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HomeMy WebLinkAbout11-22-10 (3)COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 2 8-0601 RECEIVED FROM: SUSAN M CHUBB 606 S MOUNTAIN RD DILLSBURG, PA 17019-9494 -------- fold ESTATE INFORMATION: ssN: 20~-~6-2s2~ FILE NUMBER: 2110-1 153 DECEDENT NAME: CHUBB ,1OSEPHINE DATE OF PAYMENT: 1 1 / 22 f 2010 POSTMARK DATE: 1 1 / 1 9/2010 COUNTY: CUMBERLAND DATE OF DEATH : 09 f 13j 2010 REMARKS: CHECK# 2586 SEAL PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1 162 EXf 11-96) NO. CD 013680 ACN ASSESSMENT ,AMOUNT CONTROL NUMBER 10156779 ~ 537.29 TOTAL AMOUNT PAID: INITIALS: HMW 537.29 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WELLS PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES A N D Po Box 280601 TAXPAYER RESPONSE HARRISBURG PA 17128-0601 REV-1541 EX AFP (08-08) FILE N0. 21 ACN 10156779 DATE 10-06-2010 SUSAN M CHUBB 606 SOUTH MOUNTAIN ROAD DILLSBURG PA 17019 EST. OF JOSEPHINE CHUBB SSN 201-16-2827 DATE OF DEATH 09-13-2010 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 (717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 20585- 05 Date 11 -27-1985 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 4 ~ 972.43 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 '$ 8 2 8 ' 7 5 months of the decedent's date of death, Tax Rate )( . 045 deduct a 5 percent discount on the tax due. Potential Tax Due $ 37.29 Any Inheritance Tax due will become delinquent nine months after the date of death. PART TAXPAYER RESPONSE AILURE T© RESPOND WILL RESULT IN AEI OFFICIAL TAX ASSESSMENT A. (~ The above information and tax due is correct. LQ J ~ 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 t id ax pa with 0 N L Y to be filed by the estate representative. the Pennsylvania Inheritan ce Tax return C. ~ The above informs ion is incorrect and/or d bt e s and deductions w Complete PART 2~ and/or PART L.__I below. ere paid. PART If indicating a different tax rate, please state relationship to decedent: OFFICIAL USE ONtt,~ AA.F TAX RETURN - CO PA DEPARTI~~ OF REVENUE MPUTATION OF TAX ON JOINT/TRUST ACCOUNTS pqp ?a; ~+ LINE 1. Date Established 1 1 ;:~ jA r- _ 2. Account Balance 2 $ ~.~.t'--- _ ~---, r.m 3. Percent Taxable 3 X 2 3 ~r~jj~ ~ r`,. _=;, 4. Amount Subject to Tax 4 $ 4 ,"..~~~~'~ ~~- ~_ . 5. Debts and Deductions 5 - 5 '~ ~ .~ 6. Amount Taxable 6 $ 6 e _~„~ ~3 :- ~ 7. Tax Rate ~ )( , ~-' ~ ~ } 7 ~ ~; . -~ ~~,.L PART DEBTS AND DEDUCTIONS CL AIMED DATE PAID PAYEE ilF4f'RTPTTf II~ .. ......._ _ _ __ 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. ~'~ ~ L~3a '~~~' HOME • WO R K C ~ --. ,-~ ~ TAXPAYER SIGNATURE TELEPHONE NUMBER D T~