HomeMy WebLinkAbout09-07-10COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
WARNER ADDISON
PO BOX 301
LANDISBURG, PA 17040
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PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11-96)
NO. CD 013311
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
ESTATE INFORMATION: SSN: 284-26-8527
FILE NUMBER: 2110-0858
DECEDENT NAME: HENSCHEN HOMER E
DATE OF PAYMENT: 09/07/2010
POSTMARK DATE: 09/07/2010
COUNTY: CUMBERLAND
DATE OF DEATH: 08/ 10/2010
10146541 ~ S15.26
TOTAL AMOUNT PAID:
REMARKS:
SEAL
CHECK# 545171
INITIALS: HMW
RECEIVED BY:
S 15.26
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
REV-1543 EX AFP (08.96)
ADDISON WARNER
PO BOX 301
LANDISBURG PA 17040
PENNSYLVANIA INHERITANCE TA
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE N0. 21
ACN 10146541
DATE 08-23-2010
EST. OF HOMER HENSCHEN
SSN 284-26-8527
DATE OF DEATH 08-10-2010
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 Departwent with the infor(~ation below, which has been used in calculating the
potential tax due. Records indicate that at the death of the above-na9~(ed decedent, you were a Joint owner/beneficiary of this account.
If you feel the inforwation is incorrect, please obtain written correction frowA the financial institution, attach a copy to this for9n
and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the CowAwonwealth of
Pennsylvania. Please call C717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 2b6748-00 Date Ob-22-2005 To ensure proper credit to the account, two
Established copies of this notice ^ust acco9apany
pay9aent to the Register of Wills. Make check
Account Balance $ 678.21 payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax pay99ents are ^ade within three
Amount Subject to Tax $ 339.11 99onths 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 beco9we delinquent
Potential Tax Due $ 15.2b nine 911onths after the date of death.
PART TAXPAYER RESPONSE
t.
A. ~ The above inforwwation and tax due is correct.
Resit pav9aent to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or check box "A" and return this notice to the Register of
CHECK Wills and an official assess9aent will be issued by the PA Depart(~ent of Revenue.
ONE
BLOCK 6. ~ 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 infor9Aa ion is incorrect and/or debts and deductions were paid.
Co9aplete PART 2~ and/or PART 3~ below.
PART If indicating a different tax rate, please state x
relationship to decedent: £2
TAX RETURN - COMPUTATION OF
Y
TAX ON JOINT/TRUST ACCOUNTS :.;rt ~
.. -x '~'T'
_.
:•
LINE 1. Date Established 1 ;
~ s
$ yx. ~ x~~~~'
2. Account Balance 2
3.
Percent Taxable 3 X r F.
`~
~'
$ ~ ;, ~
4. Amount Subject to Tax 4
~ ~
5. Debts and Deductions 5 -
» '
~
~~~
6. Amount Taxable 6 $
'
~~ n>
X a . r+ xn.
~ ~>,>.i M ._~' ~~
~ ~y
7. Tax Rate 7
8. Tax Due
PART DEBTS AND DEDUCTIONS CLAIMED
0
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 knowledge and belief. u n MG r ~
WORK C
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
TOTAL CEnter on Line 5 of Tax Computation) S