HomeMy WebLinkAbout02-08-06
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT 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 006307
LEISENRING SAMYUKTHA
359 RUMFORD ROAD
L1TITZ, PA 17543
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
nu____ fold
05500709
$1,496.50
ESTATE INFORMATION:
SSN:
331-34-2983
FILE NUMBER:
2105-1046
VENKATADRICHAMAKURA
02/08/2006
02/07/2006
CUMBERLAND
11/13/2005
DECEDENT NAME:
DATE OF PAYMENT:
POSTMARK DATE:
COUNTY:
DATE OF DEATH:
TOTAL AMOUNT PAID:
$1,496.50
REMARKS:
SAMYUKTHA LEISENRING
CHECK# 337
SEAL
INITIALS: RSK
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 05-1046
05500709
12-28-2005
REY-1545A AFP (7-00)
TYPE OF
EST. OF CHAMAKURA VENKATADRI
S.S. NO. 331-34-2983
DATE OF DEATH 11-13-2005
COUNTY CUMBERLAND
ACCOUNT
o SECURITY
[X] SEC ACCT
o STOCK
o BONDS
SAMYUKTHA LEISENRING
359 RUMFORD RD
LITITZ PA 17543
REHIT PAYHENT AND FORHS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
HERRILL LYNCH has provided the Oepartllent 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 beneficiary of this asset.
If you feel this inforllation is incorrect, please obtain written correction from the transfer agent, 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 Pennsylvania.
Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 872-49228
DOD Valuation
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
35,005.80
100.00
35,005.80
.045
1,575.26
TAXPAYER RESPONSE
To insure proper credit to your account, two
(2) copies of this notice IIUSt accollpany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent",
x
NOTE: If tax paYllents 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
ill
A. ~The above information and tax due is correct.
"" 1. You lIay 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. [J The above information is incorrect and/or debts and deductions were paid by you.
You must cOllplete PART ~ and/or PART ~ below.
PART
@]
TAX RETURN - COMPUTATION
If you indicate a different tax rate, please state your
relationship to decedent:
PART
~
DATE
-''> 00 C; , "60
K Q. r?4S
1575. 2(; /,([5)
-=- j..;qt . is ()
DEBTS AND
5""/0 41~UMr
LINE
1. DOD Valuation
2. Percent Taxable
3. Amount Subject to Tax
4. Debts and Deductions
5. Amount Taxable
6. Tax Rate
7. Tax Due
OF
1
2
3
4
5
6
7
TAX ON ABOVE ASSETCS)
3<", /JOb, ~{)
X 100
,1~.ocJ5. '15u
DEDUCTIONS CLAIMED
PAID
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
Under penalties of perjury, I declare that the facts I
mplete to the best of my knowledge and belief.
/
I
$
have reported above are true, correct and
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