HomeMy WebLinkAbout08-22-05 (2)__ _
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COMMONWEALTH OF PENNSYLVANIA REV-1162 EX111-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBUR~~, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 005717
KENNEDY MARY R
628 TRUSH CT
MECHANICSBURG, PA 17050
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
fold
ESTATE INFORMATION: SSN: is4-42-975$
FILE NUMBER: 2105-0748
DECEDENT NAME: SHUEY ALBERTA E
DATE OF PAYMENT: 08/22/2005
POSTMARK DATE: 08/15/2005
couNTY: CUMBERLAND
DATE OF DEATH: 05/ 1 6/2005
REMARKS:
CHECK#118
SEAL
05133114 ~ 5349.80
TOTAL AMOUNT PAID:
5349.80
INITIALS: JA
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE I N FO RMAT I O N N OT I C E
BUREAU OF INDIVIDUAL TAXES _ ^.."~'~'."t} r^ ~~"?~~
DEPT. 280601 _
HARRIS8UR6, PA vlzs-obol '"`TAXPAYER " R E S PO N S E
REV-1545 E% ~FP c09-007
FILE N0. 21 ~.` ~~ ~`'~SS
ACN 05133114
DATE 07-19-2005
_ „P, r., ,~, # ,~ TYPE OF ACCOUNT
^A^ ~ '.'^ ~~;EST`.~ ~~~' ~LBERTA E SHUEY ^ SAVINGS
S; ~._ N0. 194-42-9758 ® CHECKING
- DAVE, OF DEATH 05-16-2005 ^ TRUST
,..-~_
COUNTY CUMBERLAND ^ CERTIF.
REMIT PAYMENT AND FORMS T0:
MARY R KENNEDY REGISTER OF WILLS
628 TRUSH CT CUMBERLAND CO COURT HOUSE
MECHANICSBURG PA 17050 CARLISLE, PA 17013
v
PSECU 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, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. duestions may i.e a~~aMereu by call i.^.g C:1?] ?9?-??2?.
COMPLETE PART 1 BELOW * ~ * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0194429758-4
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
u
TAX RETURN - COMPUTATION
LINE 1. Da :e :stablished
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
PART
DATE PAID PAYEE
Date 10-03-1994
Established
5,829.99
x 50.000
2,915.00
x .12
349.80
Ta insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent°.
NOTE: If tax payments are made within three
(3) months of the decedent's date of death,
you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9l months after the date of death.
DESCRIPTION
AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
oonplete to the best of ny knowledge and belief. HOME C ~r7 ) 7 6 r "T/~_,~ ~~.5~oS
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i~Q~Y,-c y. ! \ •~~ zLz`a_~3i WORK ( )
TAX AYER GNAT RE TELEPHONE NUMBER DATE
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