HomeMy WebLinkAbout09-13-11COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11-96)
NO. CD 014958
COULSON MICHAEL E
84 FRONT STREET
WEST FAIRVIEW, PA 17025
°'----- fold
REMARKS:
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
TOTAL AMOUNT PAID:
$598.58
CHECK# 3876
INITIALS: HMW
SEAL RECEIVED BY:
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
~~ 1 `~,'
~' 1
~~
_ t ,:1
REV-1543A AFP (7-00)
_ i i:.. t
CLE~~'. OF
Q~~H~:ti'S ';n~RT
MICHAEL E COULSON
84 FRONT ST
WEST FAIRVIEW PA 17025
INFORMATION NOTICES FILE N0. 21 11-0203
AND
TAXPAYER RESPONSE ACN 11500863
REVISED NOTICE * * * DATE 09-01-2011
TYPE OF ACCOUNT
EST. OF CARRIE R STEVENS ~ SECURITY
S.S. N0. 208-38-5500 X~ sEC ACCT
DATE OF DEATH O 1- 26 - 2011 ~ STOCK
COUNTY CUMBERLAND ~ BONDS
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
FIDELIT Y has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent
If you feel this information is incorrect, please obtain written correction from the transfer agentyoattach a copyftolthisoformlandsset.
return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania.
Questions may be answered by calling C717) 787-8327.
COMPLETE PART 1 BELOW * * ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 73116
To insure proper credit to your account, two
(2) copies of this notice must accompany your
DOD Valuation 13, 301.75 payment to the Register of Wills. Make check
Percent Taxable Payable to: "Register of Wills, Agent".
X 100.00
Amount Subject to Tax 13, 301.75 NOTE: If tax payments are made within three
T a x R ate C3) months of the decedent's date of death,
X . 0 4 5 you may deduct a 5% discount of the tax due.
Potential Tax Due 598.5$ Any inheritance tax due will become delinquent
PART nine C9) months after the date of death.
~ ~\ TAXPAYER RESPONSE
A. The above information and tax due is correct \
CHECK 1. .
You may choose to remit payment to the Register of
a discount o Wills with two copies
f t
0 N E
r avoid interest, or you may check box
Wills and an offici
l o
his notice to obtain
"A" and return this notice to th
R
B L 0 C K
a
assessment will be issued by e
egister of
the PA Department of Revenue.
0 N L Y B. ~ The
to b above asset has been or will be reported and tax
paid with the Pen
e filed b
l
y the decedent's representative. nsy
vania Inheritance Tax return
C• ~ The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART 2n and/or PART ICI below.
PART If you indicate a different tax rate, please state
relationship to decedent: Your
TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSET(S)
LINE 1. DOD Valuation 1
2. Percent Taxable 2 X
3. Amount Subject to Tax 3
4. Debts and Deductions q
5. Amount Taxable 5
6. Tax Rate 6-~
7. Tax Due ~
PAR1
0
DATE PAID
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to th best of my knowle
/~~~~~~/~~ ge and belief.
,~' HOME C '7f'i )73'~'„3(~,~,
TAXPAYER SIGNATU WORK ( ) ~;_
TELEPHONE NUMBER -~ ft-~~
DATE
11EBTS AND DEDUCTIONS CLAIMED `\ \\\ \\\ \~~ \~~\ ~ ~ \ \~
l~~ 10~ S,(v`~HdJO
~J ~d~ -~