HomeMy WebLinkAbout03-08-11 (3)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 EX~11-96)
NO. CD 014095
MEAD JAMES M
1752 CONWAY HEATH
CAMP HILL, PA 1701 1
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ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
11113145 ~ $997.86
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
REMARKS:
TOTAL AMOUNT PAID:
5997.86
CHECK# 353
INITIALS: DB
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21•-~ ~ -U~~~
PO BOX 280601 C r'~ r~
HARRISBURG PA 1712s-o6o1 ~+_~.:'.. ~ ;"~r VEC TAXPAYER RESPONSE ACN 11113145
~~f~E~~1543~'7CAFP;(08 Oyxt~ 4~ DATE 02-2,rj-2011
~..~
~~
i '-~~J ,
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 PAYM ENT AND FORMS T0:
REGISTER OF WILLS
1 COURTH OUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
METRO B ANK provided the Department with the information below, which has been used in calculating the
potential tax due. Records indicate that at the death
f th
o
e above-named decedent,
If you feel the information is incorrect, please obtain written corr
ti you were a joint owner/beneficiary of this account.
ec
on from the
and return it to the above address. This account is taxable in accord financial institution, attach a copy to this form
ance with the
Pennsylvania. Please call C717) 787-8327 with questions. Inheritance Tax laws of the Commonwealth of
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 537153900 Date 10-12-2005
Established To ensure proper credit to the account, two
Account Balance copies of this notice must accompany
$ 13, 304.77 payment, to the Register of Wills. Make check
Percent Taxable X payable to "Register of Wills, Agent".
50.000
Amount Subject to Tax $ 6, 652.39 NOTE: If tax payments are made within three
Tax Rate X months of the decedent's date of death,
~ 15 deduct a 5 percent discount on the tax due
Potential Tax Due $ 997.86 .
Any Inheritance Tax due will become delinquent
PART nine months after the date of death.
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 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 L.__I below.
PART If indicating a different tax rate, please state ~ ~~. ~ ~ ~,
a relationshi to decedent: ~~~~\\~~~ \~~ ~~~~~~
p ~ \ \`
~.
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ~ NT\ \\
PAD
LINE I . Date established 1 ~~~ ~~~~ ~~~~~ ~ ~,
~O\\\
$ ~ O \~
2. Account Balance 2 ~\~~ ~\\\\\\ ~\ ~\\ \\\
3. Percent Taxable 3 X 3 \\\\\\\\\\\~\\ .
4. Amount Subject to Tax 4 $ ~ ~~~ \\~~ ~p~ \\
4 ~ ~°~~ ~~
5. Debts and Deductions 5 - ` 5 \~\\ ~~„~p\\~ ~~~~ \~\ \\
6. Amount Taxable 6 $ ~ ~~~,~\~~ ~
7. Tax Rate 7 X \ 7 ? ~~~~~~~ ~\ \~ \
8. Tax Due g $ ~ ,,,,\ \\\\\
... ...
PART DEBTS AND DEDUCTIONS CLAIMED \
0
DATE PAID PAYEE DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation) $
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.
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iL3~~Y WORK t ~f'1 ~ 571 - 3cj OU ~- "~ ~i
T ER SIGNATURE TELEPHONE NUMBER
DATE