HomeMy WebLinkAbout01-12-09COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
THOMAS RHONDA M
6416 16TH AVENUE NW
MINOT, ND 58703
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ACN
ASSESSMENT
CONTROL
NUMBER
fold
ESTATE INFORMATION: ssrv: ~s9-34-8439
FILE NUMBER: 2109-0997
DECEDENT NAME: BREWER RHONDA S
DATE OF PAYMENT: 01 / 1 2/ 2010
POSTMARK DATE: 01 /07/201 0
COUNTY: CUMBERLAND
DATE OF DEATH: 10/14/2009
REV-1162 EX(11-96)
NO. CD 012223
AMOUNT
09169752 ~ $406.76
TOTAL AMOUNT PAID:
REMARKS:
SEAL
CHECK#504
INITIALS: CJ
RECEIVED BY:
5406.76
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21
PO BOX 280601 TAXPAYER RESPONSE ACN 09169752
HARRISBURG PA 17128-0601 DATE 10-29-2009
REY-1543 IX AFP (00-007
RHONDA BERG
602 SANDBANK ROAD
MT HOLLY SPRINGS PA 17065
EST. OF RHONDA BREWER
SSN 199-34-8439
DATE OF DEATH 10-15-2009
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MEMBERS 1ST FCU provided the Department with the information below, which has been u3
potential tax due. Records indicate that at the death of the above-named decadent, you were a joint owner/ban
If you feel the information is incorrect, please obtain written correction from the financial institution, att
and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of th
Pennsylvania. Pl~asa call (717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTI
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
relationship to decedent:
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subiect 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 $
PART
a
Herr aeTn PAYEE
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
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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 ( )
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