HomeMy WebLinkAbout05-17-11 (2)COMMONWEALTH OF PENNSYL~a~~l:',
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ANDERSON DAREN D
691 S 82ND STREET
HARRISBURG, PA 17111
fold
~tE'~/-1162 EX111-96)
NO. CD C-1447'1
ACN
ASSESSMENT ~~IMOUNT
CONTRC)L
NUMBER
ESTATE INFORMATION: SSN: ~ 27-28-6716
FILE NUMBER: 211 1 -0582
DECEDENT NAME; ANDERSON VIOLET M
DATE OF PAYMENT: 05/ 1 7/201 1
POSTMARK DATE: 05/ 1 6/201 1
COUNTY: CUMBERLAND
DATE OF DEATH: 04/ 1 3/201 1
REMARKS:
SEAL
CHECK# 1 19$
11127470 X330.52
TOTAL AMOUNT PAID:
;330.52
INITIALS: DB
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-060:[
REV-1543 EX AFP (08-08)
PENNSYLVANIA INHER:[TANCE TAX
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NCI, ;~1 :.',,
ACN :L1127470
DATE 04-25-2011
DAREN D ANDERSON
691 SOUTH 82ND STREET
HARRISBURG PA 17111
EST. OF VIOLET M ANDERSON
SSN 127-28-6716
DATE OF DEATH 04-13-20J:L
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE: SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS 1ST FCU provided the Department with the information below, which has been used in calculating i:he
potential tax due. Records :indicate that at the death of the above-named decedent, you were a joint owner/benefic:iarv 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 Coimmonwealth of
Pennsylvania. Please call (717) 787-8377 with auestinns.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 186:L 61 - 11
Account Balance
Percent Taxable
Amount Subject to Tax
T a x R a t e , ,~,.~ ---~
Potential Tax Due( ~~ '~`; `~-1
PART
CHECK
ONE
BLOCK
ONLY -
Date 10-28-2008
Established
$ 15,463.31
X 50.000
$ 7,731.66
X .045
$ 347.92
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
a discount or avoid interest, or check box "A" and return this notice to the Rec~i.ster of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. I-] The above asset has been or will be reported and tax paid with the Pennsylvania ]rheritan~e Tax return
to be filed by the estate representative.
C. I_] The above information is incorrect and/or debts and deductions were paid.
Complete PART ~ and/or PART ~ below.
PART If indicating a different tax rate, please state OFFICIAL USE ONLY [~ AAF
relationship to decedent: _
PA DEPARTMENT OF REVENUE
TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
LINE 1. Date Establi~;hed 1 1
2. Account Balance 2 $ 2
3. Percent Taxable 3 X 3
4. Amount Subject to Tax 4 $ {f
5. Debts and Deductions 5 - r,
6. Amount Taxabl.c~ 6 $ 6
7. Tax Rate 7 X 7
8. Tax Due 8 $ 8
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTIOIV AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported above are true, cc:~rrect: and
r_. .
comp ete to best of my knowledge and belief. HOME C ~' ~ ) _~1~%~.~ r '`
~ ~~,5 )
TAXPAYER SIGNATUR --
TELEPI~iONE NUMBER DATE
i~ ~
H~~
To ensure proper credif: to the account, two
copies of this notice must accompany
payment to the Register of Wills. Make check
payable to "Register of Wi:L_s, A,yent".
NOTE: If tax payments are made within three
months of the decedent's d~3te of death,
deduct a 5 percent discount on the tax due.
.Any :[nheritance Tax due wil]. become delinquent
nine months after the date of death.
iolAL (Enter on Line 5 of Tax Computation) :~