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HomeMy WebLinkAbout04-01-10 (2)COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DUPLICATE TESLAR STEPHANIE N 412 N BEAVER STREET FLAGSTAFF, AZ 86001 -------- ,o~d ESTATE INFORMATION: SSN: 193-36-4451 FILE NUMBER: 2109-0838 DECEDENT NAME: TESLAR STEPHEN D DATE OF PAYMENT: 04/01 /2010 POSTMARK DATE: 03/29/2010 COUNTY: CUMBERLAND DATE OF DEATH: 08/27/2009 REV-1162 EXI11-96) NO. CD 012555 ACN ASSESSMENT AMOUNT CONTROL NUMBER 10104440 ~ 51,581.23 TOTAL AMOUNT PAID: REMARKS: STEPHANIE TESLAR CHECK# 217 SEAL INITIALS: WZ RECEIVED BY 51,581.23 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU of INDIVIDWL TAxES AND FILE N0. 21 09-0838 PO BOX 280601 '~'~ ~-'r ~' HARRISBURG PA nlze-owl _- _~.: ~,~: ~ I~~ T~-XPAYER RESPONSE ACN 10104440 ~, n;~; ,; ~, DATE 01-21-2010 ., eav-teas t~~'a-+cae'ev i ...- , ri.:. . 2010 APR - i AM IQ~ 56 p l~itL~LA i~I~i+\ /~~ ~' OflPl !/~f VIJ i~~~J ~~1 CU~iF~ , ~~~ :-;~ . PA. STEPHANIE N TESLAR 300 ADAMS RD CARLISLE PA 17015 EST. OF STEPHEN D TESLAR SSN 193-36-4451 DATE OF DEATH Q8-27-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING © TRUST CERTIF. BANK OF AMERICA NA provided the Departaent with the inforaation below, which has bean used in calculatin0 the potential tax due. Records indieet• that at the death of the above-naaed decedent, you were a joint owner/beneficiary of this account. If You foal th• inforaation is incorrect. please obtain written correction frog the financial institution, attach a copy to this fora and return it to the above address. Thf saccount is taxable ~n accordance with the Inheritance Tax laws of the Cpaaonwealth of Pennsylvania. Please call (717) 767-9E27 with quaations..~ -.-- COMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 910000824956 13 Date 0 3-12 -2008 io ensure proper credit to the account, two Estahlished copies of this notice gust accoaparo pavaent to the Raoister of Wills. Nak• check Account Balance ~ 10, 541. 52 payable to "Reyistar of Wills, Agent". Percent Taxable X 100. 00 NOTE: If tax payaents are cads within three Amount Subject to Tax g 10, 541. 52 aonths of the decedent's data of death, Tax Rate ~( , 15 deduct a 5 percent discount on the tax due. Aro Inheritance Tax due will beeoae delinquent Potential Tax Due $ 1 ~ 581 . 23 nine aonths after the date of death. C. ~ The above inf oraa eon is incorrect and/or debts and deductions were paid. Cwolet• PART 2~ and/or PART 3^ below. PART If indicating a different tax rato, please stato relationship to decedent: TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established L 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 ~ 5. Debts and Deductions 5 6. Amount Taxable 6 ~ 7. Tax Rate 7 X 8. Tax Duo 8 ~ PART DEBTS AND DEDUCTIONS CLAIMED. ^H DATE PAID PA QESCRIPTION1 AMOUNT PAID TOTAL CEnter on Line 5 of Taz Computation) # 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 ( ) `~'~~ TAXPAYER SIGNATURE TELEPHONE NUMBER DATE