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HomeMy WebLinkAbout07-13-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: GREEN GAIL 1 19 CALAMAN RD CRANSTON, RI 02910 -------- fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT RE'V-1 162 EX(1 1-96) NO. CD 014705 ACN ASSESSMENT AMOUNT CONTROL NUMBER ESTATE INFORMATION: SSN: 087-36-4142 FILE NUMBER: 211 1-0779 DECEDENT NAME: POLLAK JEFFREY D DATE OF PAYMENT: 07/ 13/201 1 POSTMARK DATE: 07/ 1 2/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 01 /03/201 1 REMARKS: 11139217 ~ 5394.33 11139216 ~ $394.33 TOTAL AMOUNT PAID: 5788.66 CHECK# 6258 INITIALS: DB SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~ S 1 BUREAU OF INDIVIDUAL T~f~`,; -!# ~ ~;,.~... ^ PO BOX 280601 _ ("~~~~, ~~a HARRISBURG PA 17128-06 '~ ~ ~-° t i~~'.~~_~ DEPARTMENT~F,R~ ENUE REV-1543 EX AFP (05-11) EST. OF JEFFREY D POLLAK SSN 087-36-4142 DATE OF DEATH 01-03-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 E.° `.f L i.. ~ ~ f ~ ; r ~ f ~i ~ CLERK of oRP~~s Co~RT GAIL GREEN 119 CALAMAN RD CRANSTON RI 02910 TYPE OF= ACCOUNT SAVINGS CHECKING TRUST CERTIF. WELL S F A R G 0 provided the department with the information below, which was used in calculating t;he inherit~3nce tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If y OU are the SpoUSe of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in FART 2. If you believe 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. Please call 717-787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 1010199086555 Date 03-03-2008 Established Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART 0 CHECK ONE BLOCK ONLY $ 15,773.00 X 16.6b7 $ 2,628.89 X PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE Na. 21 ` 1 I ~ ,~~ AND qCN 11139217 TAXPAYER RESPONSE DATE 06-09-2011 /394.33 XPAYER RESPONSE FAILURE Tfl" RESPOND WILL RESIIET IN AN `OFF~CTAI.'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 return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. WWW"' Complete PART 2~ and/or PART 3~ below. PART If indicating a different tax pate, please state OFFICIAL USE UMLY ~ A relationship to decedent : ~-' ~~ L( n~ C,r- AF PA DEPARTMENT OE REVENUE TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PpI3 Llht 1. Date Established 1_ 1 2. Account Balance 2 $ jrj ~7`~ ~ t'Z~ 2 3T- Percent Taxable 3- X f ~/n .~~,'"J 3 4. Amount Subject to Tax 4 $ ~ ~ .Z ~ ~ ~ Ci 5. Debts and Deductions 5 - 5 6. Amount Taxable 6 $ ~ 7. Tax Rate 7 X ~ ~5 7 8. Tax Due g $ ~ j ~ ~ 7 8 PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT Porn L - G ~~ Cr ~ ~'C F~ ~ ~ l ~A-L `, -- fJ ' ~ ''" ~ ~ ~c. ~ S G ~Yl ;~' E . - ^~ •". ~~~ ~i,~e ~ ~ i i e(]C l.VmpUiailOnJ $ Under penalties co et, to e,r~y}b~s TA AYER SI ATUR perjury, I declare that the facts I reported above are true, correct and t of my knowledge and belief . HOME C ~p / ) f y~ - ~, j,~) ~, E TELEPHONE NUMBER DATE To ensure proper credit to the account, two copies of this notice must accompany payment to the Register of Wills. Make check payable to "Register of Wills, Agent". NOTE: If tax payments are made within three months of the decedent's date of death, deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent nine months after the date of death. '• ~, PENNSYLVANIA INHERITANCE TAX r,;- ,,,.,r.,,,._~.. INFORMATION NOTICE ' FILE N0. 21 ~ -L~1 BUREAU OF INDIVIDUAL 1,7><~C~{ ,. -; --~ { '`' _, r ' 1 Po Box 260601 ,- ~pfe~h~ Shia AND ACN 11139216 HARRISBURG PA 17128-061 f"', :DEp~l1RFMENl!?01~F~ENUE TAXPAYER RESPONSE ~.,.,~ DATE 06-0!~-2011 REV-1543 EX AFP (05-11) a~~ ~ ~ ,~ t , ,.. ,, v EST. OF JEFFREY D POLLAK SSN 087-36-4142 DATE OF DEATH 01-03-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS © CHECKING TRUST CERTIF. QRPH~;ERK pF ~ S CQURT CUt~1,3~,~' ~'v~l ~~ , P/i BERENICE POLLAK 3661 POINCIANA 401 LAKE WORTH FL 33467 WELL S F A RG 0 provided the department with the information below, which was used in calculating the inheritance tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If yoU are the spoUSe of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe 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. Please call 717-787-8377 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 1010199086555 Date 03-03-2008 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 $ 15 ~ 773.0 0 payable to "Register of Wills, Asent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax $ 2 ~ 628.89 months of the decedent's date of death, Tax Rate ~( 1 rj deduct a 5 percent discount on the tax due. Any inheritance tax due will become de:Linquent Potential Tax Due $ 394.33 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TD RESPOND MALL RESiJLT I`N 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 C H E C K a discount or avoid interest, or return this notice to the Register of Wills and 0 N E 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 filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART ~ and/or PART 3~ below. PART If indicating a different tax rate, please state DfFjCIAL USE ONLY ~ AAF relationship to decedent: PA DEPARTMENT OF REVENUE TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD` LINE 1. Date Established 1 1 2. Account Balance 2 $ ~ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 $ (~ 5. Debts and Deductions 5 - - 5 6. Amount Taxable 6 7. Tax Rate 7 X 7 8. Tax Due g ~ $ PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above are true, correct and complete to the best of my knowledge and belief. H 0 M E C WORK ( ) TAXPAYER SIGNATURE TELEPHONE NUMBER :DATE IUTAL ~tnLer on Line 5 of Tax Computation) $ _I 0 M N O Z7 N ~ O C H O~1 ~ ~ L C O ~ V ~ ~ ~ V `~ ~.Lt ,~ ~ ~ ~ J ~ ~ ~ -~ ~~~ v ,~' ~ ) r C~ ~ ( , U Z ~ ~ ~ ~ ~ ~--i t ~ v Q~ i L i3} t ='s _"; i:t.s ~~ t.