HomeMy WebLinkAbout07-19-05
COMMONWEALTH OF PEHNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 -05- 017
05131555
07-05-2005
REY-1543 EX AFP l09~D.O~
EST. OF EDNA I MILLER
5.5. NO. 210-09-9520
DATE OF DEATH 04-19-2005
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
[X] CHECKING
o TRUST
o CERTIF.
SUSAN A BLASS
76 BEECHCLIFF DR
CARLISLE PA 17013
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PNC BANK has providgd thg Department with the information listgd bellow which has bggn usgd in
calculating the potentIal tax due. TheIr records IndIcate that at the dgath of the above decedent, you were a joint owner/beneficiary of
this account. If you fgel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above addrClss. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Questions may be answered by cailing (717J 767-63Z7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 5070070031 Date 01-17-2002
Established
Account Balance
Percent Taxable
Amount Subject to
Tal( Rate
Potential Tax Due
x
20,009.34
50.000
10,004.67
.045
450.21
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
x
NOTE: If tax payments are made within three
(3) months of the decedent"s dete of death,
you may deduct a 5Z discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Tal(
~~ TAXPAYER RESPONSE
[!] f!i!i~I~~.'ii~~'!::~I..:ii,I~~~ii!i~m1~:il::i~lli!i~I!1!1.1~~i~.iiili~~,ilil"l~i~~gg!lil.I!li.~~i:illl1,~.I,,'!I
[CHECK ]
ONE
BLOCK
ONLY
A. ~he above Inforllation and tax due is correct.
1. You may choosg to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you lIay check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent"s representetive.
C. [] The above inforllation is incorrect and/or debts and deductions were paid by you.
Vou must complete PART ~ and/or PART ~ below.
OF TAX ON JOINT/TRUST ACCOUNTS
PART
[3]
TAX RETURN - COMPUTATION
If you indicate a different tax rate, please state your
relationship to decedent:
LINE 1. Date E3tablished 1
2. Account Balance 2
3. Percent Taxable 3 X
4. Amount Subject to Tal( 4
S. Debts and Deductions S
6. Amount Taxable 6
7. Tal( Rate 7 X
8. Tax DUB 8
PART
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tal( Computation)
I
$
Under penalties of perjury, I declare that the facts I
conplete to the best of my knowledge and belief.
'C,("" Ji "'- Q.p,f,'LL.,
TAXPAYER SIGNATURE
have reported above are true, correct
HOME ('1 11) (, q I - ~ '1"7 i3
WORK ( )
TELEPHONE NUMBER
and
JiTt/l) ')
.
COMMONWEALTH OF PENNSYLVANIA
DEPA;;:TMENT OF RFVFNIJE
C:lUH!::AU UF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EXll'-961
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
BLASS SUSAN A
76 BEECHCLlFF DRIVE
CARLISLE, PA 17013
___n_u told
ESTATE INFORMATION: SSN: 210-09-9520
FILE NUMBER: 2105-0617
DECEDENT NAME: MILLER EDNA I
DATE OF PAYMENT: 07/11/2005
POSTMARK DATE: 07/11/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 04/19/2005
NO. CD 005545
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
05131555 I $450.21
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: SUSAN A BLASS
CHECK# 2347
SEAL
INITIALS: SK
RECEIVED BY:
REGISTER OF WILLS
$450.21
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
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