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HomeMy WebLinkAbout08-26-10 (2)COMMONWEALTH 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 EX(11-961 NO. CD 013257 BROWN MICHAEL S 3909 ROSEMONT AVENUE CAMP HILL, PA 1701 1 fold 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: ACN ASSESSMENT AMOUNT CONTROL NUMBER 10145576 ~ $57.67 I TOTAL AMOUNT PAID: $57.67 CHECK# 3785 INITIALS: HW SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 10-070b PO BOX 280b01 TAXPAYER RESPONSE ACN 1014557b HARRISBURG PA 17128-0601 DATE 08-20-2010 REV-1543 EX AFP (06-08) MICHAEL BROWN C/0 4613 BRIAN RD MECHANICSBURG PA 17050 TYPE OF ACCOUNT EST. OF KATHERINE E BROWN ® SAVINGS F°~3 SSN 204 - 03-814~r--j ~' ^ CH~CKING DATE OF DEATH 07-05-2t~ ~ ^`-r~t~sr ~.. COUNTY CUMBERLAND r"?--~ ~ CERTIF. REMIT PAYMENT AND FORMS T0: --:~~~~ ~ ~,,.., ,- REGISTER OF WILLS ~`=;yE~s~~ 1 COURTHOUSE SQUARE `~ ~ ~_-~ ~-, ~ - CARLISLE PA 17013 t, ;{~}~-~~'~ - .; ~"". FULTON BANK NA provided the Departwent with the inforwation below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-Hawed decedent, you were a joint owner/beneficiary of this account. If You feel the inforwation is incorrect, please obtain written correction frow the financial institution, attach a copy to this forty and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Cowworwrealth of Pennsylvania. Please call (717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 3100-25799 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax. Due PART CHECK ONE BLOCK ONLY Date 02-21-2003 Established $ 8,093.42 X 16.667 $ 1,348.93 X .045 $ 60.70 TAXPAYER RESPONSE A. ~ The above inforwation and tax due is correct. Rewit paywent 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 Wills and an official assesswent will be issued by the PA Departwent of Revenue. B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the estate representative. C. ^ The above i nforwa ion is incorrect and/or debts and deductions were paid. Cowplete PART L=J and/or PART L~l below. PART If indicating a different tax rate, please state . f, ~, to relationship to decedent: y '` TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ~"` LINE 1. Date Established 1 ~ 2. Account Balance 2 ~,,~'" ~ 3. Percent Taxable 3 X ~-, ~ a ..t~ f S: f ; 4. Amount Subject to Tax 4 $ ~`_ y~ a~ ~h Q # 5. Debts and Deductions 5 - ' ~ r~ M 6. Amount Taxable 6 x~ ` ' 7. Tax Rate 7 X ~ ;~,~' + y ~ x: 8. Tax Due 8 $ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE ~ DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, croLrrect nd complete to he est o my owledge and belief . HOME C ~ ~~7~V 7~~~ ` WORK ( ) ~,~ a~ p'1 ~~© TAXPAYER SIGNATURE TELEPHONE NUM ER DA E To ensure proper credit to the account, two copies of this notice wust accowpany paywent to the Register of Wills. Make check payable to ''Register of Wills, Agent". NOTE: If tax pavwents are wade within three wonths of the decedent's date of death, deduct a 5 percent discount on the tax due. Any Inheritance Tax due will becowe delinquent -nine wonths after the date of deat~ TOTAL CEnter on Lane 5 of iax 4omputation~