HomeMy WebLinkAbout07-11-11COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
~,P~TERRY R WILSON
607 COPPER CIRCLE
CARLISLE, PA 17015
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REV-1162 EX111-96)
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
N0. CD 014691
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
---------- --------
ESTATE INFORMATION: ssN: 246-28-1785
FILE NUMBER: 211 1-0763
DECEDENT NAME: LONG JANE
DATE OF PAYMENT: 07/ 1 1 /201 1
POSTMARK DATE: 07/ 1 1 /201 1
COUNTY: CUMBERLAND
DATE OF DEATH: 04/ 26/ 201 1
1 1 136182 ~ S 19.89
TOTAL AMOUNT PAID:
REMARKS:
$19.89
CHECK# 2552
INITIALS: MAW
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER C1F WILLS
REGISTER OF WILLS
PENNSYLVANIA INHERITANCIE TAX
INFORMATION NOTICE
INFORMATION NOTICE
BUiEAU OF INDIVIDURL TAXES AND
BUREAU OF INDIVIDUAL TAXES AND F I L E NO. 21 " 1 / ~ `7~~
PD Box 280601 ~~ ~ '"'~; .'~'~'ifER RESPONSE ACN 11136182
HARRIS BURG6PA 17128-0601 li~ ,~ ~ ~ E R RESPONSE
HARRISBURG PA 17128-0601 ~ ~~ ~'~ ~ ' ~;
C ' C _C ;: Pk~'eF
~.. L ,,t! ~ ~, ___ (DATE 05-26-2011
REV-1543 EX AFP (OB ~~ '~, `~ f~~', ~,,! ,! `,_.i-~,~
TYPE OF ACCOUNT
rGt i ! JAL t i ~;' ' `~' u i~sT . OF JANE LCING ~ SAVINGS
$$N 24E~-28-1785 ® CHECKING
CLERK ~JF DATE OF DEATH 04 - 26 - 2011 ~ TRUST
C~RP~f's CrOURi COUNTY CUMBERLAND ~ CERTIF.
Cl1M~FRl,~~~l~1 ~~"~ PA_ REMIT PAYMENT AND 1=0RMS T0:
TERRY R WILSON REGISTER OF WILLS
607 COPPER CIRCLE 1 COURTHOUSE SClUARE
CARLISLE PA 17015 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 AND PAYMENT INSTRUCTIONS
Account No. 317066 -11 Date 10 -30 -2007
To ensure proper credit to the account, two
Established copies of this notice must accompany
8 6 payment to the Register of Wills. Make check
Account Balance $
8 8 3
.
payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 441
93
.
months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential TaX Due $` 19.89
nine months after the date of death.
PART TAXPAYER RESPONSE
~ ~.
A. +~ The above information and tax due is correct.
lAI 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 $ e
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 8 +~
PART DEBTS AND DEDUCTIONS CLAIMED
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 the best of my knowledge and belief. -~ ~•_
J HOME C~l / ) ~~ / y73
n• ~` //"" d
L'1,~~ ,~~,-z~% WORK C ) ~`/`~7~~
TAXPAYE SIGNATURE TELEPHONE NUMBER DATE
TOTAL CEnter on Line 5 of Tax Computation) S