HomeMy WebLinkAbout05-24-12COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TA%ES
DEPT. 280601
HARRISBURG, PA 1 ]128-0801
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
FOUTS TODD M
84 HILLSIDE RD
MECHANICSBURG, PA 17050
---~~---- laltl
ESTATE INFORMATION: ssN: 162-sa-aa22
FILE NUMBER: 2112-0467
DECEDENT NAME: FOUTS CHRISTINE L
DATE OF PAYMENT: 05/24/2012
POSTMARK DATE: 05/15/2012
COUNTY: CUMBERLAND
DATE OF DEATH: 04/17/2012
REV-1162 EX111-961
N0. CD 016013
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
12128427 ~ 534.21
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 865
SEAL
INITIALS: HEA
534.21
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
~ PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE ~~ ~-{Gl
BUREAU OF INDIVIDUAL TAXEb6~x[/'~ "F FILE N0. 21
Po Box zeo6ol ^CL ~~~I115J( ~5f>t AND ACN 12128427
HARRISBURG PA 17128-0601 ~~^^r ~aa nTMdRrof eta TAXPAYER RESPONSE
f-`[~l'v PT DATE 04-27-2012
REV-156] EX XFP [45 -11)
?fll2 f4AY 24 APi I I' 5
ORPhAiJ'~ GUiif~'~
Ct1MBFRIAND CO.. PA
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
LOGAN L FOUTS
5201 DEERFIELD AVE
MECHANICSBURG PA 17050-6823
EST. OF CHRISTINE L FOUTS
SSN 162-64-5822
DATE OF DEATH 04-17-2012
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
MEMBERS 1ST FCU provided the department with the information below, which was usetl in calculating the inheritance tax due.
0.ecords intli ca to that at the death of the above -nametl tlecedent. you were a joint owner/beneficiary of this account. If ypU are the 5poU5e Of the
deceased and any amount other than zero is reflected below on the Potential lax Due 11 ne, note no tax may be due. but you must
notify the deoa rtment of your relatlonshiD to the deceased by checking Box C in PART 1 Delow and wri ttng "spouse" in PART 2.
If you believe the information is incorrect. Dl ease obtain written correction from the financial institution, attach a copy to this form antl return
it to the above atldress. Please call 717 -78]-8327 with questions.
COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYNENT INSTRUCTIONS
Account No. 41179 (>-00 Date 03-05-2011 To ensure Proper credit to the account, two
Established conies of this notice oust accompany
Account Balance ~` 1,520.38 Payne nt to the Reaister of Wills. Make check
pavable to "Register of Wills, ApenY".
Percent Taxable X 50.000
NOTE: If tax payments are matle wikhin three
Amount Subject to Tax $ 760.19 months of the decedent's date of death,
Tax Rate X . 0 45 deduct a 5 percent discount on the kax due.
Any inheritance tax due will become delinquent
Potential Tax Due $ 34.21 nine months after the date of tleath.
PART If indicating a different tax rate, please state ;t ~~tir ti~ {~ ~ kif t y~~,
''9
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relationship to decedent: (~ (t t' Y
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TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS
'
'
'
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'e
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LINE 1. Date Established 1
2. Account Balance 2 $
3. Percent Taxable 3 X
4. Amount Subject Yo 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
WORK C ~~ ~ 1 ~'N'~- ~L~
TELEPHON NUMB€~
Under/i enalkias of pe rdury, I d¢clare that the facts I reportetl above are true, correct antl
complQ~e to ,the best of my knowledge antl b¢li ef. unME: r l