Loading...
HomeMy WebLinkAbout11-29-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: KEISER THOMAS L 109 SALASIN DR AVONDALE, PA 1931 1-9799 fold REV-1162 EX(11-961 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: SSN: X42-20-0805 FILE NUMBER: 211 1-1271 DECEDENT NAME: KEISER LEONARD DATE OF PAYMENT: 1 1 /29/201 1 POSTMARK DATE: 1 1 /23/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 10/21 /201 1 ACN ASSESSMENT CONTROL NUMBER NO. CD 015264 AMOUNT 11173408 ~ 534.58 TOTAL AMOUNT PAID: REMARKS: 534.58 CHECK# 1520 INITIALS: DMB SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES ~~-'~-'•~~ ~ ~ ~-~~~~ PD BDX 266661 p~nnsylyania HARRISBURG PA 17128-0601 DEPARTM2NY OF REVENUE ;' REV-1543 EX AFP (05-11) PENNSYLVANIA INHERITANCE TAXI ,, INFORMATION NOTICE FILE ~~~ AND ACN '_~ TAXPAYER RESPONSE IDATE N0.21r ~~-`~~) 11173408 11-07-2011 e' V EST. OF LEONARD KEISER rL~r, ~;~ ssN 142-20-0805 C~'r ~ ~" ~ ~, },`~,r~T DATE OF DEATH 10 -21-2011 ~ d'-?! ` ~ C~)ivi'_~' i ~ ,~i ~ "~~ PA COUNTY CUMBERLAND ~, ~. . REMIT PAYMENT AND FORMS T0: THOMAS L KEISER REGISTER OF WILLS 109 SALASIN DR 1 COURTHOUSE SQUARE AVONDALE PA 19311-9799 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 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, Dlease 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. 28204 - 11 Date 11 - 03- 1984 To ensure proper credit to the account, two Established copies of this notice must accompany ACCOUnt Balance 1 536.85 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 $` 768 • 43 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 $ 34.58 nine months after the date of death. PART TAXPAYER RESPONSE 0 I, S~OI~D L.T„ IN F CI SSE~IT 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. 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 ~2 and/or PART ~ below. PART If indicating a different tax rate, please state \~ 0 CIA US ONLY AAF relationship to decedent: \~~~~ °°°°°~°~°~ PA DEPARTMENT OF REVENUE TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Taz Rate 8. Tax Due 1 2 $ 3 X 4 5 - 6 $ 7 X 8 1 2 'i 4 5 6 .. 7 8 ~~~.~.. ... .....o ,..~............... PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) S Under penalties of perjury, I declare that the facts I reported above/a_re true, correct and com to the best f my knowledge and belief. HOME C~['/~ ) Z~.$ ~ ~Z~f ~~Q..~rZ, WORK C 30'1. ) 42~] - '~'~~~' 11 iq 2~-1 TAXPAYER SIGNATURE TELEPHONE NUMBER DATE S. . ~ Y I +, ~ ~~ rd t} ` ~ ~ ~~ ~\ r '~ y~ / ~ ~ ~ ~ ~ s ~ ~ ~ _ U ~ ~ ~ 'V .~ ~ ~ ~ g ~ ?PI .... ~ P~ W ... ~ j I I~