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HomeMy WebLinkAbout04-19-10COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DEBELLO CARMEN N 26 WHITE OAK BLVD MECHANICSBURG, PA 17050 ACN ASSESSMENT CONTROL NUMBER -------- fold ESTATE INFORMATION: ssN: 128-~s-ogss FILE NUMBER: 2110-0272 DECEDENT NAME: DEBELLO ANTHONY J DATE OF PAYMENT: 04/ 1 9/201 0 POSTMARK DATE: 04/16/2010 couNTY: CUMBERLAND DATE OF DEATH: 03/10/2010 AMOUNT 10120519 ~ 5310.60 TOTAL AMOUNT PAID: REMARKS: SEAL CHECK# 668 INITIALS: CJ RECEIVED BY: 5310.60 ... ~.~r.n rnr~nirn [~TI")n C~All!_LJ REGISTER OF WILLS REV-1162 EX(11-96) NO. CD 012631 REGISTER OF WILLS PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE i ~,~- ~,i= AND FILE BUREAU OF INDIVIDUAL TAXES~~I ~_ Po sox 2BO6o1 _ TTAXPAYER RESPONSE ACN HARRISBURG PA 17128-0 601 ii~``~ '~ .~'il DATE 4 RFV-1543 E% 11FP COB-OEn N0. 21 10-0272 10120519 04-08-2010 201 APR 19 P~1 I= 46 ['1'( fix: 1 ~ 1...~~ ~_-- n~r~ ~ ., EST. OF ANTHONY J DEBELLO SSN 128-16-0989 DATE OF DEATH o3-10-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: THOMAS A DEBELLO REGISTER OF WILLS 26 WHITE OAK BLVD 1 COURTHOUSE SQUARE MECHANICSBURG PA 17050-7939 CARLISLE PA 17013 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. PNC BANK NA 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 Joint 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 tax ablesn accordance with the Inheritance Tax laws of the Commonwealth of Pennsylvania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 000005130176218 Date 01-25-2008 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance $ 13, 804.25 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 6, 902 • 13 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 $ 310 • 60 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT A. © The above information and tax due is correct. Remit payment 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 CHECK 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 information is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3~ below. PART If indicating a different relationship to decedent: tax rate, Please state JOINT/TRUST ACCOUNTS OFFICIAL U5E ONLY ~ AAF PA DEPARTMENT OF REVENUE PAD - TAX LINE RE 1. TURN - COMPUTATION OF Date Established 1 TAX ON 1 2. Account Balance 2 $ ~ 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ 4 5. Debts and Deductions 5 5 6. Amount Taxable 6 '~ 6 7. Tax Rate 7 X 7 8. Tax Due $ $ $ PART DEBTS AND DEDUCTIONS CLAIMED IUTAL ttncer on L1tIC n w~ ~~~r..~o....,.- Under penalties of perjury, I declare that the facts complete to the b st of my knowledge and belief. I have reported above are t/r~ue, correcCt~ and HOME C 77~ ) 77~ ~ ~G^~ //,J ~ ~/~~.~ ~ ~~/ /III GFi~~~ -- c 7~~ ~ 5133 ..~~~~7 .E~~ ~s'io TCt ~o~rtu~ uiiMnGV naTF naTF Pain PAYEE DESCRIPTION AMOUNT PAID USA c..k,= ,~.~~ ;~. a d',o ,a.,~ .~~ :...xw,. ~~ ~` '•9dar 3 rF r P $ ~~, ~ "'. ?!!!ate ,. ,_ :~~/, ~1_i . C..- . ~~- ._ { - -- F1 ~~ V ~J ti ~ ''C ~J ~ ,1,3 v ~ `~ ~ ~~ ~) U ~ 1 ~' ~ ~~ 444 AI ~ ~ ,~\ O ~.- "~- CS- C5- G~ %..:a M '1 v^` t v "~ ..r . J cA t ~~ l~+- ~~~ ~ ~' ~.~ ~ ~ i ~ . ~\ 1 ;..~ ~~~~3 iii it _~~ ; .;..} i„ ..•~