HomeMy WebLinkAbout09-15-10 (2)COMMONWEALTH 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
REV-1162 EX~11-96)
NO. CD 013361
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
---------- --------
ESTATE INFORMATION: ssN: ~ 97-72-7065
FILE NUMBER: 21 10-0949
DECEDENT NAME: HEFFERNAN RYAN C
DATE OF PAYMENT: 09/ 15/ 2010
POSTMARK DATE: 09/ 15/2010
COUNTY: CUMBERLAND
DATE OF DEATH: 08/01 /2010
10145992 $19.03
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 3652
SEAL
$19.03
INITIALS: HMW
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AND FILE
Po Box z8o6o1 TAXPAYER RESPONSE ' ACN
HARRISBURG PA 17128-0601
DATE
REV-1543 EX AFP (OB-08)
No. 21 ~C~l~ `~
10145992
08-20-2010
TYPE OF ACCOUNT
EST. OF RYAN C HEFFERMAN ~ SAVINGS
SSN 197-72-7065 ^ CHECKING
`~ DATE OF DEATH 08 - O 1 - 2010 ~ TRUST
~--~ ~'''' tea- COUNTY CUMBERLAND ~ CERTIF.
r `''; ~ _-_ ~ ~ `~ REMIT PAYMENT AND FORMS T0:
`~`~_ _ JO~PH ~~" ~``'~H~EFFERMAN REGISTER OF WILLS
? 240 WI I~~Y~-~.'AY 1 COURTHOUSE S6lUARE
c: ". ~~ '~ C AEMF H L- ~~:' P A 17 011 - 8 4 6 3 C A R L I S L E P A 17 013
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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. Please call i717~ 787-8327 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 must accompany
payment to the Register of Wills. Make check
Account Balance $ 2, 536.73 payable to "Register of Wills, Agent".
Percent Taxable X 16.667
NOTE: If tax payments are made within three
Amount Subject to Tax $ 422.80 months of the decedent's date of death,
Tax Rate X . 045 deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due $ 19. U3 nine months after the date of death.
PART TAXPAYER RESPONSE
~ FAILURE TO RESPOND 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.
BLOC 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 informs 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 flEFICIAL USE ONLY ~ AAF
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 $ Cf
5. Debts and Deductions 5 - 5
6. Amount Taxable 6
7. Tax Rate 7 X 7
8. Tax Due 8 $ 8
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I decl a that the facts I have reported above are true, correct and
complete t th be of my knowl ge and belief. HOME C 7~7 } ~~~~ ~~/~C3
WORK C J/7 ) I~/~O . yy~<:~
.XPAY SIGNATU TELEPHONE NUMBER DATE
TOTAL (Enter on Line 5 of Tax Computation) S
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