HomeMy WebLinkAbout01-21-11COMMONWEALTH OF PENNSYLVANIA REV-1162 EX~11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INH ERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 013930
HALBLEIB GILBERT
49 TILBURY LN
REEDSVILLE, PA 17084-9202
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold
---------- --------
10174127 ~ 5409.05
ESTATE INFORMATION: SSN: 178-16-4300
FILE NUMBER: 211 1-0085 ~
DECEDENT NAME: PENNINGTON BLANCHE E ~
DATE OF PAYMENT: 01 / 21 / 201 1 ~
POSTMARK DATE: 01 / 14/201 1 ~
COUNTY: CUMBERLAND ~
DATE OF DEATH: 1 1 /05/2010 ~
TOTAL AMOUNT PAID: 5409.05
REMARKS:
CHECK# 2231
INITIALS: DB
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
REV-1543 EX AFP (OB-08)
PENNSYLVANIA INHERITANCE
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
TAX
FILE N0. 21 "' ~~ `-~~ 'J~
ACN 10174127
DATE 12-27-2010
TYPE OF ACCOUNT
EST. OF BLANCHE E PENNINGTON ~ SAVINGS
SSN 178-16-4300 ® CHECKING
DATE OF DEATH 11-05-2010 ~ TRUST
<z COUNTY CUMBERLAND ~ CERTIF.
r-;
'~~ REMIT PAYMENT AND FORMS T0:
,.,~.. -~ GI'L~ERT ~'; ~iALBLEIB REGISTER OF WILLS
'`~ = 49":`"~ILB >>~ 1 COURTHOUSE SQUARE
-- RE~`DSVI __€" ~- PA 17084-9202 CARLISLE PA 17013
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PN~~_BA~liC NA --~ `~./ provided the Department with the information below, which has been used in calculating the
pot~elitial 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 ca'_1 C717) 78?-8327 eaith questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 5140049159
Date 03-05-2007 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 $ 91 , 914.29 payable to "Register of Wills, Agent".
Percent Taxable X 16 . b67
Amount Subject to NOTE: If tax payments are made within three
Tax $ 15
319
35
,
.
months of the decedent's date of death,
Tax Rate X .045 deduct a ercent discount on the tax due.
Potential Tax Due Any Inheritance Tax due wi 1 become delinquent
$ 689.37
nine months after the date of death.
P
RT TAXPAYER RESPONSE
A
1
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
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 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 Daid.
Complete PART 2~ and/or PART ~ below.
PART If indicating a different tax rate, please state
relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE
1.
Date Established 1 _.
2. Account Balance Z $
3. Percent Taxable 3 X
4. Amount Subject to Tax 4 $ ~- 3~ 7 ~
5. Debts and Deductions 5 - .s 7,7 C~
6. Amount Taxable 6 $ ~
7. Tax Rate 7 X
8 . Tax Due 8 $ ~ ~ c ,.r y
PART DEBTS AND DEDUCTIONS CLAIMED
DATE P AID PAYEE DESCRIPTION AMOUNT PAID
r
iviv~~ icn~er on Lane 7 oT IaX l.OmpULaLlOn) $
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
comp~l/et~e- to t~h'~Le_ b/e/,~s~t~ ~o~f my knowledge and belief . HOME C 7 ~ ) If'~'J' ~ ~ '7 ~o
'~Lil%ww ~ IV lX.E7`c,GV/+ t,~? WO R K ( ~ ~/9 ~ J o~d /~
,X PAYER SIGNATURE TELEPHONE NUMBER DATE
b3LU 4d(' 11 S I @ F' i K@
Mechanicsburg, PA 17055-5251
Check # :59851
Ta~~a io:io:~ao
Neva s
16:29 11/11/2010 Gst 13
Transaction #:102075521
ID ## 7752 371E9 8343
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* ire value your opinion. Please
* tell us about your' dining
* experience by completing an
* online survey within 7 days of
* yon visit. You could wln a
* $1,000 Band Prize or ,~ of 100 *
* $50 pr i xes . winner'-s ~-e dawn
~ weeklyi!i ~
* *
* To complete the survey and enter
* the Contest, g0 t0
* www.OliveGarvey.can and
* enter the ID on this receipt.
* NO PURCHASE NECESSARY. Void where
* prohibited. Sse Official Rules at
* www . O 1 i veGardenSt.r'v®y . caa . ~
~ ~
* Valoramos su ~inibn. Complete.Ia
- ~ --et_a_sobre su expert enci a *
* gastronbmica en ~-- *
_
* www.OliveGardenSurvey.cam. *
co~i=~ ~cPr~s Nov is, 2a1a~
Card Number Auth Cock
xxxxxxxxxxxx 9841 737250
halbleib ~rlgilbert r MasterCard
Cf~-r~clc Arnoun~t 113 _ 14
Gram u i -t y 19 _ 38
To-ta 1 132 _ 52
Add " 1 Tip ,___-._.__-._------_..__--
F i n~ 1 T o-t a l ______-_________ __.--
X- ------ ---- ---- ---- -__-- -- _ _
Carte agrees to pav total in
accordance with agreement governing
use of such cad .
Guest Copy
b~lU Oaf' I I S 18 t' 1 Ke
Mechanicsburg, PA 17055-5251
Gheck # :59851
Table 10:1O:4U0
Neva S
1s:2s liiiii2oio cst is
Transaction #:102078521
ID ## ?752 371E9 834>r3
__*~ *~x~x*~x*~~r~x~r~cxxyt~cxx*x*x~t~rxxx7t~txtx~x____.. ~_
* Y1e value Your opinion. Please
~ tell us about your dining ~
* experience by completing ~ ~
* online survey within 7 days of
* your visit. You could win a
$1,000 Grand Prize or ~ of l0U
* $50 prizes. winners are drawn
* weekly!!!
* To complete the survey and enter
* the contest, go to
~ www.OliveGardenSur~vey.com and
~ enter the ID on this receipt.
* NO Pt~2CNAS£ NECESSARY. Void where
* prohibited. See Official Rules at
* www.OlfiveGardenSurvey.co~a.
~ ~
~ Ualoramos su apinibn. Complete. la ~
. ~ -*- sobre su expert enci a
ta
* _
gastrol~ai ca en -- - _*
* www.0liveGardenSurvev.con. * - .
ca~~ E~rR~s Nov ~s, 2010
- Card Ntanber Ruth Code
xxxxxxxxxxxx 9841 737250
halbleib ~r/gilbert~ r MasterCard
Check Arnoun~t 113.14
Gr~a-t u i -t y 1 ~ _ 38
Total 132.52
Acid ' 1 T i ~ ~__.__. ~_ .-___. -
F i na 1 T o-t ai l .__--_--. __--_ _-_--
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Cardnenber agrees to pav total in
accordance with agreement governing
use of such card .
Guest Copy
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