HomeMy WebLinkAbout04-19-11 (2)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
LONG WAYNE E
1101 LINDHAM CT
APT 507
MECHANICSBURG, PA 17055
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REMARKS:
CHECK# 746
SEAL
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11-96)
NO. CD 014337
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
$79.74
TOTAL AMOUNT PAID:
INITIALS: DB
RECEIVED BY:
REGISTER OF WILLS
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601 r" ~', ` - `-,
HARRISBURG PA 171~~-b601 -- ~
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WAYNE E LONG
6926 SPRING RD
SHERMANS DALE PA 17090-8118
PART If indicating a different tax rate, please state
relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established 1
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 ~ X
8. Tax Due 8 $
D A D T
DATE PAID
C• ~ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART ~ and/or PART ~ below.
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
S
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.
Zo HOME ('~ 1''1 } (~ '7 ~ ~~,~ ~7
T Y IGNATURE WORK ( }
TELEPHONE NUMBER DATE
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND
TAXPAYER RESPONSE i
F I L E N 0. 21 ~-- ~ ti- U L-I
ACN 11126056
DATE 04-18-2011
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
XC~ CHECKING
TRUST
CERTIF.
PNC B ANK 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- O1 - 1974
To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $- 3 ~ 9$7.00 payment to the Register of Wills. Make check
Percent Taxable X payable to "Register of Wills, Agent".
16.667
Amount Subject to Tax $ 664.51 NOTE: If tax payments are made within three
Tax Rate months of the decedent's date of death,
X 1 2 deduct a 5 percent discount on the tax due.
Potential Tax Due $- 79.74 Any Inheritance Tax due will become delinquent
nine months after the date of death.
PART
TAXPAYER RESPONSE
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL 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
0 N E Wills and an official assessment will be issued by the PA Department of Revenue.
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.
DEBTS AND DEDUCTIONS CLAIMED
OFFICIAL USE` ONLY ~ AAF
PA DEPARTMENT OF REVENUE
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