HomeMy WebLinkAbout03-12-12COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INCIVIDU AL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
MONROE ANTHONY W
204 E STREET
APT 4
CARLISLE, PA 17013
-------- told
REMARKS:
CHECK# 377
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ACN
ASSESSMENT
CONTROL
NUMBER
TOTAL AMOUNT PAID:
INITIALS: CJ
AMOUNT
524.77
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
REV-1162 EX111-961
NO. CD 015689
-~ PENNSYLVANIA INHERITANCE TAX
~~ INFORMATION NOTICE FILE N0. 21 -~,-~,~~5
BUREAU OF INDIVIDUAL TAXES
Po BOX 260601 Pen ~ ,, ~^ AND ACN 11159140
HARRISBURG PA 17128-0601 F' ~ `.l~ i.'~
D EPARTMENI (1F~AEflENU E. AXPAYER RESPONSE
=%~-- °!~ ! C DATE 08-31-2011
REV-1543 iE#,pER~Sy5-11)- i-,+,j
TYPE OF ACCOUNT
~'~ {~ ~~~ ~ ~ i'-~ ~~' ~ ~ EST. OF DAWN M MONROE ~ SAVINGS
SSN 193-58-4189 ~ CHECKING
C~~~~~ J- DATE OF DEATH 08-19-2011 ~ TRUST
Q(~~'J-(~,~'~ 4~~~~j COUNTY CUMBERLAND ~ CERTIF.
C~~~r~y~-~} ~~,~~"'~ ~~ ~p REMIT PAYMENT AND FORMS T0:
ANTHONY W MONROE REGISTER OF WILLS
240 E STREET 1 COURTHOUSE SQUARE
APT 4 CARLISLE PA 17013
CARLISLE PA 17013
MEMBERS 1ST FCU 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. 1350 68-1 1 Date 10-18-2007 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 $ 1 ~ 100.81 payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 550.41 months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Anv inheritance tax due will become delinquent
Potential Tax Due $ 24.77 nine months after the date of death.
P~r TAXPAYER RESPONSE
~ FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT
A. /The above information and tax due is correct.
/L.~ Remit payment to the Register of Wills with two copies of this notice to obtain
\
/ a discount or avoid interest, or return this not ice to the Register of Wills and
C H E C K 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
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
TAX
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 1
2 $ 2
a X 3
4 $ 4
5 - 5
6 '~ 6
7 X 7
8 $ 8
OFFICIAL USE DNLY ~ AAF
PA DEPARTMENT OF REVENUE
PART DEBTS AND DEDUCTIONS CLAIMED
3^
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Unde pe ties o perjury, I declare that the facts I reported above are try,e correc~ n
co a to tf est of m knowledge and belief . HOME C 11~ ) J~
WORK t )
TAXP E IGNATURE TELEPHONE NUMBER
If indicating a different tax rate, please state
relationship to decedent:
RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
TOTAL (Enter on Line 5 of Tax Computation) S
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