HomeMy WebLinkAbout08-26-10COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX111-96)
NO. CD 013258
BROWN PATRICIA H
4613 BRIAN RD
MECHANICSBURG, PA 17055
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
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ESTATE INFORMATION: SSN: 204-03-8144
FILE NUMBER: 2110-0706
DECEDENT NAME: BROWN KATHERINE
DATE OF PAYMENT: 08/ 26/ 2010
POSTMARK DATE: 08/24/2010
COUNTY: CUMBERLAND
DATE OF DEATH: 07/05/2010
REMARKS:
SEAL
CHECK# 2728
10145575 ~ $57.67
I
TOTAL AMOUNT PAID:
INITIALS: HW
RECEIVED BY:
REGISTER OF WILLS
$57.67
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AND FILE NO . 21 10 - 0 7 0 b
PO BOX 280601 TAXPAYER RESPONSE AcN 10145575
HARRISBURG PA 17128-0601
DATE 08-20-2010
REV-1543 EX AFP <OB-08)
TYPE OF ACCOUNT
EST. OF KATHERINE E BROWN ®SAVINGS
$$N 204-03-8144 ~ CHECKING
DATE OF DEATH 07 - 05 - 2010 ~ TRUST
COUNTY CUMBERLAND ~ CERTIF.
;.y,~
REMIT PAYMENT AND FORMS T0: ~_ .,..~
PATRICIA H BROWN REGISTER OF WILLS ~~ ='-~ ' `-i
4b13 BRIAN RD 1 COURTHOUSE SQUARE ~`~~=~ ~"' f~-~~~
MECHANICSBURG PA 17050 CARLISLE PA 17013 ,~T~ ~ ~:.:~~_~. ~='
;: f:r. ~: ,, ,
FULTON BANK NA provided the Department with the information below, which has been used i~alculati~ the '
potential tax due. Records indicate that at the death of the above-named decedent, You were a ioint owner/bene iary of th' ccourl't'.~'~-~:~
~t
If you feel the information is incorrect, please obtain written correction from the financial institution, attaC a copy to ltF~c fora
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) 787-8$27 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 31 0 0-25799 Date 02-21-2003 To ensure proper credit to the account, two
Established copies of this notice must accompany
8, 093.42 payment to the Register of Wills. Make check
Account Balance ~ payable to Register of Wills, Agent
Percent Taxable X 16 . b67
NOTE: If tax payments are wade within three
Amount Subject to Tax ~` 1 , 348.93 months of the decedent's da ,
Tax Rate ~( .045 a c a percent discount on the tax due.
b 0 .7 0 ny nheritance ax due will become delinquent
Potential Tax Due nine months after the date of death.
P~T TAXPAYER RESPONSE
1
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 informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART 3~ below.
PART If indicating a different tax rate, please state '.~!
~_
relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS }~ ~' `~ `"' "'~\
_.. L
LINE 1. Date Established 1 ~:~_ ~ t .r~ ~. ~ ~,,
•~ <,
2. Account Balance 2 $ ~,`f ~z;~~ "" ~_ ~K '~'
~.
3. Percent Taxable 3 >A.,
f s „ r + r'
4. Amount Subject to Tax 4 ~ ~~;~ - 3F
ti.
5. Debts and Deductions 5 - , ~.~?" =~N;-~. ~~r''
t - ..+ n .A a .~
6. Amount Taxable 6 $ '~ A ~~' `" x~ `~ ~' ~~
7. Tax Rate 7 X ~,.::„~~~~, ,r ~ ~ ~.~ " ~ ~ ~'
8. Tax Due g ~` ~~ ~„ '~:``'
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 a d
omp eterto ~he best o my k owledge and belief. HOME C ~ ~ b " p~~~
WORK ( ) /V~ ~- ....
TAX YER E TELEPHONE NUM ER DATE
IUTAL ~tnter on Line 5 of Tax Computation) S
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