HomeMy WebLinkAbout08-30-11 (2)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
COHEN ELISA S
3122 YALE AVENUE
CAMP HILL, PA 1701 1
N0. CC> 014907
told
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
CHECK# 585
ESTATE INFORMATION: ssN: 200-5o-5ozn
FILE NUMBER: 211 1-0919
DECEDENT NAME: LYTLE TAMI N
DATE OF PAYMENT: 08/30/201 1
POSTMARK DATE: 08/29/201 1
couNTY: CUMBERLAND
DATE OF DEATH: 05/31 /201 1
11150653 ~ 5356.10
REV-1162 EX(11-96)
TOTAL AMOUNT PAID:
REMARKS:
SEAL
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
INITIALS: DB
RECEIVED BY:
5356.10
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAXI
~ ~~
INFORMATION NOTICE ~-- IC
BUREAU OF INDIVIDUAL TAXES ' FILE NO. 21 '
PD sox zsosol eons ~ ~ ~`}f AND i ACN 11150653
HARRISBURG PA 17128-0601 P ~~~ `TAX P AY E R RESPONSE
DE PARTMENT DF REV ENLLE `DATE 07-29-2011
REV-1543 E% APP~(0~5 -1})"- - ~ -~••~'J
i ~.~_'i _.U ~ ~:_ ~:
Ul. ~K OF
O~PHHI~~~S ;.,C)UR7
CUR~~'' ='1 ^1~, , "~ PA
ELISA S COHEN
3122 YALE AVE
CAMP HILL PA 17011
EST. OF TAMI N LYTLE
SSN 200-50-5024
DATE OF DEATH 05-31-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
PSE CU 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 Sp0U5e 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 hP 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. 9301229119 Date 10-29-2002 To ensure vroper credit to the account, tvo
Establ ished copies of this notice must accompany
payment to the Register of Wills. Make check
Account Balance 4 997.84
~ payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 2,498.92 months of the decedent's date of death,
Tax Rate ~( lrj deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
Potential Tax Due g 374.84 ~,5 = 351.,fGnine months after the date of death.
P
RT TAXPAYER RESPONSE
A
~
FAILURE TO RESPONH WILL RE T I 4FFICiAL TAX ASSESSMENT
A. I../~ The above information and tax due is correct.
LJ Remit payment to the Register of Wills wlth two copies of this notice to obtaiin
C H E C K a discount or avoid interest, or return this notice to the Register of Wills and
an official assessnent will be issued by the PA Department of Revenue.
0 N E
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 ~2 and/or PART 3~ below.
PART If indicating a different tax rate, please state FI\C~1L US~~~~~ Y~ ~ AAF
relationship to deceden t:
PA DEPARTMENT OF REVENUE
TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
~~
~INc .. Dais 5stablisheu i j
2. Account Balance 2 $ 2
3. Percent Taxable 3 X 3
4. Amount Subject to Tax 4 $ !+
5. Debts and Deductions 5 ~j
6. Amount Taxable 6 $ 6 ~..
7. Tax Rate 7 X ~ \
8. Tax Due 8
PART DEBTS AND DEDUCTIONS CLAIMED
^3
DATE P AID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I reported above are true, correct and
comp t to the est~gf my knowledge and belief.
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TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
TOTAL CEnter on Line 5 of Tax Computation)
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