HomeMy WebLinkAbout12-30-11COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
BULLOCK MARY L
28 WIDERWATER DR
NEWNAN, GA 30265
-------- told
ESTATE INFORMATION: SSN: 256-44-3829
FILE NUMBER: 211 1-0457
DECEDENT NAME: HAWKINS DAISY REE
DATE OF PAYMENT: 12/30/201 1
POSTMARK DATE: 1 2/27/201 1
COUNTY: CUMBERLAND
DATE OF DEATH: 04/05/201 1
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
11179852 ~ 525.72
TOTAL AMOUNT PAID:
REMARKS:
SEAL
CHECK#5223
INITIALS: DMB
RECEIVED BY:
525.72
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162EX111-961
N0. CD 015404
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
_ _
r ) , _ #~1FORMATION NOTICE FILE N0. 21 11-0457
BUREAU OF INDIVIDUAL TAXES ;' ~• f
PU BOX 280601 penns~uama~. AND AcN 11179852
HARRISBURG PA 17128-0601 DEPARTMENTOFFtEVENUE- ~•~-~AX P AY E R R E S P O N S E
DATE 12-07-2011
REV-1543 E% RFP (05-11)
'' ``~~ r" + r,
r ~.,...jV I ~ t~ f,~ TYPE OF ACCOUNT
EST. OF DAISY R HAWKINS ~ SAVINGS
_
~
CIE' $$N 256-44-3829 ~ CHECKING
,
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DATE OF
DEATH 04-04-2011
~ TRUST
_
CI )~~`~'; <(1~ ~ } ~~ COUNTY CUMBERLAND ~ CERTIF.
REMIT PAYMENT AND FORMS T0:
MARY BULLOCK REGISTER OF WILLS
38 WIDEWATER DR 1 COURTHOUSE SQUARE
NEWNAN GA 30265 CARLISLE PA 17013
SOVEREIGN BANK 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
.: to the shave address. ?lease call ?1?-???-8?77 with nu?ct;nnc.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0641157711 Date 01-26-2009 To ensure proper credit to the account, two
Established copies of this notice must accompany
payment to the Register of Wills. Make check
Account Balance $ 342.88 payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 171 .44 months of the decedent's date of death,
Tax Rate X 15 deduct a 5 percent discount on the tax due.
- Any inheritance tax due will becone delinquent
Potential TaX DUe $ 25.72 nine months after the date of death.
PART TAXPAYER RESPONSE
~ L1IR TQ RCSP WILT. f~ES ~LT SIN ~fsFIC ~AL TAX ASSESSMENT
A. ~ The above information and tax due is correct.
Remit Davment 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 Resister of Wills and
an official assessment will be issued by the PA Department of Revenue.
C ONE
BLOC K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
O 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 3^ below.
PART If indicating a different tax rate, please state ~ ,~~~CjAL USE .ONL~~AF
relationship to decedent: PA DEPARTMENT OF REVENUE
TAX RE TURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
LINE I. 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 S
6. Amount Taxable 6 '~ 6
7. Tax Rate 7 X 7
8. Tax Due 8 $ 8
PART DEBTS AND DEDUCTIONS CLAIMED
^S
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I reported above are true, correct and
complete to the best of my knowledge and belief. HOME C )
WORK ( )
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
TOTAL CEnter on Line 5 of Tax Computation) S