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HomeMy WebLinkAbout06-15-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT RE:V-1162 EX(11-96) NO. CC} 014577 EDWARDS SHEILA E 415 E GREEN STREET SHIREMANSTOWN, PA 17011 -------- cold ESTATE INFORMATION: ssrv: ~ 86-2s-5533 FILE NUMBER: 211 1-0679 DECEDENT NAME: ODONNELL WILLIAM A DATE OF PAYMENT: 06/ 15/201 1 POSTMARK DATE: 06/ 1 4/201 1 couNTY: CUMBERLAND DATE OF DEATH: 09/ 22/ 201 0 REMARKS: ACN ASSESSMENT AMOUNT CONTROL NUMBER 11500483 ( $829.49 TOTAL AMOUNT PAID: $829.49 CHECK# 6467 INITIALS: DB SEAL RECEIVED BY: GLENDA EARNER STR,ASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES Po eox zao6ol HARRISBURG PA 171za-o6o1 f.- ~~ ~'~ _ f ~~~A ~;'.._~" ti.. ~. REV-1543A AFP (7-00) NFORMATION NOTICE E ~~' AND } { ~ TAXPAYER RESPONSE _....~1 _ ~ FILE N0. 21 ~ ~ - ~,%~ ACN 11500483 DATE 03-04-2011 o} ~ ,~ TYPE OF ACCOUNT EST. OF WILLIAM A ODONNELL ^ SECURITY CLERK OF S . S . NO . 186 - 28 - 5533 X^ sEC ACCT DATE OF QRPNAN S L~~~RT DEATH 09-22-2010 ^ srocK COUNTY +C~1P~9:..~,~~..~=r~r~: can . PA CUMBERLAND ^ BONDS REMIT PAYMENIT AND FORMS TD: SHEILA E EDWARDS REGISTER OF WILLS 415 E GREEN STREET 1 COURTHOUSE SQUARE SHIREMANSTOWN PA 17011 CARLISLE PA 17'013 FID E LIT Y has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a beneficiary of this asset. If you feel this information is incorrect, please obtain written correction from the transfer agent, 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. questions may be answered by cal~in9 C717) 7R7-P?2~ COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSl'RUCTIONS Account No. 000 To insure proper credit 1:o your account, two C2) copies of this notice must accompany your payment to the Register of Id ills. Make check DOD Valuation 36 , 86b . 17 payable to: "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are invade within three Amount Subject to Tax 18,433.09 (3) months of the decedent's date of death, Tax Rate X .045 you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent Potential Tax Due 829 • 49 nine C9) months after the date of death. PART TAXPAYER RESPONSE ^1 FAILURE Tfl RESPOND WILL RESULT IN AN flFFIC~AL TAX ASSESSMENT BASED ON THIS NCiTICE A. The above information and tax due is correct. 1. You may choose to 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 you may check box "A" and return this notice to the Register of 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 Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART a and/or PART ^3 below. PART If you indicate a different tax rate, please state your OFFICIAL USE ONLY ^ AAF relationship to decedent: PA DEPARTMENT OF REVENUE TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSET{S) PqI? LINE 1. DOD Valuation 1 1 2. Percent Taxable 2 X 2 3. Amount Subject to Tax 3 3 4. Debts and Deductions 4 - 4 5. Amount Taxable 5 ~ 6. Tax Rate 6 X 6' 7. Tax Due 7 7, 8` BART DEBTS AND DEDUCTIONS CLAIMED TOTAL (Enter on Line 5 of Tax Computation) S Under penalties of perjury, I declare that the facts I have reported above are true, cor ect and l compl t to t bes of my knowledge and belief. HOME { ~~7~~? ~ ~© // WORK { ) I TAXPA ER SIGNATURE TELEPHONE NUMBER DATE DATE PAID PAYEE DESCRIPTION AMOUNT PAID