HomeMy WebLinkAbout11-23-10 (6)COMMONWEALTH 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
REV-1162 EX(11-96)
NO. CD 013689
KIRBY CARL
704 E MARBLE STREET
MECANICSBURG, PA 17055
-------- fold
ESTATE INFORMATION: SSN: 206-10-9115
FILE NUMBER: 21 10-1 160
DECEDENT NAME: KIRBY HELEN B
DATE OF PAYMENT: 1 1 /23/201 0
POSTMARK DATE: 1 1 /22/201 0
COUNTY: CUMBERLAND
DATE OF DEATH: 1 1 /06/2010
REMARKS: CARL KIRBY
ACN
ASSESSMENT ~-MOUNT
CONTROL
NUMBER
10166524 ~ X435.77
TOTAL AMOUNT PAID:
,435.77
CHECK# 3632
INITIALS: WZ
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE //""
BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 ~" ~ ~ ~ ~c.E~~
Po Box 280601 ~ TAXPAYER RESPONSE ACN lOlbb524
HARRISBURG PA 17128-0601
DATE 11-22-2010
REV-1543 EX AFP (OB-U 8)' ~ '
10l0 ~0`d ~3 ur, , ,
I~LE~t~~ ~.Jf
VI~t~Y~~l...~1~` ~.I ~, `i fr,i~
_ , P,~,
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 i.n 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 questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 3b0869-00 Date 07-02-2009 To ensure proper credit to the account, two
Established copies of this notice must accompany
payment to the Register of wills. Make check
Account Balance $ 20 , 38b . 54 payable to "Resister of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 10, 193.27 months of the decedent's date of death,
Tax Rate X .045 deduct a 5 Percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due $ 458.70 nine months after the date of death.
PART TAXPAYER RESPONSE
D FA~.I~~:~~ ~ ~~~ ~ ,\ ~. '~~~~ ~~~,D~.T ~~..~l~~ICiA~i..`TA~C A~S~~NT
A. ~he 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 ~2 and/or PART 3~ below.
PART If indicating a different tax rate, please state OFFICIAL USE ONLY ~ AAA'
relationship to decedent: ~~
PA DEPARTMENT OF REVENUE
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 $ b
7. Tax Rate 7 X 7 \
8. Tax Due 8 $ 8 \
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under pen hies of perjury, I declare that the facts I have reported above are true, correct and
comple to~the best;- f m k w dge and belief. HOME C ~~ ) ~~~'-' ~~r
~`-~".,4 ~ ~r WORK C ) ~,-•, ~-_ ..~' 7 ~ l/~~/'G)
.XP R SIGNATURE TELEPHONE NUMBER DATE
TOTAL tEnter on Line 5 of Tax Computation) S