HomeMy WebLinkAbout11-22-10 (2)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
SUSAN M CHUBB
606 S MOUNTAIN RD
DILLSBURG, PA 17109-9494
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PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX111-96)
N0. CD 013679
ACN
ASSESSMENT AMOUNI-
CONTROL
NUMBER
ESTATE INFORMATION: SSN: 201-16-2827
FILE NUMBER: 21 10-1 153
DECEDENT NAME: CHUBB JOSEPHINE
DATE OF PAYMENT: 1 1 / 22/ 2010
POSTMARK DATE: 1 1 / 1 9/2010
CouNTY: CUMBERLAND
DATE OF DEATH: 09/13/2010
REMARKS:
10156781 ~ $1 13.75
1
TOTAL AMOUNT PAID:
~ 1 13.75
CHECK# 2585
INITIALS: HMW
SEAL RECEIVED BY; GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
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 c717) '187-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 20585- 11 Date 03- 05- 1984
To ensure proper credit to the account;, two
Established copies of this notice must accompany
Account Balance $ 15, 166.66 payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 16.667
Amount Subject to Tax $ 2 ~ 527.83 NOTE: If tax payments are made within three
months of the decedent's date of death,
Tax Rate )( . 045 deduct a 5 percent discount on the tax due.
Potential Tax Due $ 113.75 Any Inheritance Tax due will become delinquent
nine months after the date of death.
PART TAXPAYER RESPONSE
AILURE T~.~tESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AND FILE N0
21
Po Box zso6ol
HARRISBURG PA 17128-0601 .
TAXPAYER RESPONSE ACN 101 56781
REV-1543 EX AFP (08-08) DATE 1 0- 0 6- 2 0 1 0
TYPE OF ACCOUNT
EST. OF JOSEPHINE CHUBB ~ SAVINGS
SSN 201-16 - 2827 Q CHECKING
DATE OF DEATH 0 9 -13 - 2010 ~ TRUST
COUNTY CUMBERLAND ~ CERTIF.
REMIT PAYMENT AND FORMS T0:
SUSAN M CHUBB REGISTER OF WILLS
606 SOUTH MOUNTAIN ROAD 1 COURTHOUSE SQUARE
DILLSBURG PA 17019 CARLISLE PA 17013
A. n The above information and tax due is correct.
Lf~ 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.
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
a relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE I. Date 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 $
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DATE PAID
PAYEE
DEBTS AND DEDUCTIONS CLAIMED
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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.
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