HomeMy WebLinkAbout11-25-09 (4)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 012037
SAYLOR SHARON E
22 CREEK BANK DR
MECHANICSBURG, PA 17050-1814
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ESTATE INFORMATION: sSN: 210-~2-4660
FILE NUMBER: 2109-1104
DECEDENT NAME: SAYLOR DONALD S
DATE OF PAYMENT: 1 1 /25/2009
POSTMARK DATE: 1 1 /24/2009
couNTY: CUMBERLAND
DATE OF DEATH: 10/ 13/2009
REMARKS:
CHECK# 9017
SEAL
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
09173428 ~ 540.22
TOTAL AMOUNT PAID:
INITIALS: JN
REV-1162 EX(11-96)
540.22
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REG{STER OF WILLS
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INOIYIDUAL TAXES ~ ~~~rr ~ I~'r'1~~" lk AND F I LE ND . 21 QQ ~ ~ p~}
PO BOX 280601 ~ ~ ' '~' ~' ~C~''`AYER RESPONSE ACN 09173428
HARRISBURG PA 17128-0601 (` ~ `""~C: ~ ', ~,
+-(~~~; iC ~ 4`', ~, ~. -~,: DATE 11-16-2009
mev-1543 EX AFP (3B-OB)
Z~09 NOY 2S PM 2~ 5D
CLERK +~
C~ME~~" N3~C~ r;~., PA
SHARON E SAYLOR
22 CREEK BANK DR
MECHANICSBURG PA 17050-1814
EST. OF DONALD S SAYLOR
SSN 210-12-4660
DATE OF DEATH 10-13-2009
COUNTY CUMBERLAND'
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
PNC BANK NA 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 joint owner/benef6ciary 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 Cormonwealth of
Pennsylvania. Please call C7171 787-Ai27 with questions.
COMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 000005004629554 Date 07-12-2004 To ensure proper credit to the account, two
Established copies of this notice must accompany
payment to the Register of Wills. Make check
Account Balance $ 1 ~ 787 • 37 payable to "Register of Wills, Agent^.
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 893.69 months of the decedent's date of death,
Tax Rate X . 045 deduct a 5 percent discount on the tax due.
Anv Inheritance Tax due will become delinquent
Potential Tax Due ~- 40.22 nine months after the date of death.
PART TAXPAYER RESPONSE
!`I~
A. ~ The above information and tax due is correct.
Remit Dayment to the Register of Wills with two co pies of this notice to obtain
a discount or avoid interest, or check box "A" and return this notice to the Register of
CHECK Wills and an official assessment will be issued by the PA Department of Revenue.
C ONE
BLOCK B. ~ The above asset has been or will be reported and tax p aid with the Pennsylvania Inheritance Tax return
ON L Y to be filed by the estate representative.
C. ~ The above inforra ion is incorrect and/or debts and deductions were paid.
Complete PART ~2 and/or PART 3~ below.
PART If indicating a different tax rate, please state
a relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE I. 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 ~C
8. Tax Due 8
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, correct and
complete to the best of my knowledge and belief. HOME C )
WORK C )
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
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