HomeMy WebLinkAbout03-08-11 (4)COMMONWEALTH OF PENNSYLVANIA REV-1162 EX~11-96)
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
NO. CD 014096
MEAD JAMES M
1752 CONWAY HEATH
CAMP HILL, PA 1701 1
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold
---------- --------
ESTATE INFORMATION: SS-v: 193-0~-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
1 1 1 13147 ~ $1,275.28
TOTAL AMOUNT PAID:
REMARKS:
$1, 275.28
CHECK# 356
INITIALS: DB
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUA~rTI~X~S ~.~ _
PO BOX 280601 ~~~~ -- -' ~
HARRISBURG PA 17`Y~t8~b60~
i ,~; `,f;'; t
k~l~,,,_'~.,~~,. _.~ - ~ REV=154'lEX AFP (OB-OB)
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 ' ~~ -U~~~
ACN 11113147
DATE 02-25-2011
CLERK n~
ORP_~~',1"~S ~~,~I~RT
Cl1MP~-~~?!--i',~~~~, ~~~ , PA
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. 120001574 Date 05-05-2008 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance 003.71 Payment to the Register of Wills. Make check
~` 1 7 ~ payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 8 ~ 501.86 months of the decedent's date of death,
Tax Rate ~( ~ 15 deduct a 5 percent discount on the tax due.
Anv Inheritance Tax due will become delinquent
Potential Tax Due ~` 1 ~ 275.28 nine months after the date of death.
PART TAXPAYER RESPONSE
FA`s°~!N\ ~ ~ \ ~.. ~~`~~`, ~~ ~`~~ ~~ ~ ~ ~I C~ At~.~~'A,~s~~ AS 5~~~~~~T
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 intorma ion is incorrect and/or debts and deductions were paid.
Complete PART ~2 and/or PART 3~ below.
PART If indicating a different tax rate, please state ~~` ~ ~ `~" ~`~ \ ~ \\ ~
^ relationship to decedent • ~\\~ ~~~~`~`~`~~~\~"Y\~`~~ ~
2 \\~ ~ DEPARTMENT ,~ REVENUE
TAX RETURN COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS pA
LINE 1. Date Established 1 1 ~"'°o
2. Account Balance 2
2
3. Percent Taxable 3 X 3
4. Amount Subject to Tax 4 $ C{
---
5. Debts and Deductions 5 S
6. Amount Taxable 6 6
7. Tax Rate 7 X
7
8. Tax Due 8 $ 8
PART DEBTS AND DEDUCTIONS CLAIMED
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'7t? ~ '~~.'3. IC'l~(
L. ~~ WORK ( ~~ ) - Soc- 3
PAYER SIGNATURE TELEPHONE NUM ER DATE
TOTAL (Enter on Line 5 of Tax Computation) $