HomeMy WebLinkAbout03-08-11COMMONWEALTH OF PENNSYLVANIA FiEV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 014093
MEAD JAMES M
1752 CONWAY HEATH
CAMP HILL, PA 1701 1
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
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ESTATE INFORMATION: SSN: 193-01-2449
FILE NUMBER: 211 1-0308
DECEDENT NAME: MEAD JAMES L
DATE OF PAYMENT: 03/08/201 1
POSTMARK DATE: 03/07/201 1
CouNTY: CUMBERLAND
DATE OF DEATH: 01 / 13/201 1
TOTAL AMOUNT PAID:
11113268 ~ $70.06
REMARKS:
$70.06
CHECK# 355
INITIALS: DB
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL~XL~S`,-~,'~ "^ ;'
PO BOX 280601 ~'.!_'~_! -'
HARRISBURG PA 17128-Qib¢'1' ,! - ,~
,~
REV-1543 EX AFP (OB-08)
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
F I L E N 0. 21 -- ( ~- ~4~
ACN 11113268
DATE 03-01-2011
~~~.
_ ~"'kr'.i ~ ~ .:4.Jt_i 1 ~
*~ JAMES M MEADE
1752 CONWAY HEATH
CAMP HILL PA 17011
EST. OF JAMES L MEAD
SSN 193-01-2449
DATE OF DEATH 01-13-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
METRO 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. 833438997 Date 08 -14 - 201 0 To ensure proper credit to the account, two
Established copies of this notice must accompany
4 6 7 . 0 $ payment to the Register of Wills. Make check
Account Balance $ payable to "Register of Wills, Agent".
Percent Taxable X 100.00
NOTE: If tax payments are made within three
Amount Subject to Tax $ 467.08 months of the decedent's date of death,
Tax Rate X ~ lrj deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due $` 70.06 nine months after the date of death.
PART TAXPAYER RESPONSE
' ~~, ~ O ~~ ~ " ANT
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 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~ and/or PART ~ below.
PART
2 If indicating a different
relationshi to decedent • tax rate, please state ~ ~
~ ~~~~~~~~ ~~°~ ~ ~" ~Q
~ ~ \ ~
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PA D .. NT .' ~ ~ \\
TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD \
;~; ~
LINE 1. Date Established 1 1 ~~
2. Account Balance 2 $ ~
3. Percent Taxable 3 X ~ ~°°
4. Amount Subject to Tax 4 $ 4
5. Debts and Deductions 5 - ~ 5
6. Amount Taxable 6 $ ~ 6
7. Tax Rate 7 X 7
8. Tax Due g ~` $ >
PART DEBTS AND DEDUCTIONS CLAIMED
3^
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 of my knowledge and belief . HOME C ~~ 7 ~ ~G3 "~ ~17p
r-tit m
PAYER
ATURE
WORK ( 71 7
TELEPHONE NU
1 - 35a v 3 ~ ~ ,,
DATE
IUTAL ctnter on Line 5 of Tax Computation) $