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Home My WebLink About01-04-10 (2)COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BOURINSKI ALEXIS 1171 BOILING SPRINGS ROAD MECHNAICSBURG, PA 17055 ACN ASSESSMENT CONTROL NUMBER fold ESTATE INFORMATION: ssN: FILE NUMBER: 2110-0002 DECEDENT NAME: BOURINSKI JOYCE DATE OF PAYMENT: 01 /04/201 0 POSTMARK DATE: 1 2/31 /2009 COUNTY: CUMBERLAND DATE OF DEATH: 12/03/2009 REV-1162 EX(11-96) NO. CD 012188 AMOUNT 09180003 ~ 541.15 09180001 ~ 57.10 TOTAL AMOUNT PAID: REMARKS: SEAL CHECK#5530 INITIALS: CJ RECEIVED BY: 548.25 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS PENNSYLVANIA INHERITANCE T INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AN D PO BOX 280601 TAXPAYER RESPONSE HARRISBURG PA 17128-0601 REY-1543 IX wFP (OB-OB) FILE N0. 21-~Q-Q(~Qa, ACN 09180001 DATE 12-18-2009 TYPE OF ALEXIS BOURINSKI 1171 BOILING SPRINGS RD MECHANICSBURG PA 17055 EST. OF JOYCE BOURINSKI SSN DATE OF DEATH 12-03-2009 COUNTY. CUMBERLAND. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ACCOUNT ® SAVINGS ^ CHECKING ^ TRUST ^ CERTIF. MEMBERS 1ST FCU 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, 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 Cowmonwealth of Pennsylvania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 190278-0 0 Date 01-14-2000 To ensure vroper credit to the account, two Established copies of this notice ^ust accompany payment to the Register of Wills. Make check Account Balance $ 947.14 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are ^ade within three Amount Subject to TaX $ 157 • $6 months of the decedent's date of death, Tax Rate ~( .045 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will Decome delinquent Potential Tax Due ~ 7.10 nine months after the date of death. PART TAXPAYER RESPONSE A. IK :ne above information and tax due is correct. u Remit pm/mant 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 B L 0 C K 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. Coeplete PART 2~ and/or PART 3^ below. PART If indicating a different tax rate, please state ~`"` ~; i ~ I~~s~s ~ ~' ~, iU9 i~~~ ;~ i ~ ~~ ; r ~ ~ 9h i}~V3 !I~ t 'll;~ '1 y~ • ~ ~ relationship to decedent: s y ~ p i ~ ~( d I IIb ~ 4~ i I~ ' ~ ~ ` ~ ~ ~~ I ~~ ^ n ~,, ~ ~ ~ ~~~~ ~ I~I ~~ i a~lll i ~, ~ ~ ~ ~ I~II~~I , ~ p61I!~I Ili I,~!,~ TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ~ ~ ~~? ~~ i I' ~!uiijj!~~I t ~~y °, ';I~,~I~~i~p9 !4:,, ~( ~ ~!,,Pi~~~,i''' .~.: ~ LINE 1. Date Established 1 . ~a'i, ~ s`' ~ ...:w, 2. Account Balance 2 $ r~.,w~wwy, 3. Percent Taxable 3 X `~ ~' 4. Amount Subject to Tax 4 $ ~{ i~ Q ~ ~ 5. Debts and Deductions 5 ~ , n tr 8~ e51 '',~ it~'~tq~ f~i I t „ 9~ ~ ~~y.w ~'` ~~ 6. Amount Taxable 6 $ ~ E.o y ~~ ~ x ',', ~ ~n~•, 7. Tax Rate 7 X ~' 8. Tax Due 8 $ ~ z -, PART DEBTS AND DEDUCTIONS CLAIMED. _ ;: DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury. I declare that the facts I have reported abovTeyare tru®, correct /amend comp t® to the t my ledge and belief '" HOME C ~S ! ) ~. ~~'~ ~'y' ~( c WORK C ) ~, rwv vro c•rruwr( TFI FPIJf1NF NIIMAPR TIATF TOTAL (Enter on Line 5 of Tax Computation? 6 PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21-'lu-(~~°L PD Box zao6ol TAXPAYER RESPONSE ACN 0918000? HARRISBURG PA 17128-0601 DATE 12-18-2009 REV-1543 IX IIFi COB-08) ALEXIS BOURINSKI 1171 BOILING SPRINGS RD MECHANICSBURG PA 17055 EST. OF JOYCE BOURINSKI SSN DATE OF DEATH 12-03-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU 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 inforoation is incorrect, please obtain written correction from the financial institution, attach a copy to this fora 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 I BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 190278-42 Date 01-14-2000 Established Account Balance $ 5, 486.02 Percent Taxable X 16.667 Amount Sub~eet to Tax $ 914.35 Tax Rate X .045 Potential Tax Due ~ 41.15 PART To ensure proper credit to the account, two copies of this notice oust accompany payment to the Register of Wills. Make check payable to "Register of Wills, Agent". NOTES 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 will become delinquent nine months after the date of death. A. ~he above inforoation and tax due is correct. 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 B L 0 C K 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 ~ below. PART If indicating a different tax rate, please state 4 ~ Gib r rJ~ ilk ~«~~, i~ ~ r iu. v to decedent: tionshi l g y VIE ~ ~ ~ ~ ~~ ~ ~' I p re a $ ^ ~ `p II ,,66 4 I ~ I~ ~' .T t ''~.'~~F ~~ a ~ I P P I ~ ~ ' t I ~ 9~ ~ ~~ ~~ ~ ~~ ~~ ~ ~ ~~~ ~ ~ ~ ~ ~ ~~ TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ~: ~' °' ~~~ ~'~ ~ ~ ~ ~ ~'"' ~ ~' "~ ~ ~ ~ °' ~~ '~ ~~ ~, LINE 1. Date Established 1 :', ~ 2. Account Balance 2 $ I ? 3. Percent Taxable 3 X ~ " 4. Amount Subject to Tax 4 $ rt ~ 5. Debts and Deductions 5 ~ $ _ ~ „~ ~ 6. Amount Taxable 6 ~ 7. Tax Rate 7 X s, ^,; ~Y ` r' 8. Tax Due 8 $ ~ ,M : PART DEBTS AND DEDUCTIONS CLAIMED 3^ narF Darn. PAYEE DESCRIPTION, AMOUNT PAID TOTAL CEnter On Line 5 Of IaX l:OmpuLailOnJ ~ Under penalties of perjury. I declare that the facts I have reported a~bjoj've?are true, coQrrec and ~y comp etc to th best my owledge ~nd be ef. T HOME C " f ) ~ ~ o '~ ~ J WORK ( ) _____ ___..__. _ rrs rounur u)IUnCO nATC __ _f ~~ f t ' ~ ~ r- ~; ~ ' ~: ~. Y.. } ~ ~ S i ~ nr*3 ~ ~• }} 7t ~f %~ l ~' 9 ~ ~ F I ; +~ `~ 0 4 ~~ ° '~ ~~~~ ~ ~T. `tii \/ V ``~ °~ ~~ ~ ~~ ~ ~~ ,_ .: 4 4 ~E ~~ ~:~ ~. ~- . ~n ro~'~ :~~' ~ ~ .. m y ,.,. 1 .~ '~ ~ ? (~ C% pQ ~ ~ w ~ •.~. .O O .^" y .-. C .c~ a~~i .-.. >~