HomeMy WebLinkAbout07-21-05
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COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRIS8URG, PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXFAY~n~$P'ONSE
'IE REVISED NOTICE":~ ''IE 'IE
FILE NO. 21 05-0331
ACN 05128670
DATE 07-13-2005
'IE
REV-1545 EX AFP 109-00)
20;'5 ~ST .~)OF ~.LI~"~~TH MADAMS
S.S.--NO. II '~19-3-L24-1729
D~E_~OTQEATH 03-13-2005
C'::c6UN1'~\-; CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
[Xl CHECKING
o TRUST
o CERTIF.
r.
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
JOHN J ADAMS
525 7TH ST
NEW CUMBERLAND PA 17070
'""i
PNC BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this forN and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the ComNonwealth
of Pennsylvania. Questions may be answered by call1ng (717) 787-83Z7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 5000632297 Date 03-01-1999
Established
x
2,088.47
50.000
1,044.24
.15
156.64
TAXPAYER RESPONSE
To insure proper credit to your account, two
(2) copies of this notice must accompany your
paYNent to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
Tax
NOTE: If tax payments are made within three
(3) months of the decedent.s date of death,
yoU may deduct a 5% discount of the tax due.
Any inheritance tax due will beCONe delinquent
nine (9) months after the date of death.
PART
ill
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
~The above inforNation and tax due is correct.
~l. You Nay choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you Nay check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA DepartNent of Revenue.
c=J 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 representative.
c=J The above information is incorrect and/or debts and deductions were paid by you.
You NUSt cONplete PART ~ and/or PART ~ below.
If you indicate a different tax rate, please state your
relationship to decedent:
PART
~
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
lINE 1. D&te Established 1
2. Account Balance 2
3. Percent Taxable 3 X
4. Amount Subject to Tax 4
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7 X
8. Tax Due 8
PART
@]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
I
$
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowledge and belief.
HOME (
WORK (
TELEPHONE
)
)
NUMBER
DATE
TAXPAYER SIGNATURE
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX( 11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 005606
BECKER GILBERT M
303 SHEPHERDSTOWN ROAD
MECHANICSBURG, PA 17055
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold ---._---~- --------
05128670 I $156.64
ESTATE INFORMATION: SSN: 193-24-1729 I
FILE NUMBER: 2105-0331 I
DECEDENT NAME: ADAMS ELIZABETH M I
DA TE OF PAYMENT: 07/22/2005 I
POSTMARK DATE: 07/21/2005 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 03/13/2005 I
I
TOTAL AMOUNT PAID: $156.64
REMARKS:
CHECK# 751
INITIALS: JA
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS