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HomeMy WebLinkAbout09-14-11REV-1162EX111-96) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT THOMAS BRIDGETTE 1453 THREE SQUARE HOLLOW ROAD NEWBURG, PA 17240 fold ESTATE INFORMATION: FILE NUMBER: DECEDENT NAME: DATE OF PAYMENT: POSTMARK DATE: COUNTY: DATE OF DEATH SSN: 165-26-71 12 2111-0974 SINGER WILLIAM J 09/14/2011 09/03/201 1 CUMBERLAND 06/30/2011 TOTAL AMOUNT PAID: REMARKS: CHECK#1956 SEAL INITIALS: CJ RECEIVED BY: NO. CD 014965 511.39 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ACN ASSESSMENT AMOUNT CONTROL NUMBER ,. ~ PENNSYLFORMATIONENOTICEE TAX FILE _ - IN ACN Y Lew AND BUREAU of INDIVIDUAL TAXES p~~~-~y1~arn~ .. n TAXPAYER RESPONSE DATE PO BOX 280601 17128_0601 ~EPARTMENT.OF.REVERSUE kF `~ HARRISBURG PA -~._ , ~EW~l`~43 _k% AFA (~Y-11) _ !;J }~' 14 t ,_ ~r _ .~, G1,~~J't } '~ BRIDGETTE THOMAS 1242 BLACK GAP RDPA 17222 FAYETTEVILLE EST. OF WILLIAM J SINGER SSN 165-26-7112 DATE OF DEATH 06-30-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQ70R3 CARLISLE PA N0. 21 "~l~~~~ 11156379 p8-24-2011 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. ou are the spouse of the provided the department with the information balow, which was used in calculating the inheritance a be due, but you must ou were a joint owner/beneXiciary of this account. If y Due line, note no tax may in PART 2. s ouse" Box C in PART 1 below and writing P ORRSTOWN BANK checking to this form and return Records indicate that at the death of the above-na t0 the deceased by deceased and any amount other than zero is reflected below on the Potential the department of your relationship notify the information is incorrect, please obtain written correction from the financial 'npAYMENT tINSTRUCTIONS If you believe SIDE FOR FILING AND it to the above address. Please call 717 *7SEEwREVER$Es COMPLETE PART 1 BELOW 01 _ p5-1998 To ensure Proper credit to the account, two Date copies of this notice must accompanMake check Account No. 103000047 payment to the Register of Wills. Established 1 ,5 1 8 9 0 payable to "Register of Wills, Agent . $ 16.667 Account Balance X Percent Taxable $ 253.16 Amount Subject to Tax X ,1 5 Tax Rate $ 37.97 Potential Tax Due TAXPAYER RESPONSE PART 1 CHECK ONE C BLOCK ONLY NOTE: If tax Payments are made within three months of the decedent's date of de~axrdue. deduct a 5 Percent discount on the Anv inheritance tax due will become delinquent nine months after the date of death. AILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX 1 ase state i If indicating a different tax rate, p pART relationship to decedent: 7AX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS IPAD LINE 1. Date Established 2. Account Balance 3, Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate g. Tax Due 2 $ s X 4 '~ 5 6 $ Ii~3A 1 2 3 4 5 6 7 a ASSESSMENT PA DEPARTMENT OF 8 DEBTS AND DEDUCTIONS CLAIMED pART 0 PAYEE DATE PAID _~_ DESCRIPTION ONLY U AAF REVENUE AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) Under penalties of perjury, I declare that the facts I reported above are true, correct a(n~d complete to the best of my knowledge and belief. HOME C ~I~ ) ~J~ ~ ~a _~, j~ "~ 1C p WORK ( ) ~' a i~-~ i ,Q,.(..Li n ~7 ~ DAT E __ _ __,..,.r„~r• TELEPHONE NUMBER 1 A. ^ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain avoid interest, or return this notice to the Register of Wills an the PA Department of Revenue. a discount or an official assessment will be issued by The above asset has been or will be reported and tax Paid with the Pennsylvania inheritance tax return B' the estate representative. filed by C, The above information is incorre3t below. debts and deductions were poi . Complete PART 2~ and/or PART ~ OFFICIAL USE ., i BUREAU OF INDIVIDUAL TAXES P~~nsyl,~ania PO BOX 280601 fc F,] J 4 ''d» HARRISBURG PA 17128-0601 n' p~EPARTMENVOF R~VEN,y~. ,.. _. REJ.-1543 E% AFP (OS`-lit )', PENNSINFORMATIONENOTICEE T AND ;1r- TAXPAYER RESPONSE ~~ ~~~~: ~.~j ~RPNi~,~v~~? {.~~o~.~~T PAULINE M S'ING~R~ 1453 N HARMON RD PA 17240 NEWBURG FILE N0. 21 ~~ ~ `~ ~'~~~~ ACN 11156378 DATE 08-24-2011 EST. OF WILLIAM J SINGER SSN 165-26-7112 DATE OF DEATH 06-30-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQ7013 CARLISLE PA TYPE OF ACCOUNT SAVINGS © CHECKING TRUST CERTIF. inheritance tax due. o ark the spouse of the provided the department with the information below. which was used in calculating 13e d but you must pint owner/beneficiary of thinoteon0 tax m Yu ~~~ in PART 2. ine. s 'fuse ORRSTOWN BANK 1 to this form and return checking Box C in PART 1 below and writing p Records indicate that at the death of the above-named decedent. You were a deceased and any amount othoU~ relationship tofthe deceased by the Potential Tax Due notify the department of y lease obtain written correction from the financial institution, attach a copy If you believe the information is incorrect, p SIDE FOR FILING AND PAYMENT INSTRUCTION it to the above address. Please call 717 * 7SEE wREVERSEs COMPLETE PART 1 BELOW 01-05-1998 7o ensure proper credit to the account, two Date copies of this notice must accompany Account No. 103000047 Established payment to the Register of Wills.en{ake check 1 , 518 .90 payable to "Register of Wills. As Account Balance X 16.667 NOTE: If tax payments are made within three Percent Taxable 253.16 months of the decedent's date of death, . O 0 deduct a 5 percent discount on the tax due. Amount Subject to Tax X Any inheritance tax due will become delinquent Tax Rate OQ nine months after the date of death. Potential Tax Due XppYER RESPONSE P ART 1 CHECK ONE C BLOCK ONLY TA AILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT A ^ The above information and tax due is correct. 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 an the PA Department of Revenue. an official assessment will be issued by The above asset has been 5e^ ativee reported and tax Paid with the Pennsylvania inheritance tax return B the estate rep re filed by C, ~ The above information is incorre3t below. debts and deductions were paid. RT 2~ and/or PART Complete PA UJt uiaLY LJ A'~`F OFFICIAL If indicating a different tax rate, Please state pA DEPARTMENT OF REVENUE PART relationship to decedent: X ON JOINT/TRUST ACCOUNTS PAD - CALCULATION OF TA I - TAX RE TURN 1 ~ 2 - LINE 1. Date Established 2 $ 3 - 2, Account Balance 3 X 4 - 3, percent Taxable 4 5 - G Amount Subject to Tax . 5. Debts and Deductions ~ $ 6• 6. Amount Taxable X 7 I 7 a 7, Tax Rate g. B Tax Due DEBTS AND DEDUCTIONS CLAIME PART 3~ DESCRIPTION PAYEE DATE PAID s TOTAL CEnter on Line 5 of Tax Computation) -^~ AMOUNT PAID Under penalties of perjury, I declare that the facts I repor HOME ovC are j omplete to the best o my knowledge and belief. C , WORK DA E- ~, / ~ TELEPHONE NUMBER ~' ~~ e5, ~i. t ~t €^~# i ~ S~ r~ } r. ly~ r ;~ .w t`~ s+ °`` ao~ °~ ~~~ a ~ °¢" o x ; a,z~ 3 ~~z S69 ! l ~.Ir ~" , _ ~ .:_ r ~ CL~FI< GF~ ppn;J"nl~~' ~":r~a EyT ill"- ti";`~! : ,;v~.~; ~ in r,! 'F 1t'~~ ~ h~~ r,'{'v;r i hi O s d ~ o ~ ~' ~ o •rr i;! t13 ! ~i its i :~ .,.., ~~'' .,.~