HomeMy WebLinkAbout06-06-11COMMONWEALTH OF PENNSYLVANIA
REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 014542
KEEPER KAREN S
14 CRAMER RD
HIPPENSBURG, PA 17257
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
fold
ESTATE INFORMATION: ssN: 190-16-1997
FILE NUMBER: 211 1-0651
DECEDENT NAME: RINEHART WILLIAME
DATE OF PAYMENT: 06/06/201 1
POSTMARK DATE: 06/02/201 1
COUNTY: CUMBERLAND
DATE OF DEATH: 02/27/201 1
TOTAL AMOUNT PAID:
1 1 134831 ~ $16.00
REMARKS:
$16.00
CHECK# 3590
INITIALS: DB
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 2$'~069I•
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PENN~YL~AANIi'A INHERITp-NCE TAX
INFI7RMA'1'ION NOTI~:E
.AND
TAB;PAYE:R RESPONSE
FILE N0. 21 -~ ~_ v(,~~v~
ACN 11134831
DATE 05-24-2011
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(~,~lNtB~ ~ ART
KARER'
14 CRAMER RD
SHIPPENSBURG PA 17257
FIST. OF WILLIAM E RINEHART
SSN 190-16-1997
DATE OF DEATH 02-27-2011
COUNTY CUMBERLAND
RE=MIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
PAT RIOT 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 corr~action 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. 1533870-00 Date 04-06-1987
To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 2 ~ 132 » 72 payment to the Register of Wills. Make check
payable to "Register of Wills, Agent"
Percent Taxable X 16.667
Amount Subject to Tax $ 355.46 NOTE: If tax payments are made within three
months of the decedent's date of death,
Tax Rate ~( deduct a 5 percent discount on the tax due.
Potential Tax Due ~- 16.00 Any Inheritance Tax due will become delinquent
nine months after the date of death.
PART TAXP ESPONSE
a
6
A. .The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
CHECK 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.
C. ~ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART 3~ below.
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 7 X
8. Tax Due g $
PART
0 DEBTS AND DEDUCTIONS CLAIMED
Under penalties of perjury, I declare that the facts I have reported a'~byove, are true, correct and
omplete to he best f my knowledge and belief. HOME C G~ ( ~ ~3~- ~~?j~
S-
T PAYER SIGNATUR ~ ~ ~~ ~ -~ `~C
TELEPHONE NUMBER DATE
DATE PAID PAYEE nE=CrRrarrnnr _.._...__ _
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