HomeMy WebLinkAbout11-23-09 (3)PENNSYLVANIA INHERITANCE TAX
INF,9l~MATION NOTICE
It-~~ ,, .,~. -r ~ t ~, ,
BUREAU OF INDIVIDUAL TAXES t~)~ ~' ~•~ ~ r,~' -" AND FILE
PO BOX 280601 - ^. ~-„ 'i°~
HARRISBURG PA nlza-o6B1 `,~"~_,,;;h,;~~i`:~,~-~`~~YER RESPONSE ACN
DATE
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N0. 21 09-0449
09159260
09-17-2009
EST. OF DOROTHY M GOTSHALL
Ci~~iK~l' SSN 206-10-9488
ORPHANS CrJ~~RTp~ATE OF DEATH 05-02-2009
C~I~V'[~'`-r~~ "<~`'~~ ~-''~~~ ' BOUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
DAVID L GOTTSHALL REGISTER OF WILLS
1690 OBERLIN RD CUMBERLAND CO COURT HOUSE
MIDDLETOWN PA 17057-2948 CARLISLE, PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
WACHOVIA BK NA provided the Department with the information below, which has been ased in calculating the
potential tax due. Records indicate that at the death of the above-named decedent, you were a ioint owner/benefdciary 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 theiCommonwealth of
Pennsylvania. Please call (717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 247412041980770 Date 12-11-2003 7o ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
$ 11,504.38
X 50.000
$ 5,752.19
X .15
$ 862.83
PART
CHECK
ONE
BLOCK ]
ONLY
payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
NOTE: If tax payments are ^ade within three
months of the decedent's date of death,
deduct a 5 percent discount on the tax due.
Any Inheritance Tax due Nill become delinquent
nine months after the date of death.
I.T T
A. ~ The 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 ~tegister of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. ~ The 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 infarma 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: _
-
i ~ ,i ~,y ~ ,z
:y
a
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~~
TAX RETURN - COMPUTATION OF TAX ON JOIN
T
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R
U ST ACCOUNTS '' ~-~`? ~1~,
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LINE 1. Date Established 1 ~~~ -s
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2. Account Balance 2 $ /~. SOS/, 3)~
3.
Percent Taxable 3 X '
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4. Amount Subject to Tax 4 $ ,~ 7Sa~ ~ w~~' ~ `'^'~~
5. Debts and Deductions 5 - O
6. Amount Taxable 6 $ S
, 7.~~-,~7 '±
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7.
Tax Rate 7
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8. Tax Due 8 $ a.~ , gJ ~
±
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PART DEBTS AND DEDUCTIONS CLAIMED
0
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. .,nur ~ h/rl L7r IC~I~?
~~
D T
(VIAL lCnLer on Line s or iax Computation) ;
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
GOTTSHALL DAVID L
4500 OXFORD RD
HARRISBURG, PA 17109
fold
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ESTATE INFORMATION: SsN: 206-~0-9488
FILE NUMBER: 2109-0449
DECEDENT NAME: GOTSHALL DOROTHY M
DATE OF PAYMENT: 1 1 /23/2009
POSTMARK DATE: 1 1 /20/2009
COUNTY: CUMBERLAND
DATE OF DEATH: 05/02/2009
REV-1162 EX111-96)
NO. CD 012028
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
09159260 ~ 5258.85
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 263
SEAL
INITIALS: JN
5258.85
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
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