HomeMy WebLinkAbout08-23-06
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, FA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
WAREHAM GLENN L
107 OLD YORK ROAD LOT 117
NEW CUMBERLAND, PA 17070
nnn__ fold
ESTATE INFORMATION: SSN: 203-20-7992
FILE NUMBER: 2106-0748
DECEDENT NAME: SHIELDS GLADYS F
DA TE OF PAYMENT: 08/23/2006
POSTMARK DATE: 08/23/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 03/16/2006
NO. CD 007139
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
06120924 I $222.92
I
I
I
I
I
I
I
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TOTAL AMOUNT PAID:
REMARKS: WAREHAM GLENN l
CHECK# 394
SEAL
INITIALS: AJW
RECEIVED BY:
REGISTER OF WILLS
$222.92
GLENDA FAIRNER STRASBAUGH
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
06120924
05-12-2006
REV-1543 EX AFP r09-00l
EST. OF GLADYS F SHIELDS
S.S. NO. 203-20-7992
DATE OF DEATH 03-16-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
[Xl CHECKING
o TRUST
o CERTIF.
GLENN L WAREHAM
107 OLD YORK RD LOT 117
NEW CUMBERLAND PA 17070
I~EMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
FUL TON BANK has provided the Department with the information listed bEllow 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
UT PennsYlvania. wuesrions may be answered by calling l717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 3622-23390 Date 10-01-2003
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
2,972.27
50.000
1,486.14
.15
222.92
TAXPAYER RESPONSE
To insure proper credit to your accountl 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 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Tax
PART
IT]
A. S The
,1.
I
above information and tax due is correct~
You may choose to remit payment to the Register of Wills with blo copies of this notice to obtain
a discount or avoid interest, or you may check box nAn and retur'n 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. D 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. D The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
If you indicate a different tax rate, please state your
relationship to decedent:
PART
@J
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
OF
1
2
3
4
5
6
7
8
x
TAX ON JOINT/TRUST ACCOUNTS
x
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 abelve are true, correct and
complete to the best of, my knowl~dge and belief. HOME ( !; i ) . ,
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