HomeMy WebLinkAbout01-10-11 (6)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX111-96)
NO. CD 013870
POZSGAY JUDITH M
681 ST JOHNS DR
CAMP HILL, PA 1701 1
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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 /03/201 1
COUNTY: CUMBERLAND
DATE OF DEATH: 10/29/2010
REMARKS:
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
10173682 ~ 5675.02
TOTAL AMOUNT PAID:
5675.02
CHECK# 2387
INITIALS: DB
sEaL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
W4RRISBUR6 PA 17128-0(,6,,+01` `
~I i~1l~i F ~,I..~ ~EV-1`fi~I7~E%"IfkP (08-08)
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE N0. 21 - ~~- C~~~
ACN 10173682
DATE 12-23-2010
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C~ER~C ~~y 7
JUDITH M POZSGAY
b81 ST JOHNS DR E
CAMP HILL PA 17011
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
a 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 t717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 60661110953 Date 05-0$-1995 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 $ 30 ~ 000.82 payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 15 ~ 000.41 months of the decedent's date of death,
Tex Rate )( . 045 deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due $ 675.02 nine months after the date of death.
PART TAXPAYER RESPONSE
0
Under penalties of perjury, I'declare that the facts I have reported above are true, correct ~~d
complete to the best of my knowledge and belief. H 0 M E C~ ~ ) 7 ~ .J
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.XP YER SIGNATUR TELEPHONE NUMBER A
TOTAL'(Enter on Line 5 of Tax Computations ~
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