HomeMy WebLinkAbout03-14-11COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
KIRK JOHN ALAN
315 15TH STREET
NEW CUMBERLAND, PA 17070
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ACN
ASSESSMENT
CONTROL
NUMBER
ESTATE INFORMATION: SSN: 213-52-8992
FILE NUMBER: 2110-0656
DECEDENT NAME: WILCOX ADELE KEIGLER
DATE OF PAYMENT: 03/ 14/201 1
POSTMARK DATE: 03/ 14/201 1
COUNTY: CUMBERLAND
DATE OF DEATH: 02/ 1 8/2010
AMOUNT
10501506 ~ 52,996.05
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 1002
SEAL
$2,996.05
INITIALS: HMW
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
RE'V-1162 EX~11-96)
NO. CD 014122
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE INFORMATION NOTICE FILE N0. 21 10-0656
BUREAU OF INDIVIDUAL TAXES
Po Box 280601 A N D
TAXPAYER RES
PONSE ACN 10501506
HARRISBURG PA 17128-0601
DATE 09-10-2010
REV-1543A AFP (7-00)
TYPE OF ACCOUNT
EST. OF ADELE K WILCOX ^ SECURITY
S.S. N0. 213-52-8992 X^ sEC ACCT
DATE OF DEATH 02-18-2010 ^ STOCK
COUNTY CUMBERLAND ^ BONDS
REMIT PAYMENT' AND FORMS T0:
BENJAMIN V SMITH REGISTER OF WILLS
645 PIKOL ST #6 1 COURTHOUSE SQUARE
HONOLULU HI 96814 CARLISLE PA ].7013
FIDELIT Y has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a beneficiary of this asset.
If you feel this information is incorrect, please obtain written correction from the transfer agent, 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.
puestions may be answered by calling C717) 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 672105198 To insure proper credit to your account, two
C2) copies of this notice must accompany your
payment to the Register of Wills. Make check
DOD Valuation 133, 157.72 payable to: "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax 66 ~ 578.86 (3) months of the decedent's date of death,
045 You may deduct a 5% discount of the tax due.
Tax Rate X . Any inheritance tax due will become delinquent
Potential Tax Due 2, 996.05 nine C9) months after the date of death.
PART TAXPAYER RESPONSE
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A. he above informat ion and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
C H E C K
Wills and an official assessment will be issued by the PA Department of Revenue.
ONE
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 decedent's representative.
C. ^ The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART 2^ and/or PART ^3 below.
If you indicate a different tax
PART rate, please state your ~, ` ~~\~ •~~ ~ \' ~ "\ ~ •\
..~ '~~~~~\~~~ ~ ~
relationship to decedent: ~~` \
PA'.
TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSET(S) PAD ~~~~~•~~` \
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LINE 1. DOD Valuation 1 ,
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2. Percent Taxable 2 X
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3. Amount Subject to Tax 3 ~~... `~
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4. Debts and Deductions 4 -
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5. Amount Taxable 5 5
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6. Tax Rate 6 X 6
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7. Tax Due 7
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PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTI ON AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation) s
der penalties of pe jury, I declare that the facts I have repor a/~dQ~abov a e true~,f corgrect and
co to to the best of knowledge and belief. HOME C ~v0 ~ ~ ~~ --/
WORK ( ~ ~ ` ~ ~` -
TA SIGNA U TELEPHONE NUMBER DATE