HomeMy WebLinkAbout11-03-10COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
WALLACE HALEY N
220 1 /2 SOUTH BROAD STREET
JERSEY SHORE, PA 17740
fold
ESTATE INFORMATION: ssN: 206-38-7953
FILE NUMBER: 2107-0539
DECEDENT NAME: WALLACE THOMAS M
DATE OF PAYMENT: 1 1 /03/2010
POSTMARK DATE: 1 1 /02/2010
COUNTY: CUMBERLAND
DATE OF DEATH: 05/17/2007
TOTAL AMOUNT
REMARKS:
CHECK# 1010
INITIALS: SAP
SEAL
RECEIVED BY:
REGISTER OF WILLS
REW-1162 EX(11-96)
NO. CD13592
i
ACN
4SSESSMENT A
CONTROL
NUMBER
OUNT
07132251 ~ 5 3.93
SAID: 5
GLENDA EARNER STRAS 3.93
BAUGH
REGISTER OF WILLS
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
6UREAU OF INDIVIDUAL TAXES
DEPT. 280601
NIIRRISBURG, PA 17128-0601
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10t0 NOV -3
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HALEY N WALLACE
1421 SILVERCREEK DR
MECHANICSBURG PA 17055
REMIT PAYMENT AI
REGISTER OF WILLS
CUMBERLAND CO COU
CARLISLE, PA 170
E OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
FORMS T0:
T HOUSE
3
COMMERCE BANK has providod the Department with the infonation listed below which has boon used in
caleulatine the potential tax due. Their records indicate that at the death of the above decedent, you ware a joint nor/beneficiary of
this account. If you feel this infonation is incorrect, please obtain written correction frog the financial institut on, attach a copy
to this fora and return it to the above address. This account is taxable in accordance with the Inheritane• Taos Laws of the Commonwealth
of Peenea»krmnia.- emmmtione mw •e anwered-iy,oalitno [7171..ZBZ=532.7_. _
COMPLETE PART I BELOW ^ * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTR CTIONS
Account No. 536952054
Account Balance
Percent Taxable
amount Subieet to Tax
Tax Rata
Potential Tax Dua
Data 05-08-2005
Established
319.01
x 50.000
159.51
x .15
23.93
PART
~~
CHECK
ONE
BLOCK
ONLY
To insuro proper credit to ye r account, two
C2) copies of this notice mus aecompary your
payment to the Resister of Wi ls. Make chock
paysble tos "Rapistar of Will Aaent".
NOTES If tax payments era ma • within three
C3) months of tM decedent's at• of death,
you may deduct a 5X discount f the tax duo.
Aty inheritance tax duo will acom• delinquent
nine [9) months after the qat of death.
A. ~ The above information and tax dw is correct. II
1. You ^ay choose to remit payment to the Register of Wills with two copies of this n~tiee to obtain
a discount or svoid interest, or you may chock box "A" and return this notieo bo t • Rapistar of
Wills and an official assessment will be issued 6Y the PA Department of Revenue.
B. ~ Tha above asset has bean ar will be roported and tax paid with the Pennsylvania InhariFane• Tax return
to be filed by the decedent's representative.
C. ~ Tha above infonation is incorrect and/or debts and deductions ware paid by you.
You must complete PART 2^ and/or PART ~ below. it
PART If you indicate a different tax rata, plaasa state your
relationship to daeadant:
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 Dua
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4
5
6
7 X
8
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL CEnter on Lino 5 of Tax Computation) #'.
Under penalties of perjury, I declare that the facts I have roportad above era true, c rrect and
omp eta to #ha bast of my knowledpa and belief. HOME C ~I ) ~ ~ U~~~
FW., WORK C ) ' - -ll~
TA PAYE SIGNATURE TELEPHONE NUMBER DATE
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INFORMA AND NOTICE FILE N0. 21 07-0539
TAXPAYER RESPONSE ACN 07132251
DATE 07-26-2007
EST. OF THOMAS M WALLACE
S.S. N0. 206-38-7953
DATE OF DEATH 05-17-2007
COUNTY CUMBERLAND
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