HomeMy WebLinkAbout06-09-10COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
NO. CD 012874
MCAULIFFE EMILY G
45 WEST VIEW
CARLISLE, PA 17013
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
REMARKS:
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PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
10125685 ~ $108.05
ESTATE INFORMATION: SSN: 383-40-0536
FILE NUMBER: 2110-0503
DECEDENT NAME: ORLOWSKY JAMES M
DATE OF PAYMENT: 06/09/2010
POSTMARK DATE: 06/09/2010
COUNTY: CUMBERLAND
DATE OF DEATH: 04/ 18/2010
CHECK# 2943
SEAL
TOTAL AMOUNT PAID:
INITIALS: SAP
REV-1162 EX~11-96)
$108.05
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AND FILE NO. 21 ~ ~ 0 ""Q~~
PO BOX 280601 ~ _ ~ .~
f~, ~~` TAXPAYER RESPONSE ACN 10125685
HARRISBURG PA 17128-0601 " ,
`~` DATE
REV4~ Etas ~ua5 ` ~~ - 0 5 - 0 6 - 2 010
~~I~ JUG --9 AM 9~ 4~
C~.~.RccK ~C~URT
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V~~~t.. `. L.r''. ~dt.J 'J~-` .
EMILY G MCAULIFFE
45 WEST VIEW
CARLISLE PA 17013
EST. OF JAMES M ORLOWSKY
SSN 383-40-0536
DATE OF DEATH 04-18-2010
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
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 point 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 of
Pennsylvania. Please call (717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
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.
Account No. 282288-0 0 Date 03-28-2006 To ensure prover credit to the account, two
Established copies of this notice must accompany
7 5 8 .2 7 payment to the Register of Wills. Make check
Account Balance $ payable to "Register of Wills, Agent".
Percent Taxable X 100.00
NOTE: If tax payments are made within three
Amount Subject to Tax $ 758.27 months of the decedent's date of death,
Tax Rate X . 15 deduct a 5 percent discount on the tax due.
1 1 3.7 4 Anv Inheritance Tax due will become delinquent
Potential Tax Due $ nine months after the date of death.
PART TAXPAYER RESPONSE
.":;'i' ~` ~ '' :' / ~ ' , i r ~ , ~" "'v!" `r ~ : c •rr'%'.,'r~to': c';...: :•. M f, f ~ ;~,:::.`,^' ~r.
:•. i..` ;Ir.!rrFrr,`:s%.,,;.:fcr,,• ;,;;, ~~:/.,iiv.,.aw%3~ra7frf c.. ,!%, rr': :s%t'f%t''~r:.: ~:~'~. ;,,.
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
Wills and an official assessment will be issued by the PA Department of Revenue.
C. ~ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART ~ below.
PART If indicating a different tax rate, please state ,'~:'~n ` '~• '""'""f~," '' ""~~'y`'`" ' A~";
relationship to decedent: ~~.t„
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TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ~ ' F```~`! r !%i%~~```%'~+F
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LINE
1.
Date Established 1 `~1!:
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3. Percent Taxable 3 X f~~r'~~.%sr,~~` .%: ~~ '`.~ rye.: ~"
4.
Amount Subject to Tax 4
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Amount Taxable 6
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Tax Rate 7
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8 . Tax Due ,
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PART DEBTS AND DEDUCTIONS CLAIMED
3^
DATE P AID PAYEE DESCRIPTION AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation) ~
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
com lete to the bes y kn edge and belief. HOME 0717 ~ys" ~~ ~ d
~ ~ WORK C )
TA PAYER GNA URE TELEPHONE NUMBER DATE