HomeMy WebLinkAbout11-30-10COMMONWEALTH 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
REV-1162 EX(11-96)
NO. CD 013719
KIRBY CARL D
704 E MARBLE STREET
MECHANICSBURG, PA 17055
--------- fold
ESTATE INFORMATION: ssN: 206-~0-9~ ~ 5
FILE NUMBER: 21 10-1 160
DECEDENT NAME: KIRBY HELEN B
DATE OF PAYMENT: 1 1 /30/2010
POSTMARK DATE: 1 1 /29/201 0
COUNTY: CUMBERLAND
DATE OF DEATH: 1 1 /06/201 0
REMARKS:
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
10166582 $954.90
TOTAL AMOUNT PAID:
$954.90
CHECK# 3636
INITIALS: DB
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES _
-, -., ;
PO BOX 280601 _
HARRISBURG PA 17128-060'1- ,.~
1~~',. .., '-atE~-~1i43 EX 'AFf'(OS -OB)
PENNSYL'VANTA INHERITANCE T~-X
INFORMATION NOTICE:
AND
TAXPAYER RESPONSE
FILE N0. 21 - Il'- ~ ~~~
ACN 10166582
DATE 11-23-2010
L~1~ ~Y 34 A 11= ~
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** CARL D KIRBY
704 E MARBLE ST
MECHANICSBURG PA 17055
EST. OF HELEN B KIF;BY
SSN 206-10-9115
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 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? 787-832' with a~estians.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 360869-45 Date 11-12-2009 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 $ 22, 336.71 payable to "Resister of Wills, Agent".
Percent Taxable X 100.00
NOTE: If tax payments are made within three
Amount Subject to Tax $ 22, 336.71 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 $ 1 , 005.15 nine months after the date of death.
PART TAXPAYER RESPONSE
FAILURE Ta RESPOND WILL RFS~LT IN AM OFFICIAL 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
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 ~ AAF`
relationship to decedent: PA DEPARTMENT DF 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 +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, correct and
~.pmplete to the b sty of my knowledge and belief . HOME C ~~ 71 ~~' ~ " ~~ 7
,X PAYER SIG ATUR TELEPHONE NU BER D,
d
TOTAL (Enter on Line 5 of Tax Computation) S
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