HomeMy WebLinkAbout02-22-11COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
MCINTIRE BOPHA T
1139 COUNTRY CLUB ROAD
CAMP HILL, PA 17011
told
ACN
ASSESSMENT
CONTROL
NUMBER
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT NQ, CD 014040
ESTATE INFORMATION: ssN: 213-3s-o5ss
FILE NUMBER: 211 1-0165
DECEDENT NAME: MCINTIRE BURTON W
DATE OF PAYMENT: 02/22/201 1
POSTMARK DATE: 02/ 1 8/201 1
COUNTY: CUMBERLAND
DATE OF DEATH: 01 /02/201 1
REV-1162 EX(11-96)
AMOUNT
11102849 ~ 52.95
TOTAL AMOUNT PAID:
REMARKS:
SEAL
CHECK# 685
52.95
INITIALS: SAP
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER cOF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601 `
REY-1543 E% AFP ~6'b-68~
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND FILE
~ ,ri ~~.~
'~~~- ~AYER RESPONSE ACN
~~' I ~ DATE
11102849
01-17-2011
CLER'r~
ORPNl~~`J'~ i~CUPT
SAMNANG K MCINTIRE
1139 COUNTRY CLUB ROAD
CAMP HILL PA 17011
EST. OF BURTON W MCINTIRE
SSN 213••38-0563
DATE OF DEATH 01-02-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS 1ST FCU 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. 198556-0 0 Date 11-08-2000 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance 392.67 payment to the Register of Wills. Make check
~` payable to "Register of Wills, Agent".
Percent Taxable X 16.667
NOTE: If tax payments are made within three
Amount Subject to Tax $ 65.45 months of the decedent's date of death,
Tax Rate )( . 045 deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due ~` 2.95 nine months after the date of death.
PART TAXPAYER RESPONSE
FAIL'E TO ~RESPOND~` ILL SUL \ N OFFI~~ TAX ~,SSESSMENT
A. The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
C H E C K a discount or avoid interest, or check box "A" and return this inotice to the Register of
0 N E Wills and an official assessment will be issued by the PA Department of Revenue.
B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
O 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 ~ and/or PART ~ below.
PART If indicating a different tax rate, please state OFFICIAL US,ir ~1LY ~ A
relationship to decedent: PA DEPARTMENT OF REVENUE ~~
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
LINE 1. Date Established 1 ..~ 1
2. Account Balance 2 $ 2 ~°
3. Percent Taxable 3 X 3
4. Amount Subject to Tax 4 $ 4 ~"
5. Debts and Deductions 5 rj '
6. Amount Taxable 6 $ ~°0 6 '
7. Tax Rate 7 X ~ 7
8. Tax Due 8 $ g'` ~ "
PART DEBTS AND DEDUCTIONS CLAIMED
8^
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under naXties of perjury, are that the facts I have
c lete to th~N best ~ knowledge and belief.
GNATURE
reported above are true, correct and
HOME ( )~
WORK CGO ~' .~4 !'~~l
TELEPHONE NIIM R~~
DATE
TOTAL CEnter on Line 5 of Tax Computation) 8