HomeMy WebLinkAbout03-07-11 (3)COMMONWEALTH OF PENNSYLVANIA
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
STOUFFER DONALD M
1 WEST PENN ST APT 106
CARLISLE, PA 17013
-------- fold
ESTATE INFORMATION: SSN: 204-02-1478
FILE NUMBER: 211 1-0300
DECEDENT NAME: STOUFFER AMY E
DATE OF PAYMENT: 03/07/201 1
POSTMARK DATE: 03/07/201 1
COUNTY: CUMBERLAND
DATE OF DEATH: 1 1 /21 /2010
REMARKS:
SEAL
CHECK# 2121
REV-1162 EXI11-96)
NO. CD 014084
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
1 1 1 14210 ~ $1,384.91
TOTAL AMOUNT PAID:
INITIALS: HMW
RECEIVED BY:
$1,384.91
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OE WILLS
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES A N D
PO Box 280601 TAXPAYER RESPONSE
HARRISBURG PA 17128-0601
REV-1543 EX AFP (OB-OB)
FILE N0. 21 '' J ~" D~G~
ACN 11114210
DATE 03-02-2011
M
DONALD .W- STOUFFER
292 STEELSTOWN RD
NEWVILLE PA 17241
EST. OF AMY E STOUFFER
SSN 204-03-1478
DATE OF DEATH 11-21-2010
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
ACNB 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. 131369 Date Ob-Ob-2001 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance
67,
9 2 7.9 9 payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 50.000
Amount Subject to Tax
~ 33, 964.00 NOTE: If tax payments are made within three
months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Potential Tax Due
$ 1 , 528.38 Any Inheritance Tax due will become delinquent
nine months after the date of death.
PART
a TAXPAYER RESPONSE
A. ~ Th e 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
0 N E a discount or avoid interest, or check box "A" and
Wills and an official assessment will be issued by return this notice to the Register of
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 PA RT 2~ and/or PART 3~ below.
PART If indicating a different tax rate, please state ~
relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE
1 .
Date Established 1
/tg ~~ ~~ ~\\
\~~ ~ \ ~ \ \
2. Account Balance 2 $ ~~ Q,~7, fj~ \ \ ~ \
3. Percent Taxable 3 X ~ 7p ~
4. Amount Subject to Tax 4
~ . 9~ . D~
5. Debts and Deductions 5
6. Amount Taxable 6 $ ~0 ~ \ ~\
7. Tax Rate 7 X ~y ~~~ ~ ~~
8. Tax Due 8_ ~` ~.~ y. 9~ \\ ~ ~~ .
~ ~
PART DEBTS AND DEDUCTIONS CLAIMED _.
DATE PAID PAYEE DESCRIPTION
AMOUNT PATiI
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 ~/'7 ~ ~ --~:1 7
WORK ( ~ . 7 ~
AXPAYER S GNATURE TELEPHONE NUMBER DA E
~~~.+~ « nLer on pine S or Iax Computation) $
DATE PAYEE DESCRIPTION AMOUNT
PAID ~~
'11/26/10 First Church of GodFor lunch after funeral 300.00
of Newville
'12/14/10 Presbyterian HomeAssisted living for two 2,272.00
weeks.
'12/14/10 Guardian Pharmac~Medication at Forest P~ 54.37
Home
'12/14/10 Millennium PharmaMedication at Presbyte 50.13
Home
'12/14/10 Egger Funeral HomAdded Expenses for 99.30
funeral.
'12114/10 PPL Last Electric Bill at Apt. 18.22
'12/17/10 Eby Granite Markings on HeadstonE 113.00
'2/24/11 Weigle & AssociateLawyer Expenses 281.25
TOTAL 3,188.27