HomeMy WebLinkAbout06-12-12COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA iJ128-0601
RECEIVED FROM:
ADAMS ELIZABETH K
801 N HANOVER ST
CARLISLE, PA 17013
mie
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ESTATE INFORMATION: ssN: isa-o~-eaa~
FILE NUMBER: 2112-0666
DECEDENT NAME: KEATLEY MARY
DATE OF PAYMENT: 06/12/2012
POSTMARK DATE: 06/11/2012
couNTY: CUMBERLAND
DATE OF DEATH: 03/22/2012
ACN
ASSESSMENT
CONTROL
NUMBER
REV-1162 EXI11-961
NO. CD 016099
AMOUNT
12128746 ~ S 160.53
TOTAL AMOUNT PAID:
REMARKS:
SEAL
CHECK# 6479
INITIALS: HEA
RECEIVED BY:
S 160.53
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
~ PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE FILE NO. 21
BDREA~ OF INDIVIDUAL TAXES AND
Po Box 280601 Pennsylvania ~/p yip ACN 12128746
HARRiS BURG PA 17128-0601 pEPAPTMENT nF PE VENUE ~Ahr~iGMV g~~iS~~NS~
. ^ M1CCC •••1JCY r • DATE 05-15-2012
XEV -I Sf3 E% %FV 105-11)
ELIZABETH K ADAMS
719 ALBERTA AVE
MECHANICSBURG PA 17050-2272
EST. OF MARY KEATLEY
SSN
DATE OF DEATH 03-22-2012
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
PNC BANK NA provitletl 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 tleDa rtment of your relationship to the deceased by checking Boz 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 puesti ons.
COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 5070023235 Date 01-01-1979 To ensure [.roper credit to the account, two
E5tab115hed copies of this notice oust accompany
p avnent ko the Register of Wills. Make check
Account Balance $ 4,488.00 payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If 1: ax Daynents are made within Three
Amount Subject to Tax $ 2,244.00 months of 1:he decetlent's data of death.
~( 15 deduct a 5 percent tli scount on ther.~ix due.
Tax Rete , Anv inherit:anca tat 11 becomEtiL elingue
Potential Tax Due $ 336.60 nine month:: otter th of aeaUa.a „~
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A. The above information antl tax due is corset. r-^,
2
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Remit pevment to the Re9isker of Wills with two copies of this notice to/N}leS
CHECK a discount or avoid interest, or return this
ill be issued by the
t
i
l notice to the
PA Department Re6i star of
of Revenue. nd Z'
< S,' ,, ,... T
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r assessmen
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an offic
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B. ~ The above asset has been or will be repo rtetl and tax paitl with the Pennsvl valPta inhe ri tan r~tax rln~rLT]
-
ONL Y led by the estate representative. (:- ~A
C. The above inf arena eon is incorrect and/or debks
~ antl deductions were paid.
and/or PART ~ below.
ConDlete PART 2
PART If indicating a different tax rate, please state
relationship to decetlent:
TAX RETURN - CALCULATION
LINE 1. Data Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
e. Tax Due
PART
OF TAX ON JOINT/TRUST ACCOUNTS
DATE PAID PAYEE
DESCRIPTION
AMOUNT PAID
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Untlar penalties of perdury, I de<la ra that the facts I reportetl above ar¢ true, correct and tt11
omplete to t9e best o(f'~my knowledge and b¢lief. HOME C'1C1 ) 1~J~• SZBt11\
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