HomeMy WebLinkAbout03-22-11COMMONWEALTH OF PENNSYLVANIA REV-1182 EXI11-981
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280801
HARRISBURG, PA 1 7 1 28-0 801
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 014166
PAVLOVICH CONTANCE
18A COLLATE DRIVE
CAMP HILL, PA 17011
-------- fold
ESTATE INFORMATION: SSN: zoz-zo-5965
FILE NUMBER: 211 1-0370
DECEDENT NAME: HILL JEAN M
DATE OF PAYMENT: 03/22/2011
POSTMARK DATE: 03/20/201 1
COUNTY: CUMBERLAND
DATE OF DEATH: 05/13/2010
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
1 1 1 17541 ~ $155.27
TOTAL AMOUNT PAID:
REMARKS: CONSTANCE PAVLOVICH
CHECK# 3795
INITIALS: WZ
SEAL RECEIVED BY:
REGISTER OF WILLS
$155.27
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE 2r7
BUREAU OF INDIVIDUAL TAXES - ~[
`~~' AND FILE N0. 21 - I+ - ~J
PO BOX 200601 -
HARRISBURG PA nlza-oeol ; ~,: T',I1~~AYER RESPONSE ACN 11117541
- DATE 03-15-2011
YEV-1563 EX ~FV (re•Oa1
%~ ~ rG '~ ~ ,' ~~~, is TYPE OF ACCOUNT
EST. OF JEAN M HILL ~ SAVINGS
C~,,~Y~ r,~ SSN 202-20-5965 ® CHECKING
O'~,~(-~'yi~!~C~ f ~,~ r,~T DATE OF DEATH 05-13-2010 ^ reusT
~i~j1~1~t~,~~~~,~il`,~'y ~ ~ ~~~ COUNTY CUMBERLAND ~ CERTIF.
REMIT PAYMENT AND FORMS T0:
CONSTANCE PAVLOVICH REGISTER OF WILLS
18A COLLATE DR 1 COURTHOUSE SQUARE
CAMP HILL PA 17011-7621 CARLISLE PA 17013
SOVEREIGN BANK provided the Department with the inforaation below, which has been used in calculatins the
potential tax tlue. Recortls indicate that at the death of the above-naaed decedent, you were a joint owner/beneficiary of this account.
If you feel the inf oraation is incorrect, please obtain written correction froa the financial institution, attach a copy to this forty
and return it to the above atldress. This account is taxable in accordance with the Inheritance Tax laws of the Coaaorerealth of
Pennsylvania. Please call C717) 787-0327 with questions.
COMPLETE-PART 1. BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0771022336 Data 10-09-2001 To ensure proper credit to the account, two
Established copies of this netice aust accoapara.
ACCOUnt Balance $ 7, 679.26 pays°nt to the Resister of Wills. Make check
payable to "Resister of Wills, Asent••.
Percent Taxable X 50.000
Amount Subject to Tax ~ 3,839.63 ND7E, If tax Deyaents are aatle within three
aonths of the decedent's date of death.
Tax Rata X ~ lrj deduct a 5 percent discount on the tax due.
Potential Tex Dua Arty Inheritance Ta: due Mill becowe tlalinquent
$ 575.94 nine aonths after the date of death.
PART TAXPAYER RESPONSE
A. ~ The above inforastion and tax due is correct.
Resit pay^ent to the Resister of Wills Ylth two copies of this notice to obtain
CHECK a discount or avoid interest, or check bas ••A" srrd return this notice to the Rapistar of
0 N E Wills and an official assessaent will be issued by the PA Departaent of Revenue.
BLOC K B. ~ The above asset has been or will ba reported and tax paid with the Pennsylvania Inheritance Tex return
0 N L Y to be filed by the estate representative.
C. ~ The abore inforaa ion is incorrect and/or debts and deductions were paid.
CoaDlete PART 2~ and/or PART 3^ below.
PART If Sndicatins a different tax rate, please state
O relationship to decodent:
TAX RETURN - COMPUTATION OF TAX ON JDINT/TR1U'"ST ACCOUNTS
LT NE T -IIit o- E§2 eblished i -~~~~-:- ~-~~+p-~ - ~- ~ -
2. Account Balance 2 $ 7{p 7 ~f, o~lo
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION ektnnur Darn
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TOTAL (Enter on line 5 of Tax Computation) ;
Undor penalties of perjury, I tlecla re that the facts I have reported above are true, correct and
c plate to the boat o
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