HomeMy WebLinkAbout03-20-12COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280801
HARRISBURG, PA 17128.0801
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1182 EX(11-961
NO. CD 015724
LONG TERRI L
2048 WEXFORD RD
PALMYRA, PA 17078
roa
FILE NUMBER: 2112-0325
DECEDENT NAME: LONG WAYNE E
DATE OF PAYMENT: 03/ 20/ 2012
POSTMARK DATE: 03/19/2012
COUNTY: CUMBERLAND
DATE OF DEATH: 01 /01 /2012
REMARKS:
SEAL
CHECK# 2987
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
12110856 ~ $332.11
121 10858 ~ $178.31
TOTAL AMOUNT PAID:
$510.42
INITIALS: HMW
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
~ PENNSYLVANIA INHERITANCE TAX
BUREAU OF INDIVIDUAL TAXES ~~~~TION NOTICE FILE No. 21 "'/~'Qa~
Po cox Zaosol 4{,, AN D
pennSylVania ~ , 7•.:~,~ ~y~ ACN 12110856
HARRISBURG PA 17128~06a1 DEPARTMENT OF REVENUE ~i~+L~t'Zi~A,iW~*~~'ER RESPONSE DATE 02-15-.2012
NEY-1543 EX AFP (,3-Il) - '
I2 ~I~{lj 20 ~~ `t; (~~ TYPE OF ACCOUNT
EST.' OF WAYNE E LONG ^ SAVINGS
S$N 191-26-6575 ®cNECKING
~~ {~ ~ DATE OF DEATH O 1- O 1- 2012 ^ TRUST
~~~F~.AN[} ~,}„ COUNTY CUMBERLAND ^ CERTIF.
-REMIT PAYMENT AND FORMS T0:
TERRI L LONG REGLSTER OF WILLS
204$ WEXFORD RD 1 COURTHOUSE SQUARE
PALMYRA PA 17078-9253 CARLISLE PA 17013
ORRST OWN BANK provided the department wtt"~ the infiormation below, which was used in cal cutating the.inheritance tax due.
Records indicate that .at the death of the above-named decedent, you were a ,point ownerlbeneficiary of this account. I1 you. are the Sp017ae Af the
deceased and any amount other than zero is reflected below on the'Potential Tax -0ue line, note no tax may be due, but yyoµ must
notify the department of your relationship to the deceased by checking Box E in PART 1 below and writing "spouse" in PART`2.
If yyou 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 717-787-8321 with questions.
- --CaMPtETE PART 1-$ElOW * SEE REYERSR-SIDE FOR FILING AND PAYMENT I~1$TRUCTIQNS _____
Account No: 149000679 ~ Date 08-11-2010 To ensure vrober credit to the account.. two
Established cevfes of this notice oust accoapaw
Account Balance 46 61.62 pavrent to the Register of Wills. Naka chock
~ payable to "Register of Wills, Agent".
Percent Taxable X 16 .667
NOTE: If tax pavaents are ode within thrsa
Amount Subject to Tax $ 7,768 .59 aonths of decedent's dot of death.
Tax Rate )( , 15 nedu a 5 percen on tM tax dw.
Any inheritance tax due will becoae•delinquent
Potential Tax Due ~ 1 , 165 .29 nine aonths aftor the date of death.
A. ^ The above inforration and tax duo is correct.
Reait payaent to the Register of wills with two covies of this notice to obtain
r CHECK a discount or avoid interest, or return this notice to the Register of Wills and
I ONE ~ an official assessaent will be issued by the PA Departaent of Revenue.
PART _ DEBTS AND DEDUCTIONS CLAIMED
3^ '
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Undor penalties of perjury. I declare that the facts I reported above are true, correct and
complete to the best of my owledge and belx.ef. HOME C ) ~ ^d'
WORK c ~ g
TAXPAYER SIGNATURE TELEPWONE NUMBER ei~.f ~ y`~ T
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