HomeMy WebLinkAbout09-15-10COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
HEFFERNAN JILL A
240 WINDING WAY
CAMP HILL, PA 1701 1
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PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ACN
ASSESSMENT
CONTROL
NUMBER
ESTATE INFORMATION: SSN: 197-72-7065
FILE NUMBER: 2110-0949
DECEDENT NAME: HEFFERNAN RYAN C
DATE OF PAYMENT: 09/ 15/ 2010
POSTMARK DATE: 09/ 1 5/2010
COUNTY: CUMBERLAND
DATE OF DEATH: O8/01 /2010
AMOUNT
10145993 ~ 519.03
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TOTAL AMOUNT PAID:
REMARKS:
CHECK# 3653
SEAL
$19.03
INITIALS: HMW
RECEIVED BY: GLENDA EARNER STR~-SBAUGH
REGISTER OF WILLS
REV-1162 EX111-96)
NO. CD 013360
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
PSECU 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 of
Pennsylvania. riease caii i7!%) 78T-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0197727065-S1 Date 07- 15- 1993 To ensure proper credit to the account, two
Established copies of this notice mush accompany
Account Balance $ payment to the Register oi` Wills. Make check
2, 536.73 payable to "Register of Wills, Agent".
Percent Taxable X 16.667
NOTE: If tax payments arcs made within three
Amount Subject to Tax $` 422.80 months of the decedent's date of death,
Tax Rate )( . 045 deduct a 5 percent discount on the tax due.
$ Any Inheritance Tax due will become delinquent
Potential TaX Due 19.03 nine months after the date of death.
PART TAXPAYER RESPONSE
0
FAI~.URE TO RESPL}ND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT
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 Inheritance Tax return
0 N L Y to be filed by the estate representative.
C. ~ The above intorma ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART lJ below.
PART If indicating a different tax rate, please state OFFICIAL l!S`E DNLY ~ AAF
relationship to decedent:
PA DEPARTMENT DF 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 $ 6
7. Tax Rate 7 X 7
8. Tax Due g $ $
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION eMniiNT pern
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of? my knowledge and belief. HOME C~~ ) ~~/ ~'L-~~~
i ~ W O R K ~ ~~~ ~ c~. - ~~~~~~--~
TA PAYER SIGNA URE TELEPHONE NUMBER DATE
BUREAU OF INDIVIDUAL TAXES
Po Box 280601
HARRISBURG PA 17128-0601
REV-1543 EX AFP <oe-o8> INFORMATION NOTICE
AND
TAXPAYER RESPONSE
F I L E
ACN
DATE
NO. 21 r f G'~(~' %~ y` ~,
10145993 ~
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TYPE OF ACCOUNT
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~ SSN 197-72-7065 ~ CHECKING
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`==-= DATE OF DEATH 08 - O 1 - 2010 ~ TRUST
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