HomeMy WebLinkAbout05-17-11COMMONWEALTH OF F'ENNSti'._VA'•;I,4
DEPARI-MENT OF REVENUE
BUREAU OF INDIVIDLIAt_ TARE`_
DEPT. 280601
HARRISBURG, PA 17128-6601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 014470
ANDERSON DAREN D
691 S 82ND STREET
HARRISBURG, PA 17111
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REMARKS:
CHECK#1197
SEAL
AC:N
ASSESSMENT AMOUNT
CONTROL
NUMBER
REV-1162 EX(11-961
TOTAL AMOUNT PAID:
INITIALS: DB
RECEIVED BY:
REGISTER OF WILLS
,~ 1 ~~ . ~ 7
GLEND,A EARNER STRASBAUGH
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0607. -
REV-1543 El( AFP (08-08)
~PENNSYLWANIA INHER:[TANCE= TAX
INIFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NCI, ;?1 .~'~``
ACN /1127469
DATE= 04-25-2011
TYPE OF ACCOUNT
EST. OF VIOLET M ANDERSON ~ SAVINGS
SSN 127 - 28 - 6716 ~ CHECKING
DATE OF DEATH 04 - 13 - 201 1 ~ TRUST
COUNTY CUMBERLAND ~ CERTIF.
REMIT PAYMENT AND FORMS T0:
DAREN D ANDERSON REGISTER OF WILLS
691 SOUTH 82ND STREET 1 COURTHOUSE SQUARE
HARRISBURG PA 17111 CARLISLE P,A 17013
MEMBERS 1ST FCU provided the Department with the information be:Low, which has been used in calculating tl7e
potential tax due. Records ndicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account.
If you feel the information, :(s 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 1717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING ANI) PAYMENT INSTRUC'T'IONS
Account No. 186161-00 Date 07-27-1999
To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 672.85 payment to the Register of Wills. Make check
payab:~e to "Register of Wilas, Agent".
Percent Taxable X 50.000
Amount Subject to Tax $ 336.43 NDTE: If t:ax payments are naade within three
months of t:he decedent's. dai:e of death, ~-!'~
Tax Rate --- X . 045 deduct a 5 percent discount on the tax due. ~
Potential Tax Due #t-, , ~'j`~~ $ 15.14 Any Inheritance Tax due will. become delinquent
~-•------"` nine months after the date of death.
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PART TAXPAYER RESPONSE
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT-
A. r- The above information and tax due is correct.
L Remit payment to the Register of Wills with two copies of i:his 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 Lepartment of Revenu?.
B L 0 C K B. I`_I The above asset has been or will be reported and tax paid with the Pennsylvania L~)heritance Tax return
O N L Y J to be filed by the estate representative.
C. L_-1 The above information is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART LJ below.
PART If indicating a different tax rate, please state
relationship to decedent: - OFFICIAL USE ONLY ~ AAF
TAX RETURN - COMPUTATION OF TAX ON JOINTITRUST ACCOUNTS PAD PA DEPARTMENT OF REVENUE
LINE 1. Date Established 1 1
2. Account Balance 2 $ 2
3. Percent Taxable 3 X 3
4. Amount Subject t(~ Tax 4 $ ~
5. Debts and Deductions 5 - 5
6. Amount Taxable 6 $` 6
7. T a x R a t e 7 X 7 ~"-~---~--
8. Tax Due g $ $
._._._
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE T1FCf'I?TPTrn~r _--_
Under penalties of pe•~jury, I declare that the facts I have reported above are true, correct and
complete to best of my knowledge and belief.
, ;, ;
I, r.~~
TAXPAYER SIGNATU ~ ~ ~> ,y +~ ~ ~~, + ~
TELEPHONE NUMBER ~~ DATE: