HomeMy WebLinkAbout04-23-12COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601 PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
WOOD TRACY J
1 1 10 CHARLES ST
MECHANICSBURG, PA 17055
fold
ESTATE INFORMATION: ssrv: 22s-a4-ss~ s
FILE NUMBER: 2112-0479
DECEDENT NAME: SHAW LURIE B
DATE OF PAYMENT: 04/23/2012
POSTMARK DATE: 04/1 1 /201 2
COUNTY: CUMBERLAND
DATE OF DEATH: 12/05/201 1
REMARKS:
SEAL
CHECK# 1750
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
121 13545 ~ S 17.85
TOTAL AMOUNT PAID:
S 17.85
INITIALS: DMB
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
REV-1162 EX111-961
N0. CD 015880
~ PENNSYLVANIA INHERITANCE TAX r>
INFORMATION NOTICE FILE N0. 21 - ~ '~ ~'~ lvr
BUREAU OF INDIVIDUAL TA , ,,.~~ AND ACN 12113545
Po eox zeo6ol ~~~'~ ~~n ~~ 8 TAXPAYER RESPONSE
HARRISBURG PA 17128-0661._: o~pAaTMeNTdf'.R4w~ue DATE 02-23-2012
~~ 'i- ``~ REV-1543 E% AFP (05-11)
p CuL~E' RK Gfi
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Cl }MRERI . N.^~~1! i C~? . PA
TRACEY J WOOD
1110 CHARLES ST
MECHANICSBURG PA 17055-3946
EST. OF LURIE B SHAW
SSN 226-44-6616
DATE OF DEATH 12-05-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
MEMBERS 1ST F CU 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 PAY"MEN7' INSTRUCTIONS
Account No. 298110-11 Date 12-29-2006 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 $ 793.23 payable to "Register of Wills, Agent".
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
~'~ ~2 MFR 23 F~ I2~ 2l
X 50.000
$ 396.62
X .045
PART
I
Lt
CHECK
ONE
[ BLOCK
ONLY
A3S~SS
A. ~.I The above information and tax due is correct.
CJ Remit Dayment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or return this notice to the Register of Wills and
an official assessment will be issued by the PA Department of Revenue.
B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
filed by the estate representative.
C. ~ The above informs ion is incorrect and/or debts and deductions were Daid.
Complete PART ~Z 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 PAD
1
2
3 X . ,__
4
5
6 `~
7 X
8
OFFICIAL USE ONL1~Lj AAF~.
PA DEPARTMENT OF REVENUE
1
2
?i
4
5
6
7
6
PART DEBTS AND DEDUCTIONS CLAIMED
3^
nnTG peTn PAYEE DESCRIPTION AMOUNT PAID
NOTE: If tax payments are made within three
months of the decedent's date of death.
deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
nine months after the date of death.
TDTAL CtnLer On t.1ne a or Ian mNU~a ~~..~„ -
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 C )
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
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