HomeMy WebLinkAbout07-28-10COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
KAUFFMAN SANDRA L
78 LITTLE RUN ROAD
CAMP HILL, PA 1701 1
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PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11-96)
NO. CC- 013107
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
ESTATE INFORMATION: ssrv: ~ s9-09-o6~s
FILE NUMBER: 21 10-0448
DECEDENT NAME: BAILEYS ELIZABETH C
DATE OF PAYMENT: 07/28/2010
POSTMARK DATE: 07/28/2010
COUNTY: CUMBERLAND
DATE OF DEATH: 04/03/2010
REMARKS:
10139898 $75.04
TOTAL AMOUNT PAID:
$75.04
CHECK#1294
INITIALS: CJ
SEAL RECEIVED BY: GLENDA EARNER STR,ASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AND FILE NO. 21 10-0448
Po Box 280601 - ~ ~ TAX~P~'YER RESPONSE ACN 10139898
HARRISBURG PA 17128-0601 ,~
'"-- ~ ~ DATE 07-07-2010
REV-1543 EX AFP (OB-O8~' ~ ,.... ~ ~~ -
r, ~ ,,a TYPE OF ACCOUNT
~~J~O ~~~ ~~ ~~' ~`~~ EST. OF ELIZABETH C BAILE"fS ~ SAVINGS
S$N 189-09-0673 ~ CHECKING
C :{ ~,r
~~~.R,~ ~~ DATE OF DEATH 04-03-2010 ~ TRUST
p~p~,~„',~,~~t~RT COUNTY CUMBERLAND ~ CERTIF.
CU~`y,~ ~, t - ,,, :~. ~ 'REMIT PAYMENT AND FORMS T0:
SANDRA J KAUFFMAN REGISTER OF WILLS
C/0 50 OLIVER RD 1 COURTHOUSE SQUARE
ENOLA PA 17025 CARLISLE PA 17013
SDVEREIGN BANK 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/benefic:iary 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 C717? 787-832? with as:cstiors.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0765144761 Date 11 - 17- 1995 To ensure proper credit to the account, two
Established copies of this notice must: accompany
Account Balance ~` 1 ~ 000.57 payment to the Register of Wills. Make check
payable to Register of Wills, Agent .
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 500.29 months of the decedent's dlate of death,
Tax Rate X 15 deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due ~` 75.04 nine months after the date of death.
PART TAXPAYER RESPONSE
~ F/IILURE TO RESPOND WILL RESULT IN AM OFFICIAL TAX ASSESSMENfi
A. ^ The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
C H E C K 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 Inhieritance Tax return
0 N L Y to be filed by the estate representative.
C. ~ The above informa ion is incorr~ect and/or debts and deductions were paid.
Complete PART ~ and/or PART I~ I below.
PART If indicating a different tax rate, please -state OFFICIAL U5E ONLY ~ AAF
a relationship to decedent:
PA DEPARTMENT OF REVENUE
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
LINE 1. Date Established 1 1
2. Account Balance 2 $ 2
3. Percent Taxable 3 X 3
4. Amount Subject to Tax 4 $ 4
5. Debts and Deductions 5 - 5
6. Amount Taxable 6 $ G
7. Tax Rate 7 X 7
8. Tax Due g ~ 8
PART DEBTS AND DEDUCTIONS CLAIMED
3^
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my k owledge and belief. HOME C~~~~~j ~'`_~~rl / , --1
WORK t ~ ~-7 ~~
TAXPAYER S AT TELEPHONE NUMBER DATE
IUTAL ctnLer on Line 5 of Tax Computation) $