HomeMy WebLinkAbout08-09-11COMMONWEALTH 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
BAER DONNA M
18 LONGWOOD DR
MECHANICSBURG, PA 17050
fold
ESTATE INFORMATION: ssN: i so-26-5ss2
FILE NUMBER: 211 1-0859
DECEDENT NAME: CORKLE ELLEN L
DATE OF PAYMENT: 08/09/201 1
POSTMARK DATE: 08/05/201 1
COUNTY: CUMBERLAND
DATE OF DEATH: 06/27/201 1
AMOUNT
ACN
ASSESSMENT
CONTROL
NUMBER
11150020 ~ 52.85
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 205
SEAL
52.85
INITIALS: HMW
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
FiEV-1162 EX(11-96)
NO. CD 014820
REGISTER OF WILLS
BUREAU OF INDIVIDUAL C~S`~: i
PU BDX 260601 pen
HARRISBURG PA 17128-06 Q~ oE.PkRTM
REV-1543 E% AFP (OS-I1)
i
TAX' y _
FILE N0. 21 "~/ c~/~`~ /,
ACN 11150020
DATE 07-27-2011
..: ~~~ ° +~~ i ( ~ ._ ~
c~.~~K o~
ORFi~~~~'S Ci~I.RT
r~, ~i~,
Cllr. r ,' ~~r; Pp
DONNA M BAER
18 LONGWOOD DR
MECHANICSBURG PA 17050
EST. OF ELLEN L CORKLE
SSN 180-26-5692
DATE OF DEATH 06-27-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
MEMBER S 1ST F CU Drovided 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 y0U 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
*_ to the zhove address. Please call 717-787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 108460-00 Date 05-09-1989 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 $ 4UD•23 payable to "Register of Wills, Agent".
Percent Taxable X 16.6b7
NOTE: If tax payments are made within three
Amount Subject to Tax $ 66.71 months of the decedent's date of death,
Tax Rate )( .045 deduct a 5 Dercent discount on the tax due.
Any inheritance tax due will become delinquent
Potential Tax Due $ 3 • OD nine months after the date of death.
PART TAXPAYER RESPONSE
FAI,L}URE TO RESPDND WILL RESULT IN AN OFFICIAL TAX ASSESSI'IENT
A. I.{I The above information and tax due is correct.
u 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
C H E C K an official assessment will be issued by the PA Department of Revenue.
C ONE
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 ~ below.
PART If indicating a different tax rate, please state OFFICIAL USE 0 NL Y U AA F
relationship to decedent: PA DEPARTMENT OF REVENUE
TAX RE TURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
LINE 1. Date Established i 1
$ 2
2. Account Balance 2 ~
3. Percent Taxable 3 X 3
4. Amount Subject to Tax 4 $ 4
5
5. Debts and Deductions 5 ~
6. Amount Taxable 6 `fi 5
7. Tax Rate ~ X ~
8. Tax Due B '~ ~ 8
Under penalties of perjury, I declare that the facts I reported above are true, ,c/o/rr/~ect: and 2 //' '-
compl e o the best of my knowledge and belief. HOME ~ ~ ~ j '/ y ~ - ~~-% L~ !O
., WORK C ) ~ /~
~XPAYER SIGNATU E TELEPHONE NUMBER
-~ PENNSYLVANIA INHERITANCE
~ rr INFORMATION NOTICE
n5~ ~{~/ nla AND
EN~OF;REN UE TAXPAYER RESPONSE
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION AMOUNT PAID