HomeMy WebLinkAbout01-10-11 (3)COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 013873
SAKSA CHARLOTTE M
969 CHARTERHOUSE CT
WESTERVILLE, OH 43081
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold
10170473 ~ $805.60
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
TOTAL AMOUNT PAID: $805.60
REMARKS:
CHECK# 9088
INITIALS: DB
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WIL LS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
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PENNSYLVANIA INHERITANCE
INFORMATION NOTICE
AND
~~r TAXPAYER RESPONSE
TAX
FILE N0. 21 -I~ _ya
ACN 10170473
DATE 12-14-2010
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CHARLOTTE M SAKSA
969 CHARTERHOUSE CT
WESTERVILLE OH 43081-2763
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.
FIRST NIAGARA 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. Please call (717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 4160375189 Date 05-09-2006 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 $ 37, 688.83 payable to "Register of Wills, Agent".
6a
~ $as
Percent Taxable x 50.000
.
NOTE: If tax payments are made within three
Amount Subject to Tax $ 18,844.42 months of the decedent's date of death,
Tax Rate ~( ~ 1 rj deduct a percent discoun on a tax due.
Any Inheritance ax due will become delinquent
Potential Tax Due $ 2, 826.66 nine months after the date of death.
PART TAXPAYER RESPONSE
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
PART
DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
1 ("~Jr rO~1 ` x,666
2 $ :fir? ~ 6Bg . 83
3 X b,oo~
4 $ 1~.8y ,~I~
5 - ~'
6 s ~ g, Sy
x •oyS
8 $ ~ $ • OC5
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowledge and belief. HOME C ~j(4 ~ ~~1 ~ ~~~
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TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
TOTAL CEnter on Line 5 of Tax Computation) S
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