HomeMy WebLinkAbout06-02-10COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11-96)
NO. CD 012834
DOBSON MARLENE M
413 DEERFIELD RD
CAMP HILL, PA 1701 1
----- fold
ESTATE INFORMATION: SSN: 174-20-1659
FILE NUMBER: 2110-0539
DECEDENT NAME: MAILEY ROBERT N
DATE OF PAYMENT: 06/02/2010
POSTMARK DATE: 05/28/2010
COUNTY: CUMBERLAND
DATE OF DEATH: 04/ 19/ 2010
REMARKS:
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
10125682 ~ 54.66
TOTAL AMOUNT PAID:
54.66
CHECK# 301 1
INITIALS: JN
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES - AND FILE N0. 21 (O Cj~.~o'
PO BOX 280601 ~- ~~
HARRISBURG PA ln2s-0601 _ _ •- T~l~~AYER RESPONSE ACN 10125682
. , ,.
. ' ~ k. DATE 05-06-2010
REV-1543 EX AFP (08-b~D-1• . ~, ~-- '~~'
~~~~ ~~ _ ~ ~~~ j : ay TYPE OF ACCOUNT
EST. OF ROBERT N MAILEY ®SAVINGS
SSN 174 -20 -1659 ~ CHECKING
~~~R~~ ~~~ DATE OF DEATH 04 -19 - 2010 ~ TRUST
Q~I~N~~``~ u~~`.-'~T ~ COUNTY C
UMBERLAND CERTIF.
['~ A~r:";~! ~~;`'~r{ '"R,?. ~ REMIT PAYMENT AND FORMS T0:
MARLENE M DOBSON REGISTER OF WILLS
413 DEERFIELD RD 1 COURTHOUSE SQUARE
CAMP HILL PA 17011 CARLISLE PA 17013
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 from the financial institution, attach a copy to this form
and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth cf
Pennsylvania. Please call C/17) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 100727-00 Date 03-09-1988 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 621 .33 payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 16.667
Amount Subject to Tax ~- 103.56 NOTE: If tax payments are made within three
months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Potential TaX Due Any Inheritance Tax due will become delinquent
$ 4 ' 6 6 nine months after the date of death.
PART TAXPAYER RESPONSE
~~1 iy/1"~`~i ufi'•'•' .f:l. ~. I:j::•'~'Lr~;;~.?I~~i:i`:::..x~.F'%:i:';•.i:ipA:'•~.':.' vI1..~:A"~:,:1 `.'i n'
A. The above information and tax due is correct.
Remit payment 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
ONE Wills and an official assessment will be issued by the PA Department of Revenue.
BLOCK B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
ONLY to be filed by the estate representative.
C. ~ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART 3~ below.
PART If indicating a different tax rate '`"' r.F
Please state '~->~:~:~'~ %` lryl:~' /'!r}:. /r/,%' ,:
2 relationship to decedent: ~~'~``~"'~%~"~"~'• " '~" ` ~•~ ~ -
1~ f:~:: -
TAX RETURN - COMPUTATION OF TAX '°`'?"r~'"~`~'~'~°'~~~/~'~ ~ % '~"~~'~~ {"~°~ "%`~'~~
ON JOINT/TRUST ACCOUNTS ° ~~~~~~~>°`'~~'~~`.'~;;~~ >~%'%~% `~ •~•',,~ '~'~ ~~' ~...:"'~
LINE 1. "' hs~ •r:f: '~2"` ~,,:.•~f•:
Date Established 1 `"'''ter`"`•'' " I~~u'~-'%
~':E7r f'%'%~ ,~' ;.~.':: .:/1r: ' k%i ~ ~: .,k., is ' %'` `!'::%%l
~:~:5~
2 . Account B a 1 a n c e 2 $ <„r;.:<~ ~::<,~: : c, j `~c: ,' idr:;,.~3r;. ,~r ~'' ,~ p,:'!' :,s:'
e n t Taxable X ..,,~.>; ~~ 's 9';,~,`~.1:• . ~•~' `
4 . Amount Subject t o Tax 4 $ : y ~` ~~~;;%~'`'~ "` x:'"` :~~%,•f{~`r' ~` f f" `~
uFf'.s~/.:rr;c f %' ~fi!/%;'/F',: ;~' '' Jam'/•%'./f..'ri+:`• ~,.~' .~;:s~`?'
,:fr' :':. G'r ;r„s ~%I.. ~.<.3> .&n 9 .4" ~Jf:9.v'r.'.~'frg~?i3$.' ./,.Sj':f
5 . Debts and D e d u c t i - ~,r .r;,~'F•~.:F • ; `•%~ ;~:`, ~• ~.>:.% v~~•:,;,~; ::;
O n 5 5 .,ky v Ff!F .; l~; :~' %i ,,a~:,!f• r ' f ~ '~%
t Taxable 6 r•: ::y !,r,.:•~ '"'" .' `
:Y ~^ sf o`}.''rf ~/"''.rki,' f, :A'`~•~ o' ~~ f;•': t'A:G::.. /f::•5
`~~` ~`~'",%'•~'%.. .. % '~: it •: .:rs 't' ~r` ~:...s
7 . Tax Rate ~f!`:. ;::,:: •' ~ 1'~~ ` ~.,, ~ ~~•' r ,~: ;.`..: a~':
7 X ..'~'s'`~I.sf,:'::: %^1;f2i,.~''~~>;:,•y!.'F'~:~~~:..?.'• :.~.%`''/y`~i,:.'~,`4%`x%~'"'`'~ " `.r.'` :'sr~~3
8 . Tax Due $ ", f, h:::,.>:.. `.. ~ ;.:;;•• ~~,:., ~~. ~ •,,
8 :~;y F^'~ :`%~`t:: f':r. 4Y'%"~fii"%{%•A'' 'yc,`a:~;: ' y„6 : ,,•f ' ,~y,'.•;.'% ~ j
~:: j~.:~1u`'<<8.. ... •;.;s, . cf~o:? l.,r., ..'^~~i•',`:% Fr'~.1. :~Y~.l,''.:a• ``i..''•'y f,,:G.F'~a
PART .~.::«:,,f,~,:.:~ •<,:..::.x~<:~,::~,:..;:~::.:~~, ~ :
DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION wMni~u~r owrn
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best my knowledge and belief. HOME C /~ ~ ~/ -/.S~
~~~' WORK ( ) ylJ Sr~ /'~
,XPAYER SIGNATURE TELEPHONE NUMBER DATE
~~~.+~ «n~er on L1ne 5 Ot IaX Computation) S
~y
..til
~:. ~
!"t'
i~~
„~.
j~ ~
it
l .,~
~` ~ ~ ,
?~. t •-
. _ _ `,
~~~o ~u~ - ~ ~ ~ ~ o$
CLER`~C C~
~yORPI-l~~~'S GG~. ~~T ~
,.
..,
Y
1
V
"' V
w~~~
W
'~~'! ~
~ _~ y*
~,9c~ry4*,
~# .' 7C ti/
o °'
Os
w ~*
a . ,;~'
r;d{
•`f,.
:~ ~~!!
~~1.
r~
~'. r
~.~
y'~Y is ti~'f
.~. 4: ~..: ~~ , 'jP
Y+??, lA iii,. ,~'~
r:-^ .t
Y.x~.o-~ ; ; "~,
M.F~'i
~'
~„n: ~
1; y ~ .~ 'f