HomeMy WebLinkAbout01-25-11COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
CLEMENS BETTE J
315 MARKET
NEW CUMBERLAND, PA 17070
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ESTATE INFORMATION: SSN: 133-30-4477
FILE NUMBER: 2110-1 162
DECEDENT NAME: KLAR ANTONIE T
DATE OF PAYMENT: 01 /25/201 1
POSTMARK DATE: 01 /24/201 1
COUNTY: CUMBERLAND
DATE OF DEATH: 1 1 /09/2010
REV-1162 EX~11-96)
N0. CD 013939
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
11101645 ~ $37.19
TOTAL AMOUNT PAID:
REMARKS:
$37.19
CHECK# 6854
INITIALS: DB
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601 ~~}}r,~,,,. ,. s
HARRISBURG PA 17Y'2~}Qb07
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~ `. REV 1543 ~7N AFP (OB-OB)
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PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE N0. 21 10-1162
ACN 11101645
DATE 01-11-2011
1
BETTE J CL~~MEFVS P~'
315 MARKET ST
NEW CUMBERLAND PA 17070-2162
EST. OF ANTONIE T KLAR
SSN 133-30-4477
DATE OF DEATH 11-09-2010
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
PNC BANK NA 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 point 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. 5140034846 Date O 1 - O 1 - 1968 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance
` $ $
4 9 5 payment to the Register of Wills. Make check
~ . payable to "Register of Wills, Agent".
Percent Taxable X 50.000
Amount Subject to Tax
$`
247
94 NOTE: If tax payments are made within three
. months of the decedent's date of death,
Tax Rate ~( 1j deduct a 5 percent discount on the tax due.
Potential Tax Due
$
37.19 Any Inheritance Tax due will become delinquent
nine months after the date of death.
P
RT TAXPAYER RESPONSE
A
1
Under penalties of perjury, I declare that the facts I
complete to ~~st o Y knAwl dge and belief.
/
/ have reported above
HOME C ~/~ are true, correct and
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~XPAYER SIGNATURE L=
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TELEPHONE
NUMBER
l ~.~I ~ -al D f
DATE
TOTAL (Enter on Line 5 of Tax Computation) S
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