HomeMy WebLinkAbout05-29-12BUREAU OF INb1V IDUAL TA%ES
PO BOX 280601
HARRISBURG PA 1712 R-0601
Pennsylvania
OEPAPTMENT OF gEVENUE
REY-1543 EM RFP [BS -11)
PENNSYLVANIA INHERITANCE T
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE N0. 21 ~- 1
ACN 12123756
DATE 04-05-2012
TYPE OF ACCOUNT
E$T. OF PHYLLIS R DELLAFIORA ® snviwcs
$$N ^ CHECKING
DATE OF DEATH 03-20-2012 ^ rRUSr
COUNTY CUMBERLAND ^ CERTIF.
REMIT PAYMENT AND FGRMS TD:
CORAL D DELLAFIORA
2115 CREEK HILL RD
LANCASTER PA 17601-5703
REGISTER OF WILLS
1 COURTHOUSE SgUARE
CARLISLE PA 17013
MEMBERS 1ST FCU provided the department with the information below, which was used in cal culatinq the inheritance tax tlue.
Records intli sate that at the tleath of the above-nametl decetlent. you were a ,l of nt 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 wri tl ng "spouse" 1n 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 atltlress. Please call 717-787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 47426-00 Date 01-29-1985 To ensure mower credit to the account, two
Established conies of this notice wust acconwanv
Account Balance 6 692.87 wavwent to the Rewi star of Wills. Make check
~ way able to '•Register of Wills. Aaent".
Percent Taxable X 50.000
NOTE: if L'ax wavwents are na tle within kh ree
Amount Subject to Tax S` 3,346.44 non the of the decetlenk's date of death,
Tax Rate X .045 deduck a 5 wercent di nt on the ~ tlue.
Am inhe ri lance tax tl 1 beconr j linauent~
Potential TaX Duo g 150.59 nine wont h:: of ker the 7of death. ~.'El
P~T TAXPAYER RESPONSE wZ, ~ c,:.4;
~ <:h r
A. `.~Jf The above information antl tax tlue is correct. 0("-` ~
.lSI Renit waynent to the Reaister of Wills with two conies of Yhis notice to ~Cid } '~
CHECK a tli scount or avoid interesT, or return this notice ko the Register of Wi ~ad ~ ]a- =-'
an official assesswenk will be issuetl by the PA Oewartwent of Revenue. 11
ONE n'-'+ fV r~_ i'n`i
[ BLOCK ~ B. ^ The above asset has been or will be rewortad and tax paid with the Pennsvlvania inhe ritanc[ti}ax re~'ur~
ONLY filetl by the estate rewresentative.
C. ^ The above inforna ion is incorrect and/or debts antl tletlu ctions were waitl.
ConDlete PART 2~ antl/or PART ~ below.
PART If indicating a tlifferent tax rate, please state •~~~iitir:~r : 5 {i ~+~ ~'
P t+
relationship to decadent: "~#4}~«: ~ ~ ~{ ti {"t
TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS k~ " { ~ °~~~
LINE 1. Date Establishetl 1
2. Aecpunt Balance 2 $
3. Percent Taxable 3 X
4. Amount Subject to Tax 4 $
5. Debts and Deductions 5
6. Amount Taxable 6 $
7. Tax Rate 7 X
8. Tax Due 8
PART DEBTS AND DEDUCTIONS CLAIMED
3^
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
rnrAi rF~rwr ww i fm> 5 ,3t rte. r,..,,:~f ~tfnnT A
Under penalties of perjury, I tle<lare that the facts I reported above are true, ¢¢c//o~lrn~riec t/n~an
complet~`to th best of my knowledge antl belief. HOME (/"//7 7 ~.1 'fd' d~.
WORK ('I/ ~/ ) /„ 4 ri -
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1~128~0601
RECEIVED FROM:
FASSNACHT CORAL D
2115 CREEK HILL RD
LANCASTER, PA 17601
role
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ESTATE INFORMATION: ssN: 2oz-36-saaz
FILE NUMBER: 2112-0604
DECEDENT NAME: DELLAFIORA PHYLLIS R
DATE OF PAYMENT: 05/29/2012
POSTMARK DATE: 05/21 /201 2
COUNTY: CUMBERLAND
DATE OF DEATH: 03/20/2012
REV-1162 EXI11-96)
N0. CD 016030
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
12123756 ~ 5150.59
TOTAL AMOUNT PAID:
REMARKS:
5150.59
CHECK#167
INITIALS: HEA
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
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