HomeMy WebLinkAbout10-26-10COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
LINDENBERGER JANIS
5220 ROYAL DRIVE
MECHANICSBURG, PA 17055
REV-1162 EX(11-96)
NO. CD 013552
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
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ESTATE INFORMATION: SSN: 207-07-5395
FILE NUMBER: 2110-1070
DECEDENT NAME: LINDENBERGER HOPE L
DATE OF PAYMENT: 1 O/ 26/ 2010
POSTMARK DATE: 10/25/2010
COUNTY: CUMBERLAND
DATE OF DEATH: 10/04/2010
10158899 ~ $27.54
TOTAL AMOUNT PAID:
REMARKS: JANIS LINDENBERGER
SEAL
CHECK# 6298
$27.54
INITIALS: WZ
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
REV-1543 EX AF,P (08-OB>
EST. OF HOPE LINDENBERGER
SSN 207-07-5395
DATE OF DEATH 10-04-2010
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
G~1~' f ~ ^~ f _, ,,
JANIS LINDENBERG~~'` ' -
5220 ROYAL DRIVE
MECHANICSBURG PA 17055
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS 1ST F CU 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 ]oint 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) 787-8327 with q::estio~~s.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 260235-11
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
Date 02-22-2005
Established
$ 1,288.18
X 50.000
$ 644.09
X .045
$ 28.98
PART
CHECK
ONE
BLOCK
ONLY
PENNSYLVANIA INHERITANCE
INFORMATION NOTICE
AND
f/~XPAYER RESPONSE
TAX
FILE N0. 21 !~-~ ~~~
ACN 10158899
DATE 10-15-2010
ER RESPONSE
To ensure proper credit to the account, two
copies of this notice must accompany
payment to the Re ister of Wills. Make check
payab o "Register of Wi~_g
'NOTE: If tax payments are made within three ~
months of the decedent's date of death,
deduct a 5 percent discount on the tax due.
Anv Inheritance Tax due will become delinquent
nine months after the date of death.
=AiLU E TO RESPOND WILL RESULT TN AN DFFiCiAL TAX ASSESSMENT
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
Wills and an official assessment will be issued by the PA Department of Revenue.
B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the estate representative.
C. ~ The above information is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART 3lJ below.
PART If indicating a different tax rate, please state OFFICIAL USE ONLY ~ AAF
relationship to decedent:
PA DEPARTMENT OF REVENUE
TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD ~~
LINE 1. Date Established 1 1
2. Account Balance 2 $ 2
3. Percent Taxable 3 X 3
4. Amount Subject to Tax 4 +fi l,~
5. Debts and Deductions 5 - 5
6. Amount Taxable 6 $ 6
7. Tax Rate 7 X ?
8. Tax Due 8 ~ g
--
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 . HOME C ~~ ~ ) (p ~ ~'--' C~~~ /~
WORK ( ) 7- ~..- ~_.~~1~'
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE ^~~
TOTAL (Enter on Line 5 of Tax Computation) 5