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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTAT
OFFICIAL RECEIPT
REED J F
9 PINE CIRCLE
NEWVILLE, PA
1 7241
__nnn fold
ESTATE INFORMATION: SSN: 220-30-3090
FILE NUMBER: 2105-0591
DECEDENT NAME: SEIDEL HERBERT W
DATE OF PAYMENT: 06/29/2005
POSTMARK DATE: 06/28/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 01/26/2005
TOTAL AMOUNT
REMARKS: J FRANKLIN REED
CHECK# 5176
SEAL
INITIALS: VZ
RECEIVED BY:
REGISTER OF WILLS
REV-1162EXIJ }
E TAX
NO. CD 0055C
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
- --~-
05127898 I $43.82
I
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PAID: $43.82
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
,
COMMONWEALTH OF PENNSYLVANIA
DEPARTtEKT OF REVEtIJE
BUREAU Of INDIVIDUAL TAXES
DEPT. 280601
HARRISIURG~ PA 171l8-Q601
*'
ZNFORMATION NOTICE
AND .
TAXPAYER RESPONSE
FILE NO. 21-0 Sq I
ACN 051278
DA:rE 06-13- 05
E'.1545El1lFP 11'-11)
TYPE OF
COUNT
SAVINGS
CHECKING
TRUST
CERTIF.
. ,"!f-
EST. OF HERBE~T W'SEI~Et~
~A~E ~~.~~~~~~~~~:~05
COUNTY r. ' CUMBERLAND
"
REHIT PAYHENT AHD FORHS T
REGISTER OF WILLS
CUMBERLAND CO COURT HOUS
CARLISLE, PA 17013
J FREED
9 PINE CIR
NEWVILLE PA 17241
FAIUIERS NATIONAL BANK has provided the Deparbent Nith the info,...tion listed below .....ich has baen uHd in
calculating the potential tax dUll. Thtlir records indicate that at the Math of tha abo\l'. dacedent~ you "'1'. a joint ~r/w....f1c
this account. If you flKll this infor...tIOI"I is incorr8Ct~ please obtain wrUt., correction frOll the financial institution~ attach
to this fori! and return it to the Bbove address. This account is taxable in SClcardanca with the Inheritance Tax Ll!INs of the COlI
of Penns!ll\I'Bnia. Questions _y be answfIlred by calling (17) 787-83l7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 220760 Det. 06-12-1984
EstebUshed
of
opy
.alth
Account Balance
Percent Taxabl.
Aeount Subject to
Tax R.te
Potential Tax Due
x
584. 19
50.000
292.10
.15
43.82
TAXPAYER RESPONSE
To insure proper credit to your IICCQunt~
(2) copies of this notIce .ust acco.paRY
paymll1t to the A8IIistar of Ifills. M_e c
payable to: "Ragisblr of IfIlls~ Ag.,\"'.
x
Sph
I<<ITE: If ta)C paYII.,ts are aade Ni thin th
(3) 8OI1thS of the decedent.s data of dea
you ..y dIlduct a 5% discount of the tax
Any inheritance tIIx due wUl blllCo.e delin
nine (9) .QI'rths after the date of death.
t
Tax
[CHECK ]
ONE
BLOCK
ONLY
A~ 1i2f The eba". inforAtion and tax due is correct.
W--I~ You aay choose to r8llit pay...nt to the Register of Wills wIth two copies of this notice to Db
a discount or avoid int.rest~ or YOU _y check box "A" end return this notice to the Register
Wills end an official BSSBsSIKlInt will be issued by the PA DeparbHmt of Rav"'ue.
B. 0 The above .sot has been or will be reported and tax paid Mtth the P~sylveniil Inharitenca Tax re
to be filed by the d8C8d8nt.s representative.
c. 0 The sbo\I. lnfor..tion is inc:onect and/or debts and deductions ..ere paid by you.
You .ust co~letlil PART ill and/or PART 0 beloN.
If you Indlcat. _ different tax rete, pl..se stat. your
relationship to dec.dent:
PART
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PART
~
TAX RETURN - COMPUTATION
LINE 1. Dat. Established
2. Account Balance
3. P.rean't Taxable
4. MOU'It Subj....t to Tex
S. Debt. and Deductions
6. A~t Taxable
7. Tax Rat.
8. Till( Due
TAX ON JOINT/TRUST ACCOUNTS
OF
1
2
3 X
4
5
6
7 X
8
PAYEE
DESCRIPTION
AMOUNT
ID
TOTAL (Enter on Line 5 of Tax eo.pu .tion)
.
Under pen.ltle. of perjury, I declare t~t the facts I have reported above ere true, correct and
co_lete to the best of IlY knowledge - belief. HOME ( )
WORK ( )
TAXPAYER SIGNATURE TELEPHONE NUMBER DA
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