HomeMy WebLinkAbout07-15-11COMMONWEALTH 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
NO. CC) 014714
BLACK STEVEN D
225 RUPP ROAD
GETTYSBURG, PA 17325
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ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
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ESTATE INFORMATION: SSN: 201-16-4635
FILE NUMBER: 211 1-0283
DECEDENT NAME: BLACK DOROTHY F
DATE OF PAYMENT: 07/ 15/201 1
POSTMARK DATE: 07/ 15/201 1
COUNTY: CUMBERLAND
DATE OF DEATH: 02/26/201 1
REMARKS:
SEAL
CHECK# 2649
101 ~ $1' 79.09
TOTAL AMOUNT PAID:
RE:V-1162 EX(11-96)
$179.09
INITIALS: DB
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
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BUREAU OF INDIVIDUAL
PO BOX 280601 ~~~~~-;~ •'~ ^
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HARRISBURG PA 17128-Q1~L: ~.. ~
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R£V-15~3 ~6:G 41~f (08-88)
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE N0. 21 11-0283
ACN 11135071
DATE 05-24-2011
~. ~ ~
CLERK ~~F
C~RpH~,N'S COURT
STEVEN D BLACK
225 RUPP RD
GETTYSBURG PA 17325
EST. OF DOROTHY F BLACK
SSN 201-16-4635
DATE OF DEATH 02-26-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
a CHECKING
TRUST
CERTIF.
M ~ T BANK provided the Department with the information below, which has been used in calculating the
potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account.
If you feel the information is incorrect, Please obtain written correction from the financial institution, attach a copy to this form
and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of
Pennsylvania. Please call (717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRU(:TIONS
Account No. 10458530 Date 08- 13- 1993 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance 7, 959.4$ Payment to the Register o~f Wills. Make check
payable to Register of Wills, Agent .
Percent Taxable X 50.000
NOTE: If tax payments aria made within three
Amount Subject to Tax $ 3, 979.74 months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Anv Inheritance Tax due wall become delinquent
Potential Tax Due ~` 179.09 nine months after the data of death.
PART TAXPAYER RESPONSE
F~IILURE TO RESPOND WILL RE51~LT IN AN OFFiC3AL~TAX A5SES~MEN?
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 ~ below.
PART If indicating a different tax rate, please state OFFICIAL USE ONLY ~ AAF
relationship to decedent: PA DEPARTMENT OF REVENUE
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
LINE i. Date Established I 1
2. Account Balance 2 $ 2
3. Percent Taxable 3 X 3
4. Amount Subject to Tax 4 $ 4
5. Debts and Deductions 5 - 5
6. Amount Taxable 6 $ ~
7. Tax Rate 7 X 7
8. Tax Due 8 $ 8
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
compl a to the t of y knowledge and belief . HOME C ~~~ ~ ~~-~j~/~~~~
WORK C
TAXP YER NATURE TELEPHONE
R
DATE
TOTAL (Enter on Line 5 of Tax Computation) ;: