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HomeMy WebLinkAbout01-19-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTAT OFFICIAL RECEIPT DUPLICP UPHOLD CONSTANCE R 3017 NORTHWEST 62ND TER GAINESVILLE, FL 32606 fold ESTATE INFORMATION: SSN: 196-14-5340 FILE NUMBER: 2110-1270 DECEDENT NAME: UPHOLD MYRTLE Y DATE OF PAYMENT: 01 / 19/ 201 1 POSTMARK DATE: 01 / 15/2011 COUNTY: CUMBERLAND DATE OF DEATH: 1 1 /07/2010 TOTAL AMOUNT REMARKS: SEAL CHECK# 1 176366 INITIALS: DB RECEIVED BY: REGISTER OF WILLS E TAX ATE ACN ~SSESSMEN CONTROL NUMBER REV-1162 EX111-96) NO. CD 013914 AMOUNT 11500036 ~ $771.55 I PAID: GLENDA FA REGISTER O $771.55 NER STRASBAUGH F WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 1 ;- i RFV-15~EFP00) ,_ f ~- ~ ~~ .~ _~.~: 'sE -..~~''; ; J - ~ . ,.., ,. Y ; JRT CONSTANCE R U~PHa~.~D~1~ ~ `, ~~, PA. 3017 NORTHWEST 62ND TER ' GAINESVILLE FL 32606 TYPE OF ACCOUNT EST. OF MRYTLE Y UPHOLD ^ SECURITY S.S. N0. 196 -14-5340 Q sEC ACCT DATE OF DEATH 11- 0 7 - 2010 ^ STOCK COUNTY CUM ERLAND ^ BONDS REMIT PAYMENT AND FORMS T0: REGI TER OF WILLS 1 CO RTHOUSE SQUARE CARL ISLE PA 17013 AMERIPRISE has provided the Department with the information listed elow which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent you were a beneficiary of this asset. If you feel this information is incorrect, please obtain written correction from the transfer age t, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax L ws of the Commonwealth of Pennsylvania. Questions may be answered by calling C717) 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND AYMENT INSTRUCTIONS Account No. 492133335 DOD Valuation Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due 36,096.00 x 50.000 18,048.00 x .045 812.16 PART ~I E E A. ^ The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with wo copies of this notice to obtain C H E C K a discount or avoid interest, or you may check box "A" and ret rn this notice to the Register of 0 N E Wills and an official assessment will be issued by the PA Depa tment 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 decedent's representative. C. ^ The above information is incorrect and/or debts and deductions wer paid by you. You must complete PART ~ and/or PART ~ below. PART If you indicate a different tax rate, please state your © relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSET(S) LINE 1. DOD Valuation 1 2. Percent Taxable 2 X 3. Amount Subject to Tax 3 4. Debts and Deductions 4 5. Amount Taxable 5 6. Tax Rate 6 X 7. Tax Due 7 PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID T TOTAL CEnter on Line 5 of Tax Computati n) S Under penalties of perjury, I declare that the facts I have reported a ove are tr-u7e,[~co rect and complete to the\ 1"\- t of m no -edge and belief . HOME ~' ? ~"^/ 7 7 ~ AYER SIGNATURE TELEPHONE N MBER na INFORMATION NOTICE FILE N0. 21 - ~ ~ _ ~,3-l AND ACN 11500036 TAXPAYER RESPONSE DATE 01-06-2011 To insure proper credit to your account, two C2) copie of this notice must accompany your payment t the Register of Wills. Make check payable t "Register of Wills, Agent". NOTE: If tax payments are made within three C3) month of the decedent's date of death, you may d duct a 5% discount of the tax due. Any inher tance tax due will become delinquent nine C9) onths after the date of death. ~/ p ~ ~ ~ ~~ ti ~" ~N dNM ZQ sfY ~ ~j • ~ t~7~ ~ ~ w «. o " A r ~ •""~ ~. M ~ ~ .~..» ~~ /' ~ O `V 1r v~ U p ~ .+.w" N N ~ \ ~ r ~ '.~....,...rJ 1~, ~ .. 2 ~ ~ .= i M ~! ~ °.~ w ~ ,~~~ .~+ i` ~ ~ _~,~~ ~ r ...~,~ rt1 ~ ~ `~ i ~' { 1 '..../ ~ '""~ ~._ 4., \ \ ~.J ~ ~_ ~ J ~ '~' `~ r 1 .tom 11 =..+r"-ter .~+.r"'r~- Q t`' ^~y~^r`~ J (\~~~\^l ~. t~ f ••+~~ I .i; ,~ r~ ~~ ~~ ~~ "t +.. ~~M 1~R