HomeMy WebLinkAbout12-01-06
COMMONWEALTH OF PENNSYLVANIA
IlEPARTtENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG I PA 17128-0601
* INFORMATION NOTICE
~ .~AND
LVn OED \!I,.,'I\Jt.~,Jrc.R RESPONSE
:+', i- .;;., '~ii-: n r. t'.!il I :
IEV-1545 EX If' . . r " I . " ,
FILE
ACN
DATE
NO.21 0<..0 .OS"O
06157535
11-22-2006
STEVEN L GOUSE
23RD STREET EXT
ENOLA PA 17025
TYPE OF ACCOUNT
2006 DEe -I PH is'158oF WALTER E GOUSE 0 SAVINGS
S. S. NO. 714-18-2611 D CHECKING
CLERK OF DATE OF DEATH 10-01-2006 0 TRUST
ORPHAN'S COUm'UNTY CUMBERLAND 00 CERTIF.
CUMBERl),ND CO. PA REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLEI PA 17013
PIle BAlIK has provided the Depart.ent with the info~ation listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above d8cedentl you were a joint owner/beneficiary of
this account. If you feel this infor..tion is incorrect. please obtain written correction fro. the financial institution I attach a copy
to this fo~ and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the COIIIIOnlllealth
gf PtllV\&Ylvanl.. Que.tions IIlIY be ansN8red by caning (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 31400179810 Date 02-15-2001
EstabUshed
x
81713.52
16.667
11452.28
.045
65.35
TAXPAYER RESPONSE
To insure proper credit to your account. two
(2) copies of this notice .ust 8cco.pany your
pay.ent to the Register of Wills. Make check
payable to: "Register of Willsl Agant".
Account Balance
Percent Taxable
A~t Subject to Tax
Tax Rate
Potantial Tax Due
x
NOTE: If tax pay.ents are .ade within three
(3) Bonths of the decedent"s date of death.
you ..y deduct a 5;( discount of the tax due.
Any Inheritance tax due will beco.e delinquent
nins (9) sonths after the date of death.
PART
[!]
[CHECK ]
ONE
BLOCK
ONLY
A. 0 The above infor.ation and tax due is correct.
~l. You .ay choose to r..it pay.ent to the Register of Wills with two copies of this notice to obtain
a discount or avoid interestl or you .ay check box "A" and return this notice to the Register of
Wills and an official assesssent will be issued by the PA Depart.ant of Revenue.
B. 0 The above asset has been or will be reported and tax paid with the PemsYivania InherltBl'lce Tax return
to be filed by the decedent"s representative.
C. 0 The above infor..tion is incorrect and/or debts and deductions were paid by you.
You .ust cOllplete PART 0 and/or PART ~ below.
If you indicate a different tax ratel please stata your
relationship to decedent:
PART
[!}
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Data Established 1
2. Account Balanee 2
3. Percent Taxable 3 X
4. ~t Subject to Tax 4
5. Debts end Deductions 5
6. AlIOUnt Taxable 6
7. Tax Rate 7 X
8. T~Due 8
PART
I!l
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
.$ h:t~ 1~L.()au/JL
I
TOTAL (Enter on Line 5 of Tax COMPutation)
DESCRIPTION
~ cI~,-
AMOUNT PAID
11 t!r ~5"
I
$
Under penalties of parjurYI I declare that the filets I
cQIIPlete to the best of IIY knowledge and belief.
have reported above are truel correct and
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W~:~EP~ONE N~MBER
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TAXPAYER SIGNATURE
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RECORDED OFf\CE OF
Dc(.\\t~lTP nr:: \M\\\. ;.~
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20n~ OEe - \ PM \2: 58 ,
CLERK Of
ORPt'AN'S caUR1
CUMBERlN\lf) CO, AA
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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
GOUSE STEVEN L
23RD STREET EXT
ENOLA, PA 17025
____n__ fold
ESTATE INFORMATION: SSN: 714-18-2611
FilE NUMBER: 2106-1050
DECEDENT NAME: GOUSE WALTER E
DATE OF PAYMENT: 12/01/2006
POSTMARK DATE: 12/01/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 10/01/2006
NO. CD 007499
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
06157535 I $65.35
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK#0369409797
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$65.35
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS