HomeMy WebLinkAbout11-22-10COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
BORSUK DENISE
280 ECHO ROAD
CARLISLE, PA 17015
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PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11-96)
N0. CD 013684
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
---------- --------
ESTATE INFORMATION: ssrv: 202-48-4422
FILE NUMBER: 2110-1 154
DECEDENT NAME: BORSUK DREW A
DATE OF PAYMENT: 1 1 / 22/ 2010
POSTMARK DATE: 1 1 /22/2010
COUNTY: CUMBERLAND
DATE OF DEATH: 1 1 /02/2010
10164666 ~ $8.85
TOTAL AMOUNT PAID:
REMARKS: DENISE BORSUK
SEAL
REGISTER OF W-LLS
$8.85
INITIALS: WZ
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES A N D
PO BOX 280601 - 'r-.
HARRISBURG PA 1?128-0601 _ _ T ~-~-A Y E R R E S P O N S E
~ `~
-~~r h' '~',
REV-1543 EX AFP tam. 4831 ~,, ;~,~
FILE N0. 21 ~ ~(~ ` ~' ~~'
ACN 10164666
DATE 11-11-2010
2(IlQ ~V 22 P 2~ 4
C~~~~~
ORP~d'~,i ~.~~':.~~T
DANIELLE BORSUK
280 ECHO ROAD
CARLISLE PA 17015
EST. OF DREW A BORSUK
SSN 202-48-4422
DATE OF DEATH 11-02-2010
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 (?I?? 7R7-832? with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
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.
Account No. 154193-00 Date 10-26-1995
To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 1 ~ 179.73 payment to the Register of Wills. Make check
payable to 'Register of Wills, Agent".
Percent Taxable X 16.667
Amount Subject to Tax NOTE: If tax payments are made within three
$ 1 9 6 .6 3 months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Potential Tax Due Any Inheritance Tax due will become delinquent
`~ $ ' 8 5 nine months after the date of death.
PART TAXPAYER RESPONSE
1^
FAIL~R~ TO RESP~ID WILL RESULT IN AN UFFICiAL 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
C H E C K a discount or avoid interest, or check box "A" and return this notice to the Register of
0 N E Wills and an official assessment will be issued by the PA Department of Revenue.
C. ~ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART ~ and/or PART ~ below.
PART It indicating a different tax rate, please state
relationship to decedent:
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 3
4. Amount Subject to Tax 4 $ 4
5. Debts and Deductions 5 - 5
6. Amount Taxable 6 $
6
7. Tax Rate 7 X
7
8. Tax Due g $
8
OFFICIAL USE ONLY ~ AAF
PA DEPARTMENT OF REVENUE
~~ - ~~ ~~~ ~~~ L111C ~ or i ax computation) $
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. H 0 M E ( ' ~ ) ~ ~~ 1
r
PA R SIGNATURE TELEPHONE NUMBER DATE
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION wMn~i~iT owr„