HomeMy WebLinkAbout04-19-11COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 014338
MULLEN GEORGE O
6926 SPRING ROAD
SHERMANS DALE, PA 17090
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ESTATE INFORMATION: SSN: 170-32-3372
FILE NUMBER: 211 1-0494
DECEDENT NAME: LONG DONALD H
DATE OF PAYMENT: 04/ 1 9/201 1
POSTMARK DATE: 04/ 19/201 1
COUNTY: CUMBERLAND
DATE OF DEATH: 03/ 17/201 1
REMARKS:
CHECK# 1 135
SEAL
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
11126055 ~ $79.74
TOTAL AMOUNT PAID:
INITIALS: DB
REV-1162 EX(11-96)
$79.74
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES ~~~_1-;`t,";
PO BOX 280601 ,- ~- -- ,; ~
HARRISBURG PA 17128-0601 j"i~ _
REV-1543 EX AFP (08-OB)
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
~ AND
TAXPAYER RESPONSE
,~
FILE N0. 21 " ~~ ~'"~~'
ACN 11126055
DATE 04-18-2011
~. ~i~
MARY L MULLEN
6936 SPRING RD
SHERMANS DALE PA 17090-8118
EST. OF DONALD H LONG
SSN 170-32-3372
DATE OF DEATH 03-17-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS 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 SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 5140137917 Date 02- O 1 - 1974 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 3, 987.00 payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 16.667
NOTE: If tax payments are made within three
Amount Subject to Tax $ 664.51 months of the decedent's date of death,
Tax Rate ~( 12 deduct a 5 percent discount on the tax due.
Anv Inheritance Tax due will become delinquent
Potential Tax Due $ 79 • 74 nine months after the date of death.
PART TAXPAYER RESPONSE
FEEII<URE TO RESPOND WILL RESULT IN AN OFFICIdI. TAX ASSESSMENT
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
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 estate representative.
C. ~ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART l__.1 below.
PART If indicating a different tax rate, please state DFFICIAL USE DNLY ~ AAF
relationship to decedent:
PA DEPARTMENT OF REVENUE
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
LINE 1. Date Established 1 1
2. Account Balance 2 $ 2
3. Percent Taxable 3 X 3
4. Amount Subject to Tax 4 $ 4
5. Debts and Deductions 5 S
6. Amount Taxable 6 $ ~
7. Tax Rate 7 X 7
8. Tax Due 8 $ $
PART DEBTS AND DEDUCTIONS CLAIMED
3^
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported above are trye, c~lorrect and [~
complete to the best o my knowledg and belief. H O ME C ) ~ ~ "" S ~ 7
WORK C ) ~- ~~ ~~
TAXPAYER SIGhPATURE 1. TELEPHONE NUMBER DATE
TOTAL (Enter on Line 5 of Tax Computation) S