HomeMy WebLinkAbout12-30-11COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
BRYNER TIM
32 W WILLOW STREET
CARLISLE, PA 17013
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PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
ESTATE INFORMATION: ssrv: 000-00-0000
FILE NUMBER: 211 1-0624
DECEDENT NAME: BRYNER FLORENCE A
DATE OF PAYMENT: 12/30/201 1
POSTMARK DATE: 12/30/201 1
couNTY: CUMBERLAND
DATE OF DEATH: 04/23/201 1
REMARKS:
CHECK# 327
SEAL
11174041 ~ 567.06
TOTAL AMOUNT PAID:
INITIALS: DMB
567.06
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REV-1162 EX(11-96)
NO. CD 015403
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES rj~~- '' '' +""}"",4'; '
Po Box zsocol ~~ng~/(v/~~}j~
HARRISBURG PA 17128-0601 _ pEPARTMENT OF REYE'NU
REV-1543 EX AFP (05-11)
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE FILE N0. 21 11-0624
AND ACN 11174041
TAXPAYER RESPONSE DATE 11-11-2011
.~ 1"t is ~ r ,~ .:
EST. OF FLORENCE A BRYNER
_ SSN 209-20-2156
~'~.~~t\ ~~ `~- DATE OF DEATH 04-23-2011
I~tipK~'~~~ , '~'~r COUNTY CUMBERLAND
C~1~-b-~ 'S I ^ ` ~'Q REMIT PAYMENT AND FORMS T0:
TIMOTHY W BRYNER REGISTER OF WILLS
32 W WILLOW ST 1 COURTHOUSE SQUARE
CARLISLE PA 17013-3859 CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
METRO 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 y0U art 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. 537310807 Date 07-01 -2003 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 894. 17 payable to "Register of Wills, Agent".
Percent Taxable X 50. 000
NOTE: If tax payments are made within three
Amount Subject t0 Tax $ 447.09 months of the decedent's date of death,
TeX Rate ~( , lj deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
Potential Tax Due $ 67.06 nine months after the date of death.
P~r TAXPAYER RESPONSE
~ ,..... ,
F~I~ E TO RESP ILL R AhP~flFFICIdL TAX ASS Ei,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
0 N E an official assessment will be issued by the PA Department of Revenue.
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
relationship to decedent:
TAX RETURN - CALCULATION
LINE 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
OF TAX ON JOINT/TRUST ACCOUNTS
1 %- / - .~ ~~C~ 3
2 S ?3CI ~/, l 7
3 X Sb . ~OfrJ
4 $ yy7, 09
5 ~ p
6 `~ 4 L~ 7, ~ 7
7 X .IS
v~
PART
P D
DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
fIFFiG~L USE 0,~ ~ AAF
PA DEPARTMENT OF REVENUE °~~
i
2 ~
3
4
5
6
7
8 ~~~
TOTAL (Enter on Line 5 of Tax Computation) S ~
Under penalties of perjury, I declare that the facts I reported above are true,nnc//orr~e7ct! ayn'd
complete to the best of my knowledge and belief. HOME C 7/ 7 ) /'~(7 ~/"/~/
_ WORK C )~~~
TAXPAY ATURE TELEPHONE NUMBER DATE