HomeMy WebLinkAbout05-17-11 (3)COMMONWEALTH OF PENNSYLV~~,Ni~
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ANDERSON DAREN D
691 S 82ND STREET
HARRISBURG, PA 17111
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ESTATE INFORMATION: ssN: ~ 27-2s-6~~ 6
FILE NUMBER: 21 1 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:
CHECK#1199
SEAL
AfVIOUNT
ACN
ASSESSMENT
CONTROL
NUME3ER
11127471 ~ 5417.02
TOTAL AMOUNT PAID:
;417.02
INITIALS: DB
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
RE:\~-116:? EX~11-96)
NO. CD 01447?
PENNSYLVANIA INHERII~AM`ICE TAX'
INFORMATION NOT:[CE: -
AND FILE NO. 21
BUREAU OF INDIVIDUAL TAXES
PD Box z8o6o1 TAXPAYER RESPOI~ISE ' ACN 11127471
HARRISBURG PA 17128-060 . DATE 04 - 25 - 2 ~ 1 1
I
REV-1543 EX AFP (08-OB)
TYPE= OF ACCOUNT
_ EST. OF VIOLET M ANDERSON ~~ SAVINGS
$$N 127-28-6716 [] CHECKING
DATE OF DEAT}( 04 - 13 - 201 ]. ^ TRUST
COUNTY CUMBERLAND [] CERTIF.
REMIT PAYMENT AND FORMS T0:
DAREN D ANDERSON REGISTER OF WILLS
b91 SOUTH 82ND STREET 1 COURTHOUSE: SQUARE
HARRISBURG PA 17111 CARLISLE PA 17013
MEMBERS 1ST FCU 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 ANLI PAYMENT INSTRUCTIONS
Account No. 186161-05 Date 12-15-2000 To ensure proper credit to the account, two
Established copies of this notice must accompany
payment to the Register of Wills. Make check
Account Balance $ 19 , 509.63 payab a to "Register of Wi1:1s, Agent".
Percent Taxable X 50.000
NOTE: If tax payments ~:~re made within three ~_.c+,~
Amount Subject to lax $ 9 , 754.82 months of the decedent's. date of death, '1~ "~ '~
Tax Rate . ,~ X . 045 dieduct a 5 percent discount on the tax due.
A.ny Inheritance Tax due will become delinquent
Potential Tax Duet, ~-~11~~:,~ $ 438.97 nine months after the decte of death.
'1 ~~~
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
a discount or avoid interest, or check box "A" and return this notice to the Rcagist:er of
C H E C K 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 lnheri-lance Tax return
0 N L Y to be filed by the estate representative.
C. E,J The above information 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 OFFICIAL USE ONLY ~ AAF
relationship to decedent: _ PA DEPARTMENT OF REVENUE
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
LINE 1. Date Establi:>hed 1 1
2. Account Balance 2 $ 2
3. Percent Taxab:Le 3 X 3
4. Amount Subject to Tax 4 $ 4
5. Debts and Deductions 5 - 5
6. Amount Taxable 6 $ 6
7. Tax Rate 7 X 7
8. Tax Due 8 $ 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 true, correct and
complete to ,~.lze best of my knowledge and belief . i ,j
P, ~;
WORK ("i~-31 ) ~ lR:: ~`i ~;% ~ f5 ij
_ ~:
AXPAYER SIGNATU TELEPHONE NUMBER D~4TE
TOTAL (Enter on Line 5 of Tax Computation) $
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