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HomeMy WebLinkAbout03-21-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1~1zs-osol PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT JOHNSON CHENAY 211 W RIDGE STREET CARLISLE, PA 17013 -- fold ESTATE INFORMATION: ssN: 173-40-3126 FILE NUMBER: 211 1-0364 DECEDENT NAME: JOHNSON GERALD M DATE OF PAYMENT: 03/ 21 / 201 1 POSTMARK DATE: 03/18/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 12/ 16/2010 REMARKS: SEAL CHECK# 335 ACN ASSESSMENT CONTROL NUMBER AMOUNT 11108318 ~ $22.52 TOTAL AMOUNT PAID: INITIALS: DB RECEIVED BY: REGISTER OF WILLS REGISTER OF WILLS $22.52 GLENDA EARNER STRASBAUGH REV-1162 EX(11-96) NO. CD 014158 BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 ~ r ~., ~; ~ : ~ - ''` ~ .REV-1543 EX AFP' AQ8-~ ' ~ ~, - . 'J y. _. ~.. PENNSYLVANIA INHERITANCE INFORMATION NOTICE AND TAXPAYER RESPONSE ,~„ ~~ CHENAY C~,l~,' ¢` ' ~ , ,~T 211 W RIDGE ST ~''~'' t ,,' ~~ CARLISLE PA 17013-4009 EST. OF GERALD M JOHNSON SSN 173-40-3126 DATE OF DEATH 12-16-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FDRMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS © CHECKING TRUST CERTIF. PNC BANK NA 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 SIDEwFOR FILING AND PAYMENT INSTRUCTIONS Account No. 5004992855 Date 07-17-2006 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 1 ~ 000.83 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to Tax $ 500.42 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 $ 22.52 Any Inheritance Tax due will become delinquent 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 f 0 N E o 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 Inheritan T to be filed by the estate representative. ce ax return C. ~ The above informs 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: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Late Established ~, - 2. Account Balance 2 $ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 $ 5. Debts and Deductions 5 - 6. Amount Taxable 6 $ 7. Tax Rate 7 X 8. Tax Due g $ riarc ~ 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) ~ Under penalties of perjury, I declare that the facts I have reported above are true, correct and omplete to the best of,ni knowledge and belief. ~ !,,/ HOME C 11~ ~ 3~~ ~ ~~~~~ WORK C TAXPAYER SIG TUR TELEPHONE NUMBER DATE DEBTS AND DEDUCTIONS CLAIMED TAX FILE N0. 21 ~- `'- ~~ ACN 11108318 DATE 02-11-2011 USA FIRST-CLASS FOREVER i. "jC. S~ t' .~ t t00i ~, .~ ~ ~#y p ~ a . ~ ^: jj$ a ! ! s ~ ~~ ~ ~ ~ ~~ t ~ ~.: ~~ ~ ~~ nx,~ r -'.' :.K ,+.,. y ~. ~.:.. ~~, 'k,.i+ (~ I: ~~ . ~~ ~ F ~~ " ~ ~~ ~ s- ~ dj:: T ~-~-'. ~~ .. _.~.- J ~ J rM _ ~ ~l ~.--- C~_~~ ~. ~~~ ~ ~~ ( ' 4,^' _~ ~~ ~ `~.~ ~.. <J ~ -_, _--- ;~ , -.--~ ~ ~~ -w.~` i. `~- _/ ,~ f ~.-~- ~ ~ J ~~ ,~ ~~ `/ ~~ ~ ,' 1 .~