HomeMy WebLinkAbout11-15-10COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11-96)
NO. CD 013643
LONG JESSE W
1 152 EASY ROAD
CARLISLE, PA 17015
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ESTATE INFORMATION: SSIV: ~ 97-40-6546
FILE NUMBER: 21 10-0896
DECEDENT NAME: LONG RUTH A
DATE OF PAYMENT: 1 1 / 1 5/201 0
POSTMARK DATE: 1 1 / 1 5/201 0
COUNTY: CUMBERLAND
DATE OF DEATH: 07/29/2010
REMARKS:
ACN
ASSESSMENT ,AMOUNT
CONTROL
NUMBER
10159840 ~ 5231.22
TOTAL AMOUNT PAID:
~~231.22
CHECK# 2807
INITIALS: DB
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
Po Boxf-asB~s~r ~.-~ -, ~ _ ~ ._
HARRISBURG PA 1128-~~0'1 • '+~~~
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E
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND FILE N0. 21 10-0896
TAXPAYER RESPONSE ACN 10159840
REV-1543 EX AFP (08-08)
DATEE 10-22-2010
C~.ER-~e ~ F
JESSE W LONG
200 SULPHUR SPRING RD
CARLISLE PA 17013-8729
EST. OF RUTH A LONG
SSN 197-40-6546
DATE OF DEATH 07-29-2010
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
XC~ CERTIF.
SOVEREIG N BANK 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/benefi.ciary 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 (:ommonwealth of
Penncylvan~.a Please call (717) 787-8327 Frith questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 1695214575 Date 05-23-1995
To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 10 ~ 276.58 payment to the Register of Wills, Make check
payable to "Register of Wills, Agent".
Percent Taxable )( 50.000
Amount Subject to Tax $ 5 ~ 138.29 NOTE: If tax payments are made within three
months of the decedent's date of death,
Tax Rate X . 045 deduct a 5 percent discount on the tax due.
Potential Tax Due $ 231 .22 Any Inheritance Tax due will become delinquent
nine months after the date of death.
PART
TAXPAYER RESPONSE
F,A~L+~RE TO RESPDND i~ILL R~SD~T IN AN OF~'IC~~-L TAX ASSESS~IfNT
A. The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
C H E C K a discount or avoid interest, or check box "A" and return this notice to the Rergister of
0 N E Wills and an official assessment will be issued by the PA Department of Revenue.
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.
Oi~FICIAL USE DNLY ~ AAF
PA DEPARTMENT OF REVENUE
PAD
1
2
3
4
5
6
7
8
PART If indicating a different tax rate, please state
relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. llate Established 1
2. Account Balance 2 $
3. Percent Taxable 3 X
4. Amount Subject to Tax 4 $
5. Debts and Deductions 5 -
6. Amount Taxable 6 $
7. Tax Rate ~ X
8. Tax Due g $
~hR~
DATE PAID
C. ~ The above information is incorrect and/or debts and deductions were paid.
Complete PART ~2 and/or PART ~ below.
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation) g
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
comple to the best of my know dge and belief.
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