HomeMy WebLinkAbout03-08-11COMMONWEALTH 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 EX(11-96)
NO. CD 014091
ENTWISLE J R
5313 COBBLESTONE DR
MECHANICSBURG, PA 17055
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ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
ESTATE INFORMATION: SSN: 167-24-2071
FILE NUMBER: 211 1-0307
DECEDENT NAME: SIENKIEWICZ STELLA H
DATE OF PAYMENT: 03/08/201 1
POSTMARK DATE: 03/07/201 1
COUNTY: CUMBERLAND
DATE OF DEATH: 01 /07/201 1
REMARKS:
11111231 ~ $164.16
TOTAL AMOUNT PAID:
$164.16
CHECK# 9480
INITIALS: DB
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES ~T''"~' ~` ~ I
PO BOX 280601 '`-'^-'`
HARRISBURG PA 17128-0601 ~,~,,~ ,'
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REV-1543 EX AFP C08-OB)
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE ii
~ AND FILE N0. 21 - I i `~~~~
TAXPAYER RESPONSE acN 11111231
DATE 02-22-2011
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ANTONIETT G ENTWISLE
5313 COBBLESTONE DR
MECHANICSBURG PA 17055
TYPE OF
EST. OF STELLA H SIENKIEWICZ
SSN 167-24-2071
DATE OF DEATH 01-07-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
M8~T 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. 63892707 Date 12-07-1998
To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance ~` 7, 680.42 payment to the Register of Wills. Make check
payable to Register of Wills, Agent".
Percent Taxable )( 50.000
Amount Subject to Tax $ 3, 840.21. NOTE: If tax payments are made within three
months of the decedent's date of death,
Tax Rate )( . 045 deduct a 5 percent discount on the tax due.
Potential Tax Due Any Inheritance Tax due will become delinquent
172 • $ 1 nine months after the date of death.
PART TAXPAYER RESPONSE
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 notice 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
0 N L Y B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the estate representative.
C. ~ The above informs ion is incorrect and/or debts and ded
Complete PART 2~ and/or PART 3~ below. uctions were paid.
PART If indicating a different tax rate, please state \ ~~~
relationship to decedent: ~ ~~~\~~
\
\
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS pAD \ \ ~ \ \
LINE 1. Date Established 1 \~ ~~ ~ ~ ~~
~
2.
Account Balance 2
$
~ ~~, y'~ ~ ~
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3. Percent Taxable 3 X .~Q ~~~\\,~\~~.. ~,
4. Amount Subject to Tax 4 $ ~ ~~ ~~ ~~ ~ \° '~~~_
5.
Debts and Deductions 5
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6. Amount Taxable 6 $ ~~ ~~~~~~~~~~~~ ~~\~ ~~
7. Tax Rate
7_
X
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8. Tax Due 8_ $ L~l~7i/~P ~ ~ O
~ 8\
PART
0 DEBTS AND DEDUCTIONS CLAIMED
DATE P AID PAYEE DESCRIPTION
A41AI1\IT nar7~
• ~ •--~ Y_YY ~~~ ~~~ amine ~ or 1 ax I.omputat3on) g
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complet~ o th~e~best of my k o le ge and belief. HOME ( ~`~ } ~ 7'~~~
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TAXPAYER SIGNATUR TELEPHONE NUMBER DATE
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