HomeMy WebLinkAbout10-06-10REV-1162EX(11-96)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
BARRICK REVENNA C
102 HOLLENBAUGH RD
CARLISLE, PA 17015
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ACN
ASSESSMENT
CONTROL
NUMBER
fold
ESTATE INFORMATION: ssN: 203-~0-7307
FILE NUMBER: 2110-0996
DECEDENT NAME: WARNER MARY E
DATE OF PAYMENT: 10/06/2010
POSTMARK DATE: 10/06/2010
COUNTY: CUMBERLAND
DATE OF DEATH: 08/28/2010
AMOUNT
10155128 ~ 51,123.86
TOTAL AMOUNT PAID:
REMARKS:
SEAL
CHECK# 552713
INITIALS: CJ
RECEIVED BY:
REGISTER OF WILLS
51,123.86
GLENDA EARNER STRASBAUGH
NO. CD 013450
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
REV-1543 EX AFP <RB-
YOIO OCT -G AM IO~ OJ EST. OF MARY E WARNER
SSN 203-10-7307
CLERK C~ DATE OF DEATH 08-28-2010
r4'OlRtPHANS CJ~.%RT COUNTY CUMBERLAND
CUN'B~~l. ~.~`~~ r~.' , PA REMIT PAYMENT AND FORMS T0:
REVENNA C BARRICK
102 HOLLENBAUGH ROAD
CARLISLE PA 17015
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND FILE
~' ' ' ' "+'~'AhC~'JAYER RESPONSE ACN
!.~ '~ "! ' ~^ DATE
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
10155128
09-29-2010
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS 1ST FCU 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 C717) 767-8327 withquesiions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 318841-00 Date 11-30-2007 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 ~` 52 r 578 • 33 payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $` 26 ~ 289 • 17 months of the decedent's date of death,
)( .045 deduct a 5 percent discount on the tax due.
Tax Rate Anv Inheritance Tax due will become delinquent
Potential Tax Due ~` 1 ~ 183 • 01 nine months after the date of death.
PART TAXPAYER RESPONSE
SPO °~~~R~~ ~~°~IN OF ~fA9C.1~SSES
A. ~ The above information and tax due is correct.
Remit payment 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 assessment will be issued by the PA Department of Revenue.
ONE
C
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 ~ below.
PART If indicating a different tax rate, please state ~ '\ ~~ QF~j~jgL~35E~~ON~Y ~~~
relationship to decedent: PA DEPARTMENT OF REVENUE
TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS FAD
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 b $ d 6
7.
Tax Rate 7 X
7 .~
~-
8. Tax Due 8 '~ $
PART DEBTS AND DEDUCTIONS CLAIMED
0
nerF porn PAYEE DESCRIPTION AMOUNT PAID
:uis~~ •cn~er wn -
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 )
WORK C )
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