HomeMy WebLinkAbout06-15-11COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11-96)
NO. CD 014581
GUDZ GENEVIEVE KLEE
201 CLAY AVE #2
ENOLA, PA 17025
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ESTATE INFORMATION: SSN: 160-38-2920
FILE NUMBER: 211 1-0680
DECEDENT NAME: HANZLIK ROBERT F
DATE OF PAYMENT: 06/ 15/201 1
POSTMARK DATE: 06/ 14/201 1
COUNTY: CUMBERLAND
DATE OF DEATH: 04/04/201 1
REMARKS:
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
1 1 136373 ~ $ 5.00
TOTAL AMOUNT PAID:
$5.00
CHECK# 1972
INITIALS: HMW
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES '•'" „,.~ AND FILE NO. 21 ''
PO BOX 280601 { :~'` 3 ~., t~"~"~~~ i~' .~~~
HARRISBURG PA 17128-0601 ~XPAYER RESPONSE ACN 11136373
~iL7~`.±iC~:,;~.: %r~~~~ f ~ DATE 05-27-2011
REV-1543 EX AfP (08-OB)
if~i ~ ~~N f 5 P i~~ t~;~
CLERK OF
ORP~1N'S COURT
Ci1MRER~.~ti[~ CQ„ PA
GENEVIEVE K GUDZ
201 CLAY AVE # 2
ENOLA PA 17025
EST. OF ROBERT F HANZLIK
SSN 160-38-2920
DATE OF DEATH 04-04-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
SOVEREIG N BANK 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. 0921720521 Date 12-07-2002
To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $- 1 ~ 402.98 payment to the Register of Wills. Make check
~~ payable to "Register of Wills, Agent".
Percent Taxable X 50.000
Amount Subject to Tax $ 701 .49 NOTE: If tax payments are made within three
months of the decedent's date of death,
Tax Rate ~( ~ 15 deduct a 5 percent discount on the tax due.
Potential Tax Due ~- 105.22 Any Inheritance Tax due will become delinquent
nine months after the date of death.
PART TAXPAYER RESPONSE
A. ^ The above information and tax due is correct.
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
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 s $ ~
PART DEBTS ND DE UCTI
o ~~
DATE PAID PAYEE
CLAIME
~ ~
SCRIPTION
i
Un r penalties of perjury, I decla
co wete to t ~ best of my ~cnowledg
TAXPAYER SIGN~XTUi~--
on Li
t t the facts I~
nd belief.
$ s
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
~~-a =~
AMOUNT PAID
ave reported above are true, correct ands `~
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