HomeMy WebLinkAbout01-10-11COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
SAKSA CHARLOTTE M
969 CHARTERHOUSE CT
WESTERVILLE, OH 43081
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PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ESTATE INFORMATION: SSN: 163-44-4552
FILE NUMBER: 211 1-0042
DECEDENT NAME: POZSGAY MADELINE M
DATE OF PAYMENT: 01 / 10/201 1
POSTMARK DATE: 01 /07/201 1
COUNTY: CUMBERLAND
DATE OF DEATH : 10/ 29/ 2010
REV-1162 EX(11-96)
NO. CD 013875
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
10173681 ~ 5320.89
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 9085
SEAL
INITIALS: DB
5320.89
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601 r'. "
HARRISBURG PA 17128-0601
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REV-1;543 .EX AFP.+(bYaYbY
PENNSYLVANIA INHERITANCE
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
TAX
FILE N0. 21 -'~~ ~~~"
ACN 10173681
DATE 12-23-2010
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CHARLOTTE M SAKSA
969 CHARTERHOUSE CT
WESTERVILLE OH 43081
EST. OF MADELINE M POZSGAY
SSN 163-44-4552
DATE OF DEATH 10-29-2010
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
DOLLAR BANK 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. P.leasp call (717) 7@7-8327 wi*.h questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 60660b10823
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
Date 08 - 09 - 1994
Established
$ 15,012.27
X 50.000
$ 7,506.14
X .045
$ 337.78
To ensure proper credit to the account, two
copies of this notice must accompany
payment to the Register of Wills. Make check
payable to "Register of Wills, Agent". ~ 32() .~~
NOTE: If tax payments are made within three
months of th e e date of deat
deduct a percent discount on a tax due.
Any Inhere ante ax ue wi 1 become delinquent
nine months after the date of death.
Under penalties of perjury, I declare that the facts I have reported affbove are true, correct and
complete to the best of my knowledge and belief. HOME Cpl{ ) 8`11 20L~~
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,X PAYER SIGNATURE TELEPHONE NUMBER DATE
TOTAL (Enter on Line 5 of Tax Computation) S
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