HomeMy WebLinkAbout01-31-12COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
REV-1162 EX111-96)
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
N0. CD 015526
ANDRICK DONNA
516 EAST COOVER ST
MECHANICSBURG, PA 17055
fold
ESTATE INFORMATION: SsN: 516-46-2057
FILE NUMBER: 211 1-1353
DECEDENT NAME: KEMP ROBERT JAMES
DATE OF PAYMENT: 01 /31 /201 2
POSTMARK DATE: 01 /31 /2012
couNTY: CUMBERLAND
DATE OF DEATH: 1 2/ 1 7/201 1
REMARKS:
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
12100426 ~ 51, 547.43
TOTAL AMOUNT PAID:
51,547.43
CHECK# 5699
INITIALS: HEA
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIYIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
~~.
Pennsylvania
DEPARTMENT OF REVENUE
REV-1543 E% AFP (05-11)
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE FILE N0. 21
AND ACN 12100426
TAXPAYER RESPONSE DATE 01-03-2012
EST. OF ROBERT J KEMP
SSN 51b-46-2057
DATE OF DEATH 12-17-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
DONNA D ANDRICK REGISTER OF WILLS
51b E COOVER ST 1 COURTHOUSE S(~UARE
MECHANICSBURG PA 17055-4227 CARLISLE PA ]17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
SOV EREIG N 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 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 be'1ow 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. 2331026211 Date 06-12-1987 To ensure proper credit to the account, two
Established copies o~F this notice must accompany
Account Balance 20 , 735.99 Payment Ito the Register of Wills. Make check
payable Ito "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: IMF tax payments are made within three
Amount Subject to Tax $ 10,368.00 months o1F the decedent's date of death,
Tax Rate X 15 deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
Potential Tax Due ~ 1 , 555.20 nine months after the date of death.
PART TAXPAYER RESPONSE
~ 1rAIL TO RE WId~. SU~.T OF TAX ASS 7
...;
A. ~ The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to ob9$~pQ rv f~r'i
a discount or avoid interest, or return this notice to the Register of Will --~~77~'~"Zjjjj Cam„
C C 0 N E K ~ 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 p~ ~nce t~ return -;E'#`
ONLY filed by the estate representative. ~C/~~ ~""' ti' S'")
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 OF TAX ON JOINT/TRUST ACCOUNTS
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
1
2
3 X
4
5
6
7 X
8
~ICiAI~ USE 'l.Y,
ARTMENT OF RG,YENI~E
AD
1
2
3
4- _ -_ .~ ... . _ ..... .~.
5
6
7
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I reported above are true,
correct and
complete to th best of
m
y knowledge and belief. HOME ( ~~~~ -l
) S~~O ~~4y S
~
)
DATE
TOTAL (Enter on Line 5 of Tax Computation) 8