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HomeMy WebLinkAbout11-23-09COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: JOLLIFF NATHALIE 1201 DICKINSON DRIVE CARLISLE, PA 17013 fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: SSN: 5'14-09-6541 FILE NUMBER: 2109-1092 DECEDENT NAME: JOLLIFF ROBERT C DATE OF PAYMENT: 1 1 / 23/ 2009 POSTMARK DATE: 10/21 /2009 couNTY: CUMBERLAND DATE OF DEATH: 09/09/2009 ACN ASSESSMENT CONTROL NUMBER AMOUNT 09161205 ~ 520.42 TOTAL AMOUNT PAID: REMARKS: CHECK# 3955 SEAL INITIALS: DM 520.42 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REV-1162 EX(11-96) NO. CD 012026 REGISTER OF WILLS PENNSYLVANIA INHERITANCE TAX NTY CUMBERLAND r.~ ~ CERTIF. REMIT PAYMENT AND FORMS T0: C7 ~ NATHALIE JOLLIFF REGISTER OF WILLS .C ~ ~' ~~~ 1201 DICKINSON DRIVE CUMBERLAND CO COURT HOU~ © r~--rj CARLISLE PA 17013 CARLISLE, PA 17013 ~~ rn-- t t~-~ t? c"7 C~ '-r7 ~ - ~ --w MEMBERS 1ST FCU provided the Department with the information below, which has bean ~ calculating the ~_y.~ potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/be iciary of ~s accbur~~..~ If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy td~is 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 C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 -09 - ~d9a Po BOX 280601 TAXPAYER RESPONSE ACN 09161205 HARRISBURG PA 17128-0601 DATE 09-23-2009 mrv-1543 IX AFP (00-08) TYPE OF ACCOUNT EST. OF ROBERT C JOLLIFF ® SAVINGS SSN 514-09-6541 ~ CHECKING DATE OF DEATH 09-09-20.09 ~ TRUST COU Account No. 27522-00 Date 07-06-1981 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 907 60 Payment to the Register of Wills. Make check . payable to "Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to Tax ~ 453 80 NOTE: If tax payments era made 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 ~` 20.42 Any Inheritance Tax due will become delinquent nine months after the date of death. P T TAXPAYER RESPONSE ~ 1 A. (~ The above information and tax due is correct. ' III Remit payment to the Register of Wills with two copies of this notice to obtain CHECK 0 N E a discount or avoid interest, or check box "A" and Wills and an official assessment will be issued by return this notice to the Register of the PA Department of Revenue. [ BLOCK ~ B. ~ The above asset has bean or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 NL Y to be filed by the estate representative. C. ~ The above informs ion is incorr~ect and/or debts and deductions ware paid. Complete PART 2~ and/or PART IJ below. PART If indicating a different tax rate, Please state relationship to decedent: ,, a.. 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 +fi PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, corre`c~t and com late to t best of my knowledge and belief. HOME C 7 ~ ) a~3 7?~N WORK (?('? ) o2(~S'I~~7~-/' E!d('32~t3 << ~°~'/~XI AXPAYER SI NATU TELEPHONE NUMBER DATE IUTAL center on Line 5 of Tax Computation) #