HomeMy WebLinkAbout12-30-09COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
N0. CD 012170
BENNETT BETTY
7006 SUNDAYS LANE
FREDERICK, MD 21702
fold
ESTATE INFORMATION: SSN: 171-72-9125
FILE NUMBER: 2109-1 149
DECEDENT NAME: LEE ELLEN K
DATE OF PAYMENT: 12/30/2009
POSTMARK DATE: 12/29/2009
couNTY: CUMBERLAND
DATE OF DEATH: 10/09/2009
REMARKS:
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
09175044 ~ S 107.05
1
TOTAL AMOUNT PAID:
$107.05
CHECK# 3356
INITIALS: DM
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL ~,~~,~~ .r
~, J;
PO BOX 2806Y1-~r ~ 11`" r ~ i :.
HARRISBUR6':PA ~7L2r8 ~0'I , , ~ i~
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. ._._a `. ,"~ r ..Jr r i ~".`'"'REV-1543 E% AFP <UB-00)
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND FILE
TAXPAYER RESPONSE ACN
DATE
N0. 21 - ~ -` 'r ~ ~~~
09175044
11-27-2009
2~Q9 DEC 3~ PM t ~ 36
C~~I t~~ l..`~
ORPH~'z' ~ CCURT
BETTY E BENNETT
7006 SUNDAYS LN
FREDRICK MD 21702
EST. OF ELLEN K LEE
SSN 171-12-9125
DATE OF DEATH 10-09-2009
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
ORRSTOWN BANK 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 point owner/beneficiary of this account.
If you feel the information is incorrect, Dlease 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 Commonwealth of
Pennsylvania. Please call C717) 767-8327 with questions.
COMPLETE PART I BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 4000002181 Date 09-16-2003 To ensure proper credit to the account, two
Established copies of this notice must accompany
payment to the Resister of Wills. Make check
Account Balance $ 5, 008.05 payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tex $ 2,504.03 months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due $ 112 • 68 nine months after the date of death.
PART TAXPAYER RESPONSE
a
A. fvT The above information and tax due is correct.
LuJ Remit payment to the Register of Wills with two copies of this notice to obtain
CHECK 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.
C ONE
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.
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 rate, please state ~
relationship to decedent: _
~~~~' .
TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ~`
LINE
1 .
Date Established 1 :$
mew '" ~ ~ ' wwrwNM
2. Account Balance 2 $ j °'~`' ~~»~
3. Percent Taxable 3 X
4. Amount Subject to Tax 4 $ •;
< ,a
5. Debts and Deductions 5 -
$ ~~~ ~ '~'~
6. Amount Taxable 6
7. Tax Rate 7 X ,,
8. Tax Due 8
$ •'•
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 //tru~1, co/rreLc/t and
complete to the b st of my k owledge and belief. HOME C3~ ~ ) (O~J -(p 73
(~ M~O~ C~ O / ) D / - to b S
TAXPAYE SIGNATURE TELEPHONE NUMBER DATE
TOTAL CEnter on Line 5 of Tax Computation) #
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