HomeMy WebLinkAbout04-15-11COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 014312
DRAKE JONATHAN S
5933 WILLIAMSBURG ROAD
ALEXANDRIA, VA 22303
- fold
ESTATE INFORMATION: SSN: 098-14-8806
FILE NUMBER: 211 1-0484
DECEDENT NAME: SHEEHAN CHARLOTTE A
DATE OF PAYMENT: 04/ 15/201 1
POSTMARK DATE: 04/ 15/201 1
COUNTY: CUMBERLAND
DATE OF DEATH: 1 1 / 27/ 2010
REMARKS: JONATHAN DRAKE
CHECK# 4124
SEAL
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
11118812 ~ $31.04
TOTAL AMOUNT PAID:
INITIALS: WZ
REV-1162 EX(11-96)
531.04
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
r ,-
REV-1543 EX
,~ ,.~•." '*-'r~:,".r~~G ~"EVISED NOTICE
r:N ~ ....
FILE N0. 21 i~ -~~o~
ACN 11118812
DATE 03-29-2011
_ EST. OF CHARLOTTE A SHEEHAN
k ~G'. ~ t ~ ~~ ~~ ~ ~ ` ~'~ SSN 098- 14-8806
DATE OF DEATH :t1-27-2010
~~ ~~~~ ~1F COUNTY CUMBERLAND
~~~,~ ,~+~` t'"'~~'•.RT REMIT PAYMENT AND F~DRMS T0:
s i t ~~`, vv ~J J L!J i
5933TWILLIAMSBURG RD Cll~~(~~~ ~'! +~..x,.a4'~ r~.~.y • ~A~ RECOURTHOUSEWSQUARE
ALEXANDRIA VA 22303 CARLISLE PA 1'7013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
WACHOVIA BK 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. 1040000387203 Date 07-01-1997
Established
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
$ 4,137.95
X 16.667
$ b89.67
X .045
31.04
To ensure proper credit to the account, two
copies of this notice must accompany
payment tai the Register of Wills. Make check
payable tai "Register of Wills, Agent".
NOTE: If tax payments are made within three
months of the decedent's date of death,
deduct a 5~ percent discount on the tax due.
Any Inheritance Tax due will become delinquent
nine monthis after the date of death.
PART TAXPAYER RESPONSE
. ,. , .
a . ,,... .,. , , ,
A. ('~ The above information and tax due is correct.
I~ 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 Depal-tment 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 3LJ below.
PART If indicating a different tax rate, please state
a relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ~ •~ `~~~
~
` "`
O`
LINE 1. Date Established I ~ ""
"
`
\` \ ~"~ ~ ~"~
~"
2. Account Balance 2 $ ~ ~ ~ ® ~\
X ~ ~~
3. Percent Taxable 3
$
\
4. Amount Subject to Tax 4
~
- ~~
5. Debts and Deductions 5
\ ~\ \
\
6. Amount Taxable 6 $
~
X \
7. Tax Rate 7
$ \
8. Tax Due 8 ~
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported above +are~rue, correct and
complete to the best of my kno edge and belief. H 0 M E (~) ~'
WO R K C D ) ~O = "jO 1 '~/ ~ 2D 1 1
-XP ER SIG ATURE TELEPHONE NUMBER ATE
TOTAL CEnter on Line 5 of Tax Computation) S