HomeMy WebLinkAbout03-25-11COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
N0. CD 014197
POZSGAY JUDITH M
681 ST JOHNS DR
CAMP HILL, PA 1701 1
--"---- fold
REMARKS:
CHECK# 2528
SEAL
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
REV-1162 EX111-96)
TOTAL AMOUNT PAID:
INITIALS: DB
RECEIVED BY:
REGISTER OF WILLS
,21.40
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
lu`;
REV-1543 EX AFP C08-08)
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE= N0. 21 11-0042
ACN 11116865
DATE: 03-14-2011
~u ~ i t eptrt C J ~°°~ ~
,, TYPE OF ACCOUNT
E~~ f1~-
CI EST. OF MADELINE M POZSGA,Y ^ SAVINGS
SS
,.
~,.,~ }~~, ~~.~•.,,
~~P' ''~~ ;
ART N 163-44-4552
X^ CHECKING
DATE OF DEATH l 0
_
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~ - 29 - 2010 ^ TRUST
COUNTY CUMBER
_
•~ LAND
^ CERTIF.
JUDITH M POZSGAY REMIT PAYMENT AND FORMS T0:
681 SAINT JOHNS DR ~ ~ ,
REGISTER OF WILLS
^
•
CAMP HILL PA 17011-1326 _
1 COURTHOUSE SQUARE
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CARLIS
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LE PA 17013
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PNC BANK NA -.,,-,f ~.....
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provided the Department with the information below, which has been u ~ '~
potential tax due. Records indicate that at the death of the above-named decedent
in calcy~„ating ;Xhe .!,.1
If you feel the informati
i
'
on
s incorrect, please obtain wri
and return it to the above address. This account is taxabl
P , you were a joint owner/
•b~'efTi c i a ry o t~~I~ i s ac_ co u~-%
tten correction from the financial institution,
~'tach
~
~
ennsylvania. Please call C717) 787-8327 with questions.
a copy
t
o thi~~r
e in accordance with the Inheritance Tax laws of the Commonwealth of
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT ~ ~~
Account No. 1005091188 Dat INSTRUCTIONS
e
08-24-1998
Established To ensure proper credit to t:he account, two
Account Balance $ copies of this notice must accompany
payment t
Percent Taxable X 2, 853.26
o the Register of Wills. Make check
payable to "Register of Wi:Ll
"
s, Agent
.
16.667
Amount Subject to Tax $
Tax Rate NOTE: If tax payments are made within three
4 7 5. 5 5
X
Potential Tax Due months of the decedent's date of death,
. 0 4 5 deduct a 5 percent discount: on the tax du
$
PART e.
Any Inheritance Tax due will become delinquent
21.40
nine months after th
d
e
ate of death.
TAXPAYER RESPONSE
FAILU E TO RESPONI WILL RESULT IN AN OFF~CTAL.TAX ASSESSMENT
A• The abov f
e in ormation 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 Re
0 N E Wills and an official assessment will be issued by the PA Department of Revenue9ister of
B L 0 C K B, ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inher".
0 N L Y to be filed by the estate representative.
stance Tax 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 indi r-n+;.,., .. ~_ tr _
-••~ ~ ~~~~C~rnt
relationship to decedent: tax rate, please state
'
4Ff
ICIAL 11SE ONLY
^ AAF
TAX
LIN RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PA DEPARTMENT OF REVENUE
E 1. Date Established
1 F'A D
2. Account Balance 2 $ 1
3. Percent Taxable g X 2
4. Amount Subject to Tax 4 $ 3
5. Debts and Deductions 5 - 4
6. Amount Taxable 6 $ 5
7. Tax Rate ~ ~( 6
8. Tax Due 8 $ 7
PART
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. p
~ Y1) HOME ~~ ~ ) /' ~.~~ ~~~
WORK ( ~7 ) ~ `-
TAX YER SIGNATU ~ '7~ ° = ~ ~~ (r
TELEPHONE NUMBER D TE
8
DEBTS AND DEDUCTIONS CLAIMED
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