HomeMy WebLinkAbout07-06-12 (2)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIV IDUAL TAXES
DEPT. 280801
HARRISBURG, PA 1]1280601
RECEIVED FROM:
WILSON JOAN M
217 FINEVIEW ROAD
CAMP HILL, PA 17011
REV-1162 EX(11-96)
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT NO. CD 016222
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
loltl
ESTATE INFORMATION: SSN: t~s-3o-6932
FILE NUMBER: 2112-0741
DECEDENT NAME: WILSON JAMES B
DATE OF PAYMENT: 07/06/2012
POSTMARK DATE: 07/05/2012
COUNTY: CUMBERLAND
DATE OF DEATH: 05/27/2012
12138204 ~ 586.31
TOTAL AMOUNT PAID:
REMARKS:
SEAL
CHECK#5454
INITIALS: CJ
RECEIVED BY:
586.31
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
~ PENNSYLVANIA INHERITANCE
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AND
PD BOX 288681 penn
HARRISBURG PA 17128-0601 pEPPNTM~! (,~ 1'it~', ~AXPAYER RESPONSE
ORPrUv` J COURTA~
DENISE WILSONDE H`~~~ ~" m
217 FINEVIEW RD
CAMP HILL PA 17011-8449
EST. OF JAMES B WILSON
SSN 176.30-6932
DATE OF DEATH 05-27-2012
COUNTY CUMBERLAND
REMIT PAYMENT AND FARMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
SUSQUEHANNA BANK Drovi ded 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. IT ypU ere 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 deoa rtment of your relationship to the deceased by checking Box C in PART 1 beiow and wri ttng "spouse" in PART 2.
If you believe the information is incorrect, please obtain written carrec ti on {rom the financial ins ti tuti pn. 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. 1730002100 Date 08-07-2008 To ensure proper credit to the account, two
Estebl3shed copies of this notice aunt accompany
payment to the Register of Wills. Make check
Account Balance S 12, 113.13 payable to "Register of Wills, Agent".
C. ~ Tha above info raa ton is incorreck and/or debts and deductions were paid.
Complete PART ~ and/or PART ~ below.
PART If indicating a different tax rate, p
relationship to decedent:
TAX RETURN - CALCULATION
LINE 1. Date Esta611shed
2. Account Balan<a
3. Percent Taxable
4. Amount subd¢ct to Tax
5. Debts and Detluctions
6. Amount Taxabl¢
7. Tax Rate
8. Tax Due
PART
DATE PAID PAYEE
DESCRIPTION
I declare that the facts I reported
knowledge and belief. yra
WORK
OF TAX ON JDINT/TRUST ACCOUNTS
AMOUNT PAID
~~ )ue, ~prleck an~S ~ '
7/7 ~ ~U'J(3(' 7f ~~9 7 ~' ~ '.
ME NUMBER
TAX
FILE NO. 21-~'Z-074
ACN 12138 4
DATE 06-28-2012
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