HomeMy WebLinkAbout07-26-06
CCJrv1 rv1 c'r'~VV:::.AL THJF PE['Jf\JSYL \/ ANIA
DEPL:.,F-r:~'jlEhJT OF R:=>/ENUE
HARRISE;URC3 P,~ '7128-0601
REV-1162 EX(11-96i
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
GOOD CYNTHIA A
322 BONNYBROOI< RD
CARLISLE, PA 17013
ESTATE INFORMATION: SSN: 164-30-2889
FILE NUMBER: 2106-0662
DECEDENT NAME: GOOD HELEN L
DA TE OF PA YMENT: 07/26/2006
POSTMARK DATE: 07/25/2006
COUNTY: CUMBERLAND
DA TE OF DEATH: 01/10/2006
NO. CD 007015
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
06124305 I $245.33
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$245.33
REMARI<S:
CHECI<# 2553
SEAL
INITIALS: JA
RECEIVED BY:
T AXPA YER
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
-~ - '["",'I-NFORMATION NOTICE
, AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 C\.o low'2..
06124305
05-25-2006
REV-1543 EX AFP (09-00)
. ( i
EST. OF HELEN L GOOD
5.5. NO. 164-30-2889
DATE OF DEATH 01-10-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
D CHECKING
D TRUST
[X] CERTIF .
CYNTHIA A GOOD
322 BONNYBROOK RD
CARLISLE PA 17013
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MEMBERS 1ST FCU 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 ;:IICCt)W1t ic;; taxable;;. i!"! acco!""::!Z:~C:1 ~.~ith t~Q Ir.hs.-itani;e Ti;lx LaWS ur tile COllllllonwealth
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. 49908-42 Date 03-14-2003
Established
x
10,903.43
50.000
5,451.72
.045
245.33
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".
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 become delinquent
nine (9) months after the date of death.
PART
[!]
[CHECK ]
ONE
BLOCK
ONLY
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 "An 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 representative.
C. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
x
If you indicate a different tax rate, please state your
relationship to decedent:
PART
@]
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7, Tax Rate
8. Tax Due
TAX ON JOINT/T~UST ACCOUNTS
OF
1
2
3
4
5
6
7
8
x
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
I
TOTAL (Enter on Line 5 of Tax Computation)
c
Under ....., ~~
~,l;Jt:e tt
\.II:'D C"T~ll^TIID
I declare that the facts
dge and belief.
I have reported above are true, correct
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