HomeMy WebLinkAbout07-25-11COMMONWEALTH 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
N0. CD 014761
ROCHE JOSEPH W
318 WEXLEY DRIVE
NEWTOWN, PA 18940
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ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
11501488 ~ $910.61
ESTATE INFORMATION: SSN: 154-12-7625
FILE NUMBER: 211 1-0793
DECEDENT NAME: ROCHE ALICE B
DATE OF PAYMENT: 07/25/201 1
POSTMARK DATE: 07/ 18/201 1
COUNTY: CUMBERLAND
DATE OF DEATH: 05/05/201 1
REMARKS:
CHECK# 1257
SEAL
TOTAL AMOUNT PAID:
INITIALS: HMW
REV-1162 EX111-96)
5910.61
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE -.INFORMATION NOTICE ~- ~ -- ~ ~~,
BUREAU OF INDIVIDUAL TAXES ~~~'.. ~~ ~f `~, ~,J~" AND FILE NO. 21
Po Box zso6ol ~ ; ~~, ACN 11501488
HARRISBURG PA 1n2s-o6o1 •~~ TAXPAYER RESPONSE
r'~ '~~' - J DATE 07-13-2011
REV-1543A AFP (7-00)
TYPE OF ACCOUNT
EST. OF ALICE B ROCHE ^ SECURITY
~L~~ ~~ S . S . NO . 154 -12 - 7625 X^ sEC ACCT
~R~~~~f~ r~~RT DATE OF DEATH 05-05-2011 ^ STOCK
CUPy"~- ~! ;~,"~.~ ~~'~ ~" COUNTY CUMBERLAND ^ BONDS
REMIT PAYMENT AND FORMS T0:
JOSEPH W ROCHE REGISTER OF WILLS
318 WEXLEY DRIVE 1 COURTHOUSE SQUARE
NEWTOWN PA 18940 CARLISLE PA 17013
MERRILL LYNCH has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a beneficiary of this asset.
If you feel this information is incorrect, please obtain written correction from the transfer agent, attach a copy to this form and
return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania.
Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 2AS-93331 To insure proper credit to your account, two
C2) copies of this notice must accompany your
b 0 1 .$ 5 payment to the Register of Wills. Make check
DOD Valuation 42 ~ payable to: "Register of Wi11s, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax 21 ~ 300 • 93 (3) months of the decedent's date of death,
Tax Rate X . 045 You may deduct a 5% discount of the tax due.
Anv inheritance tax due will become delinquent
Potential Tax Due 958.54 nine (9) months after the date of death.
PART TAXPAYER RESPONSE
1^
~~
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
CHECK a discount or avoid interest, or you may 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 decedent's representative.
C. ^ The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
PART If you indicate a different tax rate, please state your
relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSETCS)
LIN[ 1. DOD Valuation 1
2. Percent Taxable 2 X
3. Amount Subject to Tax 3
4. Debts and Deductions 4 -
5. Amount Taxable 5
6. Tax Rate 6 X ~ \
7. Tax Due 7
\\ ~~ ~
PART DEBTS AND DEDUCTIONS CLAIMED
a
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation) S
Under penalties of perj ry, I declare that the facts I have reported above aret~tr7ue7, c~ect and
complete t the be f my nowledge and belief. HOME Cp~/S/') ~~a / /~ s
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TAXPA SIGNATURE TELEPHONE NUMBER DATE
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