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Home My WebLink About10-06-10 (5)COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: BARRICK REVENNA C 102 HOLLENBAUGH RD CARLISLE, PA 17015 fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT 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 REV-1162EX(11-961 NO. CD 013454 ACN ASSESSMENT AMOUNT CONTROL NUMBER 10155130 ~ 5230.82 TOTAL AMOUNT PAID: REMARKS: CHECK# 552717 SEAL INITIALS: CJ 5230.82 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES - PD BOX 280601 HARRISBURG PA 17128-0601 `` i- `. PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE AND F I L E N0. 21- Id,.'~~I~, ~'''- TAXPAYER RESPONSE ACN 10155130 `) ! ~' DATE 09-29-2010 2C~0 OCT -6 Ali 10~ 06 CLERK ORPN~I~,S - r~cR3~ 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 (7173 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 318841-44 Date 11-08-2008 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 $ 10 , 798 • 71 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 5,399.36 months of the decedent's date of death, ~( , OCFGj deduct a 5 percent discount on the tax due. Tax Rate Any Inheritance Tax due will become delinquent Potential Tax Due $ 242 • 97 nine months after the date of death. PART TAXPAYER RESPONSE 0 F/~, T ESPOr(~IILL . ULT UFF'IC~IAL TA SSMEN7 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 C H E C K Wills and an official assessment will be issued by the PA Department of Revenue. ONE C BLOCK B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return O 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 relationship to decedent: TAX RETURN - COMPUTATION LINE I. 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 fDAD 1 2 3 X 4 5 6 '~ 7 X B $ C)FFIC~4L JS ONLY ~ PA DEPARTMENT OF REVENUE i .. ~~ 2 3 4 \ 5 6 7 8 ~ ~~ ~ ~ ~~ - ~ =tee ~~~ ~- ~,c~-R PART DEBTS AND DEDUCTIONS CLAIMED HATE 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. HOME C ) WORK C ) _______.__ __,....~....~ TFI FPNf1NF NIIMRFR DATE IUTAL lCnLer vn L111C ~ ...r~•o• -