HomeMy WebLinkAbout11-23-10COMMONWEALTH 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
KIRBY CARL D
704 E MARBLE ST
MECHANICSBURG, PA 17055
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ESTATE INFORMATION: SSty: 206-~0-9115
FILE NUMBER: 21 10-1 160
DECEDENT NAME: KIRBY HELEN B
DATE OF PAYMENT: 1 1 / 23/ 2010
POSTMARK DATE: 1 1 /22/201 0
CouNTY: CUMBERLAND
DATE OF DEATH: 1 1 /06/2010
REV-1162 EX(11-96)
NO. CD~ 013695
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
10166527 $540,14
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 3630
SEAL
INITIALS: DB
$540.14
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
PENNSYLVANIA INHERITANCE
INFORMATION NOTICE
ANU
~,~ :, ; , TAXPAYER RESPONSE
REY.~}543' EX il'FP SOB-OB) ' -
TAX
FILE N0. 21 ~ ~~ " ( ~~lu
ACN 10166527
DATE 11-22-2010
~~~~~1 ~~ 23 ~' #~'~ ~7
44 F~' ~ ~
C~~~r~C' ,~~ ' f ; -',~, PA,
CARL D KIRBY
704 E MARBLE ST
MECHANICSBURG PA 17055
EST. OF HELEN B KIRBY
SSN 20b-10-9115
DATE OF DEATH 11-06-2010
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 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 joint owner/beneficiary of this account
If you feel the information is incorrect, please obtain written correction from the financial institution, attach ;3 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 (717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 360869-43 Date 07-02-2009 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance 269.41 payment to the Register of Wills. Make check
2 5 , payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 12, 634.71 months of the decedent's date of death,
Tax Rate )( . 045 deduct a 5 percent discount: on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due $ 568.56 nine months after the date of death.
PART TAXPAYER RESPONSE
1^
F~ ~L~2~~~~ R~ Q~JI~~,~kl L L ~~:~'\~~~°~!~ ...~~ F F I C I:~. TAX ~s SAS ~T
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 Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
ONE
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.
C. ~ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART ~ and/or PART ~ below.
PART If indicating a different tax rate, please state OFFICIAL USE ONLY ~ AAA
relationship to decedent: PA DEPARTMENT OF RE~/ENUE ~~
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD \
LINE 1. Date Established 1 1
2. Account Balance 2 $ 2
3. Percent Taxable 3 X ~
4. Amount Subject to Tax 4 +fi 4 ,;
5. Debts and Deductions 5 - 5 ~~`~"
6. Amount Taxable 6 $ 6 \
7. Tax Rate 7 X 7
8. Tax Due 8 $ $
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported above are true, corrE~ct and
c4~plete to the best # m knowledge and belief. r~ ,~ -
i ;~ .. ~,,~ „ ~ HOME (~l~7 ~~~~~~y`..~?7
,X PAYER SIGNATU E TELEPHONE NUMBER DATE
IUTAL ctnter on Line 5 of Tax Computation) 5