HomeMy WebLinkAbout11-02-09COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EXI11-96)
NO. Ca 01 1930
STOOKSBURY AMY J
505 JONES RD
ELKTON, KY 42220
ESTATE INFORMATION: ssN: i 74-2o-67x2
FILE NUMBER: 2109-1028
DECEDENT NAME: PATRICK JAMES R
DATE OF PAYMENT: 1 1 /02/2009
POSTMARK DATE: 10/29/2009
COUNTY: CUMBERLAND
DATE OF DEATH: 08/ 1 1 / 2009
REMARKS:
SEAL
CHECK# 6942
ACN
ASSESSMENT p-MOUNT
CONTROL
NUMBER
09158435 ~ S 1,149.88
TOTAL AMOUNT PAID:
INITIALS: DM
RECEIVED BY:
S 1,149.88
GLENDA EARNER STRAISBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21
PO Box 280601 TAXPAYER RESPONSE ACN 09158435
HARRISBURG PA 17128-0601
* * * REVISED NOTICE * * * DATE 10-08-2009
eev-uas oc ~v coo-ae~
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
® CERTIF.
EST. OF JAMES R PATRICK
SSN 174-20-6742
DATE OF DEATH 08-11-2009
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
AMY J STOOKSBURY REGISTER OF WILLS
505 JONES RD CUMBERLAND CO COURT HOUSE
ELKTON KY 42220 CARLISLE, PA 17013
PSECU provided the Department with the information below, which has been i
potential tax due. Records indicate that at the death of the above-named decedent, you were a point owner/be
If you feel the inforsation is incorrect, please obtain written correction from the financial institution, a4
and return it_to the above address. This account is taxable in .accordance..with the Inheritance Tax.. laws of 1
- __ Pe-msylvanSa:' f'iaasa ca1TTTl7) ~7aT~BS2T~~-ith~g0estioiR: ~ --------._-- -- __.. _._ _. .-.-___--_ --- _-'.~._... „_.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSI
Account No. 1174206742-C51 Date 06-13-2000
Established
Account Balance $ 80, 694.21
Percent Taxable X 33.333
Amount Subject to Tax $ 26, 897.80
Tax Rate X .045
Potential Tax Due ~ 1 , 210 .40
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To ensure proper credl~to the acc,~~1'~S~ two
copies of this notice oust accompatBT
payment to the Resister of Wills. Make check
payable to "Resister of Wills, Agent".
NOTE: If tax payments are made within three
months of the decedent's data of death,
deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
nine months after the date of death.
C. ~ The above informs ion is incorrect and/or debts and deductions ware paid.
Complete PART ~ and/or PART 3~ below.
PART If indicating a different tax rate, please state
relationship to decedent:
TAX RETURN -.COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established 1
2. Account Balance 2 +~'
3. Percent Taxable 3 X
4. Amount Subject to Tax 4
5. Debts and Deductions 5 -
6. Amount Taxable 6
7. Tax Rate 7 X
8. Tax Due g ~`
PART DEBTS AND DEDUCTIONS CLAIMED
3
DATE PAID PAYEE DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation) 4
Under penalties of perjury, I declare that the facts I have reported ab+o}v+~e are tr~jue~~-,--correct and
plate to best of my knowledge and belief. HOME C o• / (~) /S ~ / '~r~ 9 yl
d WORK (oZ:yU ) ~~9i `7 C""2 C~
-~_ DATE
w. ~ine aoova information and tax due is correct.
Remit payment to the Resister of Wills with two copies of this notice to obtain,
CHECK a discount or avoid interest, or check box "A" and roturn this notice to the Resiister of
0 NE Wills and an official assessment will be issued by the PA Department of Revenue.
BLOCK ~ 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.
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