HomeMy WebLinkAbout01-10-11 (2)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
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-1182 EX111-98)
N0. CD 013874
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
10173683 ~ $214.08
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 9086
SEAL
INITIALS: DB
$ 214.08
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-D601 ~ °!!~ ~~
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND FILE
TAXPAYER RESPONSE ACN
DATE
N 0. 21 ` ~ ~ -' `-~
10173683
12-23-2010
:~~~ .~ ill P~ ~~
C(~ERK ~r
CHARLOTTE M SAKSA
969 CHARTERHOUSE CT
WESTERVILLE OH 43081
EST. OF MADELINE M POZSGAY
SSN 163-44-4552
DATE OF DEATH 10-29-2010
COiJNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
BOLLAR 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 ]Dint 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 FDR FILING AND PAYMENT INSTRUCTIONS
Account No. 60664252104 Date 02-09-2000 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 $ 10 ~ 015.35 payable to "Register of Wills, Agent". $~~~ . d
Percent Taxable X 50.000
NOTE: If tax payments are made within thre
Amount Subject to Tax $` 5 ~ 007.68 months of the decedent's date of de
Tax Rate X . 045 deduct a 5 percent discoun on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due $ 225.35 nine months after the date of death.
PART TAXPAYER RESPONSE
0
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established 1
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
2
3 X
4
5
6
7 X
8 $
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported aborv-e are true, correct and
complete to the best of my knowledge and belief. HOME C 6~4 ) ~~~ `~~bs
~_~g 1'~ ~~~~ WORK C ? i-~- 11
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
TOTAL CEnter on Line 5 of Tax Computations ~
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