HomeMy WebLinkAbout04-05-10COMMONWEALTH 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
NO. CD 012560
EVANS LAURIE A
872 R{DGE ROAD
CARLISLE, PA 17015
to,a
ESTATE INFORMATION: SSN: t99-3o-5t57
FILE NUMBER: 2110-0277
DECEDENT NAME: EVANS EVELYN M
DATE OF PAYMENT: 04/05/2010
POSTMARK DATE: 04/01 /2010
couNTY: CUMBERLAND
DATE OF DEATH: 03/09/2010
REMARKS:
CHECK#1274
SEAL
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
10117174 ~ 511.30
TOTAL AMOUNT PAID:
INITIALS: DM
REV-1162 EX(11-96)
511.30
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601 ,- ~ r... ,,r
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PENNSYLVANIA INHERITANCE T
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE N0. 21 ~" i~•'-~11
ACN 10117174
DATE 03-22-2010
2Qi~ APR -5 PPS 12~ ~-4
C~E.P,4 C
cc ORPHAI~~S GC?JRT
LAURIE~r'~~~R~ EVANS' ~A
872 RIDGE ROAD
CARLISLE PA 17015
EST. OF EVELYN M EVANS
SSN 199-30-5157
DATE OF DEATH 03-09-2010
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS 1ST FCU provided the Departaent with the inforaation below, which has been used in calculating the
potential tax due. Records indicate that at the death of the above-nosed decedent, you wero a joint owner/beneficiary of this account
If you feel the inforaation is incorrect, please obtain written correction frog 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 Coiesonwealth of
Pennsylvania. Please call (717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 171166-00 Date 10-01-1997 To ensure proper credit to the account, two
Established copies of this notice lust accospany
Account Balance 1
507
03 paysent to the Register of Wills. Make check
~
. payable to "Register of Wills, Agent".
Percent Taxable X 16.667
Amount Subject to Tax
~ 25 1
1 8 NOTE: If tax pavsents are ^ade within three
. aonths of the decedent's d8te of death,
Tax Rate X .045 deduct a 5 percent discount on the tax duo.
Potential Tax Due 1 1 .3 0 Any Inheritance Tax due wi11 bacosa delinquent
nine aonths after the date of death.
P
T TAXPAYER RESPONSE
~
1
A. ~ The above inforaation and tax due is correct.
Resit paysent 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
C O NE ~ Wills and an official assessaent will be issued by the PA Departaent of Revenue.
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 inforsa ion is incorrect and/or debts and deductions were paid.
Cosplete PART 2~ and/or PART 3~ below.
PART If indicating a different tax rate, please state
` ~ .
relationship to decedent: „.z_
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject 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 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,l~c'o/rrect and
complete to the best of my knowledge and belief. HOME C `2/'~ ) e~+/$- ja y~
/~ ~ ' WORK C `~l7 ) N'2L - /D fs .S 31-/D
'TAXPAYER S GNATURE ~ TELEPHONE NUMBER DATE
TOTAL CEnter on Line 5 of Tax Computation) #
y-,,;•f . ~..~ ;t~
CLERK ~~
ORPHAN'S ~;UJRT