HomeMy WebLinkAbout04-05-10 (2)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
EVANS LAURIE A
872 RIDGE ROAD
CARLISLE, PA 17015
/uIE
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11-96)
NO. CD 012561
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
ESTATE INFORMATION: Ssty: 19s-3o-5157
FILE NUMBER: 2110-0277
DECEDENT NAME: EVANS EVELYN M
DATE OF PAYMENT: 04/05/2010
POSTMARK DATE: 04101 /2010
COUNTY: CUMBERLAND
DATE OF DEATH: 03/09/2010
REMARKS:
CHECK#1273
SEAL
10117176 ~ $15.53
TOTAL AMOUNT PAID:
INITIALS: DM
RECEIVED BY:
$15.53
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL 7.A~SIrSn^ rn
PO BOX 280601 { ~ ~~_~ `t _
HARRISBURG PA 17128-56Uk '~ = i•-
ZOiU APR -5 PM f2~ 44
CLERK of
o~P~rv~s CouRr
CUMBER! ~`„±~D CC? . PA.
LAURIE EVANS
872 RIDGE ROAD
CARLISLE PA 17015
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND FILE
TAXPAYER RESPONSE ACN
DATE
N0. 21 -~~ ~a--1~
10117176
03-22-2010
EST. OF EVELYN M EVANS
SSN 199-30-5157
DATE OF DEATH 03-09-2010
COlTNTY CUMBERLAND
REMIT PAYMENT AND FORMS TD:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
MEMBERS 1ST FCU provided the Departsent with the inforsation below, which has been used in calculating the
potential tax due. Records indicate that at the death of the above-naaed decedent, you were a ioint owner/beneficiary of this account.
If you feel the inforsation is incorrect, please obtain written correction frog the financial institution, attach a copy to this fors
and return it to the above address. This account is taxable in accordance with tfie Inheritance Tax laws of the Cossonwealth of __ __ _ __
Pennsylvania. Please call C717) 787-8327 with questions. ~~
COMPLETE PART I BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 171166 - 11 Date 10 - O 1 - 1997
To ensure proper credit to the account, two
Established copies of this notice oust accosparry
Account Balance ~ 2
070 31 paysent to the Register of Wills. Make check
~ . payable to "Register of Wills, Agent".
Percent Taxable X 16 .667
Amount Subject to TaX $ 3 4 5 0 6 NOTE: If tax paysents are soda within three
. sonths of the decedent's date of death,
Tax Rate ~( , 0 4 5 deduct a 5 percent discount on the tax due.
Potential Tax Due
15
.53 Any Inheritance Tax due will becose delinquent
nine sonths after the date of death.
P
T TAXPAYER RESPONSE
~
~
~: '~ ~„-
CHECK
ONE
BLOCK
ONLY
above inforsation and tax due is correct.
Resit pavsent 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 Register of
Wills and an official assesssent will be issued by the PA Departsent 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 inforsa ion is incorrect and/or debts and deductions were paid.
Cosplata PART 2~ and/or PART 3~ below.
PART If indicating a different tax rate, please state
r,
relationship to decedent: •~; r ~~s `;
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 'P~ '- ,~~j~° `' '~ Y'
~«,~,~,
'!ems
LINE 1 . Date Established 1 ~
• ~- r~~~ ~
~
~„!,r
2. Account Balance 2 $ ,
.`"~f~.s, a'~`~ ,#
~~w
3. Percent Taxable 3 X fir. ~ ~~ `r~ ,~' a-,~
4. Amount Subject to Tax 4 $ ~ ~,~Y ~~"' v~#~ 'r'
5. Debts and Deductions 5 - ;~~ ~ ~ ~ ~ ~~"
"""""" ~"'~"",
6. Amount Taxable 6 ~ E~ ~
~ ,.~~ er,t*tt+ °,w-+~ ;S
7. Tax Rate 7 X ~~ '~' =~
8. Tax Due 8 $ . • ~ . Y 3.,
PART
DEBTS AND DEDUCTIONS CLAIMED
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete o the b t of knowledge and belief. HOME C 7~7 ) %T y;3 '~! 8'~/$~
-"~- ~ WORK C ?~ ~ ) y'z. Z. - v PS ;3 .T ] ~ 1 D
TAX ER SIG ATURE TELEPHONE NUMBER DATE
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
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