HomeMy WebLinkAbout01-10-11 (4)COMMONWEALTH 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 013872
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
10173680 ~ $320.89
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 9084
SEAL
INITIALS: DB
$320.89
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PENNSYLO/ANIA IN~iERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 - 11 - ~ a
Po Box 2BO6ol TAXPAYER RESPONSE ACN 10173680
HARRISBURG PA 17128-0601 ~ ,ti.
- DATE 12-23-2010
REV-1543 EX AFP <08-OB)
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CU~,~~~P?.~~~~~~;~~ ~,~„ PA,
CHARLOTTE M SAKSA
969 CHARTERHOUSE CT
WESTERYILLE 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. Please call C717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 60660310356 Date 03-07-1994 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 $ 15 ~ 011 . 8b payable to "Register of Wills, Agent".
'~3ZV' ~~
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 7,505.93 months of the decedent's date of death
Tax Rate X .045 deduct percent iscount on the tax due.
Any Inher ax due will become delinquent
Potential Tax Due $ 337.77 nine months after the date of death.
PART TAXPAYER RESPONSE
a
..
A. nJ/The above information and tax due is correct.
I~:~W Remit payment to the Register of 'Wills with two copies of this notice to obtain
a discount or avoid interest, or check box "A" and return this notice to the Register of
CHECK Wills and an official assessment will be issued by the PA Department of Revenue.
ONE
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 paid.
Complete PART 2~ andlor PART ~ below.
PART If indicating a different tax rate, please state
relationship to decedent:
TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established 1
2. Account Balance 2 $
3. Percent Taxable 3 X
4. Amount Subject to Tax 4 $
5. Debts and Deductions 5 -
6. Amount Taxable 6 $
7. Tax Rate 7 X
8. Tax Due 8 $ ,,
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best ofp my1 knowledge and belief . HOME ( 6 ~ ~ ) O~ I o~ I~8 s
_ ~.,.. ~ ~ A Q~.b~ WORK C ) ` r ~ - ~ I
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
TOTAL CEnter on Line 5 of Tax Computation) $
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