HomeMy WebLinkAbout10-06-10 (3)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
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PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ESTATE INFORMATION: ssly: 203-io-7307
FILE NUMBER: 2110-0996
DECEDENT NAME: WARNER MARY E
DATE OF PAYMENT: 10/06/2010
POSTMARK DATE: 1 0/06/201 0
COUNTY: CUMBERLAND
DATE OF DEATH: 08/28/2010
REV-1162 EX111-96)
NO. CD 013452
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
10155132 ~ $593.76
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 552715
SEAL
INITIALS: CJ
5593.76
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES._._ ;---:,'I~"
PO BOX 280601 yr'.
HARRISBURG PA 171&0801' .W
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PENNSYLVANIA INHERITANCE T
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE N0. 21 "~pV~~j(p
ACN 10155132
DATE 09-29-2010
20l0OC~ -6 A~l~' d6
G~ERK ~~ ~ y -~
~~PH~ s ~° ~~~~ p~.
REVENNA C BARRICK
102 HOLLENBAUGH ROAD
CARLISLE PA 17015
EST. OF MARY E WARNER
SSN 203-10-7307
DATE OF DEATH 08-28-2010
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 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) 767-6327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 318841-51 Date 06-02-2008 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 $ 27,778.30 payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to TeX $ 13,889.15 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 $ 625.01 nine months after the date of death.
PART TAXPAYER RESPONSE
T N F
~'0 O AX S
~
A. ~./,
~ The above information and tax due is correct.
Remit payment to the Register of Wills with two cop ies 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.
C ONE
B L 0 C K B. ~ The above asset has been or will be reported and tax pa id 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
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
z $
3 X
4 $
5 -
6 $
7 X
8 $
O~~ICIvV US~UN.Y ~ A11
PA DEPARTMENT OF REVENUE ~
D
1 _ .~ _ . _ -
Z
3
4 ...
5
6 ,
7
8
PART DEBTS AND DEDUCTIONS CLAIMED
3^
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. H OME C )
WORK C )
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TOTAL (Enter on Line 5 or iax w mpucacaon~ s