HomeMy WebLinkAbout11-17-05
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
'*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 05-0767
ACN 05150358
DATE 11-01-2005
REV-1545 EX AFP 109-DOl
EST. OF FREDA M EBERSOLE
S.S. NO. 162-22-2845
DATE OF DEATH 08-18-2005
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
IX] TRUST
o CERTIF.
...) ~
ERICA M KESSLER
968 SILVER LAKE RD
LEWISBERRY PA 17339
REHIT PAYHENT AND FORHS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
SOVEREIGN 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 form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of PAo"sylvania. QU~5tio~s ~ay ~9 answ@~ed b~ calli~g (?17) ?!?-832?
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 1055276438 Date 10-05-2000
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
13,073.86
100.00
13,073.86
.15
1,961.08
TAXPAYER RESPONSE
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 date of death,
you may deduct a 5X discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Tax
PART
[!J
A. [] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may 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.
[CHECK ]
ONE
BLOCK
ONLY
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 representative.
C. ~he above information is incorrect and/or debts and deductions were paid by you.
. You must complete PART 0 and/or PART @] below.
PART If you indicate a different ~ Lt" please state your
~ relationship to decedent: (J_C a.Avjhte..r
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established 1 to - .::; ~ ~(iO
2. Account Balance 2 I 3 /)....,3. Kto
3. Percent Taxable 3 X I O'l) . tJU
4. Amount Subject to Tax 4 13 () 73 . ~
S. Debts and Deductions S 0'
6. Amount Taxable 6 1',1. 01 ~. ~10
7. Tax Rate 7 X 4 : S
8. Tax Due 8 ;:;~. ;~}..
DEBTS
( r; ~ .elf) .' 51lfb )
AND DEDUCTIONS CLAIMED
PART
[!]
DATE PAID
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line S of Tax Computation)
Under penalties of perjury, I declare that the facts I
complete to the best of my knowledge and belief.
I
$
tJul'D t--\. ~ 0 .>..}.O <lJ-<.
TAXPAYER SIGNATURE
have reported above are true, correct and
HOME (flit ) Cr~/(' l{ Sl()
WORK ( )
TELEPHONE NUMBER
11//10$
DAT
pj.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRIS8URG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 006008
KESSLER MOLLIE M
968 SILVER LAKE ROAD
LEWISBERRY, PA 17339
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
__nun fold
101
$558.90
ESTATE INFORMATION: SSN: 162-22-2845
FILE NUMBER: 2105-0767
DECEDENT NAME: EBERSOLE FREDA M
DATE OF PAYMENT: 11/17/2005
POSTMARK DATE: 11/15/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 08/18/2005
TOTAL AMOUNT PAID:
$558.90
REMARKS:
ERICA M KESSLER
CHECK# 628
SEAL
INITIALS: RSK
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
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