HomeMy WebLinkAbout12-06-10REV-1162 EX(11-96)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 260601
HARR156URG, PA 17120-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 013742
COULSON NANCY
203 S STONER AVENUE
SHIREMANSTOWN, PA 17011
ACN
ASSESSMENT
CONTROL
NUMBER
-------- ,o~d
SSN: 195-16-2682
ESTATE INFORMATION:
FILE NUMBER: 2110-1 195
DECEDENT NAME: HAZZARD ESTHER D
DATE OF PAYMENT: 12/06/2010
POSTMARK DATE: 12/03/2010
COUNTY: CUMBERLAND
DATE OF DEATH: 04/23/2010
TOTAL AMOUNT PAID:
REMARKS: NANCY COULSON
CHECK#547
SEAL
AMOUNT
$122.74
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
INITIALS: WZ
RECEIVED BY:
REGISTER OF WILLS
YLVANIA INHERITANCE TAX
PENNS
INFORMATION NOTICE
AND
BUREAU OF INDIVIDWL TAxES ./(~ ,(~r~ j~C~YER RESPONSE
Po Box 2eoeol ~, r'~ {'~(~ 1.~~11 ! ~
HARRISBURG PA 17128-06 01 ~~~ - ~ C ~ ~~ , t.,a..~J
aEV•1533 Ex •FP (5
FILE N0. 21-- ~~ ~ ~ l~s
ACN 10168252
DATE 11-30-2010
ZQ~Q SEC -6 PM IZI ( ~ EST. OF ESTHER D HAZZARD
SSN 195-16-2682
DATE OF DEATH[ 04-23-2010
CLERK OF CUMBERLAND
C l~~SF{~COUR~' COUxT~r
(+~ ~~pC.R~J'v'tU C~., ~, REMIT PAYMENT AND FORMS T0:
COULSON w~~~ REGISTER OF WILLS
NANCY 1 COURTHOUSE SQUARE
203 S STONER AVENUE CARLISLE PA 17013
SHIREMANSTOWN PA 17011-6756
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
® CERTIF.
SOVEREIGN BANK provided the Departaent with the inforaat ion below. which has been used in ealculat ine the
Iftyouifeelritheulnf oraation isd ineorrectt please obtain writtenb correction (roan the financials institution,/attach a oPYf toh thiscform
end return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Cwmonweelth of
Pennsllvania. Please call C717) ~aI-a327 witAewoetioaa.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTION
Account No. 1685396374 Date 05-15-1998 7o ensure proper credit to the account, two
copies of this notice oust aceomparo
Established priaent to the Reeistar of Wills. Nake cheek
t"
Account Balance
Percent Taxable
Amount Subiect to Tax
Tax Rate
¢ 5,455.D5
X 50.000
$ 2,727.53
X .15
..... ,
payable to "Register of Wills, Aaan
NDTEe If tax payaents era made within three
months of the decedent's date of death,
deduct a 5 Dercent discount on the tax tlue.
Aro Inheritance Tax due will become delineuent
____ -_.,tF.~ .ftor the data of death.
A, ~ The above inforaat ion and tax due as corr.....
Remit payment to the Reaister of Wills with two conies of this notice to obtain
a discount or avoid interest, or check box "A'• and return this notice to the Reaister of
CHECK Wills and an official assessment will be issued by the PA Dapartaent of Revenue.
B L DC K B. ~ Tha above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
C ONE
ONLY to be filed by the estate representative.
C ~ CompletesPART n2 land/or1PAR7 rs~ be~a+r debts and deductions were paid.
PART If indieatina a different taz T ate^ Pl~~e~state
relationship to decedent: --Yy-*38fi
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Data Established 1
2. Account Balance 2 s
3. Percent Taxable 3 X
4. Amount Su6~ect to Tax 4 ~
5. Debts and Deductions 5 ~ ^ I'f q ~, J~3
6. Amount Taxable 6
7 X • .5D
7. Tax Rate ~ / ~ a
g. Tax Due E
DEBTS AND DEDUCTIONS CLAIMED
PART
DESCRIPTION AMOUNT PAID
DATE PAID PAYEE
s
TOTAL (Enter on Line 5 of Tax Computation)
Under penalties of perjury, I declare that the facts I have reported above are~r~ ~ o~ Great/,and
eompleto to the best of my knowledge and,b~ie~ HOME C 7~ 7 ~ 7~
~ /~ /~77 WORK C ~
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