HomeMy WebLinkAbout11-02-09 (2)__ ~ __ _ _
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280607
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
STOOKSBURY AMY J
505 JONES RD
ELKTON, KY 42220
fold
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162EX(11-96)
NO. CD 01 1931
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
ESTATE INFORMATION: SSN: ~~4-20-6742
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:
CHECK# 6941
SEAL
09158434 ~ 5927.54
TOTAL AMOUNT PAID:
INITIALS: DM
'927.54
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
_T _
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIYIDUAL TAXES AND FILE N0. 21
PO BOX 280601 TAXPAYER RESPONSE ACN 09158434
HARRISBURG PA 17128-0601
DATE 09-17-2009
REV-1543 IX AFP (OB-00]
TYPE OF ACCOUNT
EST. OF JAMES R PATRICK ^ SAViNGs
SSN 174-20-6742 ^ CHECKING
DATE OF DEATH OS-11-2009 Q TRUSr
COUNTY CUMBERLAND ^ CERTIF.
REMIT PAYMENT AND FORMS T0: t`.7
AMY J STOOKSBURY REGISTER OF WILLS t7 0 -ta
505 JONES RD CUMBERLAND CO COURT HOUS~ "° =z --"
ELKTON KY 42220 CARLISLE, PA 17013 ~ ~, -j
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PSECU provided the Department with the information below, which has been use aleulati.ma.the
Dotential tax due. Records indicate that at the death of the above-named decedent, you were a ioint owner/benef'c of thi~ccour~t "t^
If you feel the information is incorrect, please obtain written correction from the financial institution, attar copy to t}~ forol )
and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth ~~
Pennsylvania. Please call C717) 787-8327 with questions. -----_________SSS~~C!!! ..___ - -- --- _ -
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 1174206742-$4 Date 03-05-1997 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance 21, 696.91 payment to the Rogister of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 100 .00
Amount Subject to Tax
$
21,696
.91 NOTE: If tax payments are.^ade within three
months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Potential Tax Due 9 7 6 .3 6 ~~~~ Any Inheritance Tax due will become delinquent
nine months after the date'of death.
PART
CHECK
C ONE
BLOCK
ONLY
Y
above information and tax due is correct.
Remit payment to the Rogister 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
Wills and an official assessment will be issued by the PA Department of Revenue.
B. ^ Tha above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
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 rater 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 ON JOINT/TRUST ACCOUNTS
1
2
3 X
4 $
5
6 $
7 X
8
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported abov,/e~are true, correct and
cog~glete to the s of my knowledge and belief. HOME C~/~ ) ~~~~y~
lI/i~YC/.. ~ ~/1//~Ll ~//Yw~.E WORK (~(,j ) f?.?9 ~ ^JC"~ i~
BER DATE
TOTAL (Enter on Line 5 of Tax Computation) @
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