HomeMy WebLinkAbout06-03-10 (2)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 012843
KUPCHIK CAROL A
1003 ALDEN WAY
LEBANON, PA 17042
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold
ESTATE INFORMATION: SSN: 065-16-0992
FILE NUMBER: 2110-0557
DECEDENT NAME: ERIKSON MARY T
DATE OF PAYMENT: 06/03/ 2010
POSTMARK DATE: 06/02/2010
COUNTY: CUMBERLAND
DATE OF DEATH : 03/ 28/ 2010
REMARKS: CAROL KUPCHIK
SEAL
CHECK# 849
10126682 ~ $318.80
TOTAL AMOUNT PAID:
REV-1162 EX(11-96)
;318.80
INITIALS: WZ
RECEIVED BY: GLENDA EARNER STRASRAl1C;H
REGISTER OF WILLS
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES A N D
PO BOX 280601
HARRISBURG PA 1712E-o6o1 TAX P A Y E R R E S P O N S E
CAROL A KUPCHIK
1003 ALDEN WAY
REV-1543 EX AFPCOB-OB)
C~.E f-Y,~. ~.~
...i 1_' ,. ,._ _.
LEBANON PA 17042
FILE N0. 21 lv ~~~`~
ACN 10126683
DATE 05-13-2010
EST. OF MARY T ERIKSON
SSN 065-16-0992
DATE OF DEATH 03-28-2010
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SgUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
SOVEREIGN BANK provided the Department with the information below, which has been used tin 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 ei 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
Fennsvivana. Please cai3 (illi %87-ri3[7 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 3531060694 Date 03-26-2009
To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $- 1 ~ 500.36 payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 16.667
Amount Subject to Tax $- 250.07 NOTE: If tax payments are made within three
months of the decedent's date of death,
Tax Rate ~( ~ 1 Cj deduct a 5 percent discount on the tax due.
Potential Tax Due $ 37.51 Anv Inheritance Tax due will become delinquent
PART nine months after the date of death.
~ TAXPAYER RESPONSE
..... :..I.~..L.....:: :.::.:::: < :: ::.:::::.::..::::::::::::::..;::<::..;....:.....
<.::.:.:.::.: :.::::::.:.::.:::.::.:~:.::.::.:.:::.:::.::.::.::::.:::.::.::::..:.:.:.::..:..:.:.::::.::.:....:...:.:::..............:: R.E..D.L.........:...:..:.
..................::::.:..::.::.::.::.:..::::.:::..::.::::::.:::::::.:::::..:.::.:..:..::::::.:.:::.::.:.~.~:.:.:.:.:.:::..::.:::::.F.P.:~.:I.,A .::.::..::.:::..............::.:.
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
0 N E Wills and an official assessment will be issued by the PA Department of Revenue.
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 incorr~ect and/or debts and deductions were paid.
Complete PART 2~ and/or PART I~ I below.
PART I f i n d i c a t i n g a d i f f e r e n t t a x rat a ~--~ ;:::<:>::>::;>:;::::<::;:>;::;::>;:::;:>::><;:<::<:;:<::<:;::>:< ::::::::::::.::,::.;;::;:.::.:..:.:::..:...................
....:.......... :....: .
lea e e ...:.......
re
1
at'
io
ns
h'
i
t
0
d
P ec
ed
2 e
nt•
..
::
:;tL;:.;.;;'~:
^ "~_ : . ::
A_
TAX RETURN -
COMPUTATION
OF
T
AX
ON JOINT/TRUST ACCOUNT
"
LINE 1. Date Established `'``''
2. Account Balance 2 $ ~(~~
' >`[>`>
<'
3. Percent Taxable 3 X °j
~ ~ 0~
4.
Amount Subject to Tax _
4_
$ 0
,.,~ 5'd, ~`~ ?` >;
5.
Debts and Deductions
5
- >'~~~#>!
6. Amount Taxable 6 $ ~,~
}~,~'`
7.
Tax Rate
7
X
t ~" €```'
8.
Tax Due
8
$
jf, ,~ ~ b >`<'<'':
'
V
`~<
PART
0 DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation) $
Under n lties of
perju , I de lace that the facts I have reported above are true, correct: a
compl to o the be of Howl d.g and belief.
HOME ( L717 ~ ~~_L~yS?
WORK ( ~ .~~~
TAXPAYER SIGNATURE TELEPHONE NUMBER
AT