIALS: CJ
533.72
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REV-1162 EX111-96)
NO. CD 01 1917
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES ~.,+ `- ?4~~ ! {,Y AND FILE N0. 21 09-0736
PD Box zao6Bl ..TAXPAYER RESPONSE ACN 09163771
HARRISBURG PA 17128-0601 ~ ~ DATE 10-07-2009
REV-1543 E% AFP (OB-087
~~~{~ ~~+~ ~~ ~~~ 4?. ~~~, TYPE OF ACCOUNT
EST. OF MARIAN BRUDOWSKY ® savINGs
f. .-._ , ;,,;- SSN 179-14-8711 ~ CHECKING
r `'~ -s- DATE OF DEATH 07-24-2009 ~ TRUST
~+" -;,, COUNTY CUMBERLAND ~ CERTIF.
~" REMIT PAYMENT AND FORMS T0:
PATTI BUXTON REGISTER OF WILLS
725 S MAIN ST CUMBERLAND CO COURT HOUSE
MARYSVILLE PA 17053 CARLISLE, PA 17013
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 ]oint 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 X717) 7Bi-5327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 180550-0 0 Date 12-12-1998 Ta ensure prover credit to the account, two
Established copies of this notice must accompany
payment to the Register of Wills. Make check
Account Balance 4 9 8.5 3
$ 1, payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 749.27 months of the decedent's date of death,
TeX Rate X . 045 deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will became delinquent
Potential Tax Due $ 33.72 nine months after the date of death.
PART TAXPAYER RESPONSE
~ ILIl,RE ~~ R WI RESUi~~' IN OFFIC AL TA ~ A5SES~MENT
A. he 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
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 ~ below.
PART If 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
"` OFFICIAL "~'SE 0 Y ~ AAF
SPA DEPARTMENT OF VENUE
OF TAX ON JOINT/TRUST ACCOUNTS PAD
1
2
3 X
4
5
6
7 X
8
1
2
3
4
5
b
7
8
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported abnove are true, correct and
complete to the best of my knowledge and belief. Nf1MF C` 1 ~ 7 1 ~ _ ("4G ~u ~.t~~ .
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WORK C )
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