HomeMy WebLinkAbout10-10-06
ILTH OF PENNSYLVANIA
"NT OF REVENUE
J OF INDIVIDUAL TAXES
. 280601
~RISBURG, PA 17128-0601
-~
REY-15~5 EX lFP <09-DDI
INFORMATION NOTICE
TA~~;~~~i~ES~ONSE
FILE
ACN
DATE
NO. 21 06- 0773
06150872
10-03-2006
.....\.
TYPE OF ACCOUNT
!Xl SAVINGS
D CHECKING
D TRUST
D CERTIF.
2005 OCT '
eu:
ORPHJ
2r;'jS~~ Ie#- HiUj~ED6s LANGLOIS
8.8. NO. 037-10-9004
DAft~OF.DEATH 08-09-2006
r.-.-,- '" . .
',.eOUNTY. CUMBERLAND
FRANCINE A GROFF
7729 WERTZVILLE RD
CARLISLE PA 17013
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
AMERICHOICE 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 account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Questions may be answered by calling (717J 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 34891 Date 03-05-2003
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
3,855.09
50.000
1,927.55
.045
86.74
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 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Tax
PART
[!]
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. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
TAX
ON JOT~T/TRUST ACCOUNTS
~503
.~ S'S. D'1
,,&f0 0;0
,9 ;;n.S5'
-0 -
~ns~
. I ~~6 -SID ~ '1~I</O)
DEBTS AND DEDUCTIONS CLAIMED
If you indicate a different tax rate, please state your
relationship to decedent:
PART
[3J
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
x
PART
@]
DATE PAID
PAYEE
DESCRIPTION
AMOUNT PAID
Under penalties
~omPlete~o the st
.
I
TOTAL (Enter on Line 5 of Tax Computation)
perjury, I declare that the facts I have reported
my knowledge and belief. HOME (1/']
I
$
correct and
/O/h/6b
DaTE:
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
GROFF FRANCINE A
7729 WERTZVILLE ROAD
CARLISLE, PA 17013
ACN
ASSESSMENT
CONTROL
NUMBER
______n fold
06150872
ESTATE INFORMATION: SSN: 037-10-9004
FILE NUMBER: 2106-0773
DECEDENT NAME: LANGLOIS MILDRED S
DATE OF PAYMENT: 10/10/2006
POSTMARK DATE: 10/06/2006
COUNTY: CUMBERLAND
DA TE OF DEATH: 08/09/2006
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 4709
SEAL
INITIALS: JA
RECEIVED BY:
REV-1162 EX(11-96)
NO. CD 007298
AMOUNT
I
I
I
I
I
I
I
I
I
$ 82.40
$ 82.40
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
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