HomeMy WebLinkAbout09-20-11COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 1 7 1 28-0601
RECEIVED FROM:
SZAJEK JOEL
1014 SOUTHFIELD COURT
HARRISBURG, PA 17111
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PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ESTATE INFORMATION: SSN: ~ 96-05-~ 899
FILE NUMBER: 21 1 1-0355
DECEDENT NAME: SZAJEK JOSEPH
DATE OF PAYMENT: 09/20/201 1
POSTMARK DATE: 09/ 1 9/201 1
COUNTY: CUMBERLAND
DATE OF DEATH: 01 /22/201 1
REV-1162 EX111-961
N0. CD 014983
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
11156143 ~ 534.16
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 302
SEAL
INITIALS: DB
534.16
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
~ PENNSYLVANIA INHERITANCE TAXI
INFORMATION NOTICE ~, FILE NO. 21 11-0355
BUREAU OF INDIVIDUAL TAXFjS^r ~ ~ : -
PD eox zso6ol ~._ ~~„nsy~V~~ AND ACN 11156143
HARRISBURG PA 171za-o6ol - oEPngTroENroF.R&v~Wbe TAX P A Y E R R E S P O N S E
ll iDATE 08-23-2011
REV-1543 EX 0.FP (0$-11)
TYPE OF ACCOUNT
EST. OF JOSEPH P SZAJEK ~ SAVINGS
SSN 196-05-1899 ~ CHECKING
rl°~ !'
~-E~"` r`
DATE OF
DEATH O 1 - 22 - 2011
~ TRUST
T
C,~~N"r,! .` t .~i ~Rl COUNTY CUMBERLAND ~ CERTIF.
C~~Pv~i LI ~t ' r:~ p~ '
REMIT PAY MENT AND FORMS
i0:
JOEL A SZAJEK REGISTER OF WILLS
1014 SOUTHFIELD CT 1 COURTHOUSE SQUARE
HARRISBURG PA 17111 CARLISLE PA 17013
SOVEREIGN BANK provided the department with the information below, which was used in calculating the inheritance tax cue.
Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you 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, at~ach a copy to this farm and returr
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. 0971119325 Date 12-10-2009 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance 1 , 518.31 payment to the Register of Wills. Make check
$ Payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 759.16 months of the decedent's date of death,
Tax Rate ~( 15 deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
Potential Tax Due ~` 113.87 nine months after the date of death.
PART TAXPAYER RESPONSE
1^
FAILURE 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
C H E C K a discount or avoid interest, or return this notice to the Register of Wills and
an official assessment will be issued by the PA Department of Revenue.
ONE
~
BLOC 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 information is incorrect and/or debts and deductions were paid.
YYY~~~ Complete PART 2~ and/or PART 3~ below.
PART
TAX
LINE
If indicating a different tax rate, pl ase s, ate
relationship to decedent: ~{- ~ `~ ~ ~('y~ ~
RETURN - CALCULATION
1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OFFICIAL USE ONLY ~ AAF
PA DEPARTMENT OF REVENUE
OF TAX ON JOINT/TRUST ACCOUNTS PAD
l Via- ~o-.~e~1 I
2 $ l~t~,3~ ~ 2
~
3 X SO.OC I
~ 3
4 $ ~fj~,~lo 4
5 5
7 X ~.~ c~ ~
s $ 3'-t .1 M s
PART DEBTS AND DEDUCTIONS CLAIMED
^3
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Und r penalties of perjury, Ind Clare that the facts I reported above Hare true {correct and
com ete t the b t of my kno edge and belief. HOME C `~ ~ ~ ~~:~ - ~=~'
WORK C ) IUD c~l,
TAXP ER S NATU TELEPHONE NUMBER DA E
~ TOTAL (Enter on Line 5 of Tax Computation) 5
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