HomeMy WebLinkAbout05-14-10REV-1162 EX(11-96)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280801
HARRISBURG, PA 17128-0801 PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT N0. CD 012749
LYTER CLAIR M
658 COLONIAL VIEW ROA~'
MECHANICSBURG, PA 17 55
-------- inlE
ESTATE INFORMATION: ', ssN: isz-o5-9826
FILE NUMBER: 2110-x 505
DECEDENT NAME: PUSEY JOHN H
DATE OF PAYMENT: 05/ 14/ 2010
POSTMARK DATE: 05/13/ 010
COUNTY: CUMB BLAND
DATE OF DEATH: 1 2/ 14 2009
REMARKS: JOHN H PUSEY'
CHECK# 2086
SEAL
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
10122541 ~ 5253.82
TOTAL AMOUNT PAID:
5253.82
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
INITIALS: WZ
RECEIVED BY:
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
PO BOX 260601
HARRISBURG PA 17128-0601
REV-1563 F% AFr (mi-ee]
~.~«.,.
PENNSYLVANIA INHERITANCE T
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
2o~a MaY - ~ Pn 12~ o
CLEF:{. QF
p~F; ~r ^ <"~ Ca1RT
CLAIRE M LYTER ~lJ€`~~~~ ~'~ CO•, ~~"
658 COLONIAL VIEW RO D
MECHANICSBURG PA 17055
FILE N0. 21 "10 .6~5
ACN 10122541
DATE 04-22-2010
EST. OF JOHN H PUSEY
SSN 162-09-9826
DATE OF DEATH 12-14-2009
COUNTY 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 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 frow the Financial institution. attach a copy to this fan
and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of
P+,w,sYlvania. PLas~ edl C717) 787-eb27 with 9(++stiona.
COMPLETE PART 1 BELOW iESEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 5495-00 Date 03-27-1961 To ensure proper credit to the account, two
Established copies of this notice oust accompany
payment to the Register of Wills. Make check
Account Balance ~ 33,842.12 payable to "Reeister of Wills, Aoent".
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
CHECK
ONE
A
~( 16.667
~ 5,640.47
X .045
~ 253.82
NOTE: If tax payments are made within three
months of the decedent's date of death,
deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will becoea delinquent
nine months after the date of death.
ebovd information and tax due is correct.
Rami i$i payment to the Register of Wills with two copies of this notice to obtain
a di count or avoid interest, or check Dox "A" and return this notice to the Register of
Wily and an official assessment will be issued by the PA Department of Revenue.
[ BLOC K ~ B. ~ The abov asset has been or will be reported and tax Daid with the Pennsylvania Inheritance Tax return
ONL Y to be fi~ed by the estate ravresentative.
C. ~ The abov inf ores Son is incorrect and/or debts and deductions ware paid.
CompletaPART 2 and/or PART 3~ below.
PART Lf indicating a different tax rate, please state ~'.,,`,,,,,,,.
2 relationship to decedent:
^
T
AX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCDUNTS
LINE 1. Date Established 1
2. Account Balance ~~,2 $
3. Percent Taxable ~'~.3 X
4. Amount Subject to Tax ',4
5. Debts and Deductions ~i5
6. Amount Taxable ''.6 s
7. Tax Rate ~7 X
Tax Duo
8 ~~~B ~
.
DEBTS AND DEDUCTIONS CLAIMED
PART
a
DATE PAID PAYE E, DESCRIPTION AMOUNT PAID
TOTAL (Enter on Lino 5 of Taz Computation) f
U enalties r~ury,~L de are that the facts L have reported above era true, correct and
om o o to the m of my no a"' d belief. HOME C~ f7 ) ~ 9/ - 3~~
WORK ( / ) 3 ~ YYY
TA PAYER SIGNATURE TELEPHONE NUMBER DATE
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