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HomeMy WebLinkAbout21-11-1114COMMONWEALTH OF PENNSYLVANIA REV-1162 EX~11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 015090 BROWN STEVEN R 921 BIG SPRING RD SHIPPENSBURG, PA 17257 ACN ASSESSMENT AMOUNT CONTROL NUMBER fold ESTATE INFORMATION: ssN: 0~~-20-~00~ FILE NUMBER: 211 1-1 1 14 DECEDENT NAME: BROWN GILBERT S DATE OF PAYMENT: 10/ 21 / 201 1 POSTMARK DATE: 10/ 1 3/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 08/27/201 1 REMARKS: SEAL CHECK# 1040 11161688 ~ 5198.07 11161689 ~ 564.56 11161690 ~ 55,315.97 TOTAL AMOUNT PAID: 55,578.60 INITIALS: HMW RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~~` PENNSYLVANIA INHERITANCE TAX ,,,, ,I ORMATION NOTICE j f y BUREAU OF INDIVIDUAL TAXES t rr ~ 4 ', G f !L FILE NU. 21 ~' ~- 11 t ? . VVV III Po aox zaocol pennsy T1~F~. ~, ACN 11161690 HARRISBURG PA Inza-0601 oEanarMeNroRF~E~ENUE '-!:~~~4XPAYER RESPONSE DATE 09-16-2011 REV-1543 EX AFP (05 -11) .., t . ,~ ` ~ ~. ... - EST. OF GILBERT S BROWN ~~~~~{ ~~F ssN oll-2o-Tool ~~Pf~~~~'~ ~L,~~~~- DATE OF DEATH O8 - 27 - 201 I CIJ~~~~ rg~t~^ ~,-,, ~n COUNTY CUMBERLAND A. REMIT PAYMENT AND FORMS T0: STEVEN R BROWN REGISTER OF WILLS 921 BIG SPRING RD 1 COURTHOUSE SQUARE SHIPPENSBURG PA 17257-9753 CARLISLE PA 17013 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST F CU provided 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 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. 347503-05 Date 03-12-2009 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance 276,315.13 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 $` 138 ~ 157.57 months of the decedent's date of death, Tax Rate )( .045 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ 6 ~ 217.09 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPONb 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 0 N E an official assessment will be issued by the PA Department of Revenue. 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 fi by the estate representative. C. The above informs ion is incorrect and/or debts and deductions were paid. Complete PART ~2 and/or PART ~ below. OFFICIAL USE ONLY ~ AAF PA DEPARTMENT OF REVENUE 1 2 3 4 5 6 7 8 PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE, PAID PAYEE DESCRIPTION AMOUNT PAID PART If indicating a different tax rate, please state relationship to decedent: TAX RETURN - CALCULATION OF TAX ON J INT/ RU~„T ACCOUNTS LINE 1. Date Established 1 ~ ~ 2. Account Balance 2 3. Percent Taxable 3 X Q-~ 4. Amount Subject to Taz 4 5. Debts and Deductions 5 6. Amount Taxable 6 $ O ~ 7. Tax Rate 7 X • 8. Tax Due 8 $ ~ PAD ~/~~ l r I D~ G "M ~ ,~ O vF F M I G~ G A G ® D F u dti ~ N ~ ~~ D '~ TUTAL CEnter on~Line 5 of iax Compuia a onu s '. i Under alties of perjury, I declare that the facts I reported above are true,'~cjoryrect and com the est f my knowledge and belief. HOME C ) L ,~ woRK t ) /U~~/~ ~ c f T XPAYER SIGNATURE TELEPHONE NUMBER A __ BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 °~` PENNSYLVANIA INHERITANCE INFORMATION NOTICE ~~ ~lvania ;;-~~ AND ~oeq,~a>t~o~,g6ueNUe' `~-'-- ~ TAXPAYER RESPONSE REV {1'.~Gy EX'-RFP~ fR5 -11) ` J TAX FILE N0. 21-~ I' ((~~ ACN 11161689 DATE 09-16-2011 ORPHi~,i~± S ~sl)rsT STEVEN R BROWN~'l~~ ~~ ~ `~ ~ ` ~ D~. 921 BIG SPRING RD SHIPPENSBURG PA 17257-9753 EST. OF GILBERT S BROWN SSN 011-20-1001 DATE OF DEATH 08-27-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. MEMBERS 1ST F CU provided 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 you are the Sp0U5e 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 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. 34750 3-1 1 Date 01-26-2009 7o ensure proper credit to the account, two Established copies of this notice must accompany Account Balance 3 020.4$ 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 $ 1,510.24 months of the decedent's date of death, Tax Rate X . 045 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ 67.96 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPDND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT A. he 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 C 0 N E ~ an official assessment will be issued by the PA Department of Revenue. BLOC K g. ~ 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 ONLY ~ AAF relationship to decedent: PA DEPARTMENT OF REVENUE TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established 1 1 2. Account Balance 2 $ 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ 4 5. Debts and Deductions 5 5 6. Amount Taxable 6 '~ 6 7. Tax Rate 7 X 7 8. Tax Due 8 $ 8 PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above are true, correct and comp to t best of my knowledge and belief. HOME C ) WORK C ) ®r/~ TA PAYER SIGNATURE TELEPHONE NUMBER A TOTAL CEnter on Line 5 of Tax Computation) 8 ° ~ PENNSYLVANIA INHERITANCE TAX i~ INFORMATION NOTICE FILE N0. 21) ~ 1~ BUREAU OF INDIVIDUAL TAXES • I ' 't Po Box zsocol pennsyf~'.~ 1~a. ~ ~ _,~ AND ACN 11161688 HARRISBURG PA 17128-0601 DEFaHTMEw7 0F5lEpENUE - ~~~~~~~-~P AY E R R E S P O N S E i"~~.~ DATE 09-16-2011 REV-1543 E% ~FP 1115 =Y 1)~~ '" g~ r CLE~E< C~ a~~H~~~s ~~ ~~~T STEVEN R BROWN 921 BIG SPRING RD SHIPPENSBURG PA 17257-9753 EST. OF GILBERT S BROWN SSN 011-20-1001 DATE OF DEATH 08-27-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT © SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST F CU provided 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 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, attach a copy to this form and return 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. 347503-00 ~ Date 01-2 6-2009 To ensure proper credit to the account, two Establ ished copies of this notice must accompany payment to the Register of Wills. Make check Account Balance 9 266 , .30 payable to "Register of Wills, Agent". Percent Taxable X 50 .000 NOTE: If tax payments are made within three Amount Subject to Tax $ 4,633 .15 months of the decedent's date of death, Tax Rate X . 045 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ 208 .49 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESUL T IN AN OFFI CIAL TAX ASSESSMENT A. C A The above information and tax due is correct. L~J 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 ONE an official assessment will be i ssued by the PA Department of Revenue. B L 0 C K g. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return D 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 ONLY ~ AAF relationship to decedent: PA DEPARTMENT OF REVENUE TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established 1 1 2. Account Balance 2 $ 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ 4 5. Debts and Deductions 5 5 6. Amount Taxable 6 '~ 6 7. Tax Rate 7 X 7 8. Tax Due 8 $ 8 PART DEBTS AND DEDUCTIONS CLAIMED ^3 DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) S Under enalties of perjury, I declare that the facts I reported above are true, correct and comp t~ be t of,I my knowledge and belief. HOME C ) c..- /~- j~Z~L~~- WORK ( ) ~j~/ AXPAYER SIGNATURE TELEPHONE NUMBER DAT ~.':' CSf -' ~i ~_.~' :..i7 ~ .:.7. ~ i .. 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