HomeMy WebLinkAbout12-15-06
COMMOI~WEAlTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128-0601
REV-1162 EXI11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
HAHN SUELLEN
612 LYMAN AVENUE
WOMELSDORF, PA 19567
___n~__ fold
ESTATE INFORMATION: SSN: 194-24-2208
FILE NUMBER: 2106-1063
DECEDENT NAME: BURKETT JANE F
DA TE OF PAYMENT: 1 2/1 5/2006
POSTMARK DATE: 1 2/14/2006
COUNTY: CUMBERLAND
DA TE OF DEATH: 09/16/2006
NO. CD 007568
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
06159512 I $73.65
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$73.65
REMARKS: HAHN SUELLEN
CHECK#1002
SEAL
INITIALS: AJW
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER 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
06159512
12-05-2006
REV-1543 EX AFP '09-00)
xLLU~'1V K ~
SUE E HAHN
612 LYMAN AVE
WOMELSDORF PA 19567
EST. OF JANE F BURKETT
S.S. NO. 194-24-2208
DATE OF DEATH 09-16-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
[X] CERTIF.
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 account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Questions may be answered by calling (717) 787-~3?7_
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 203464-47 Date 08-31-2005
Established
x
10,337.60
16.667
1,722.97
.045
77 .53
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 57. discount of the tax due.
Any inheritance tax due will becOlle delinquent
nine (9) months after the date of death.
PART
[!]
he above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copie~f this noti~to obtain
a. discount or av?i~ interest, or y?u may ~heck box "An and return this IlQ""l._ M. to the@qister of :~G
WIlls and an ofhclal assessment WIll be Issued by the PA Department of Re~~ue. 0 --~,; cS
:) rrJ- r,
B. [] The abo~e asset has been or will be repor~ed and tax paid with the pennSYIVani~'~~rita~Tax ~e~~
to be hIed by the decedent's representative. c7 n-; _ i:'-)
" .,';c.' =0 CJl : . ,'-f,
c. D The above information is incorrect and/or debts and deductions were paid by yp~'.:) ::.." ,.J C:7
You must complete PART 0 and/or PART ~ below. ij ':er';
[CHECK ]
ONE
BLOCK
ONLY
TAX ON JOINT/TRUST ACCOUNTS
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
OF
1
2
3
4
5
6
7
8
x
x
PART
@]
DATE PAID
tzNJ./61
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
f) C/tJ
DESCRIPTION
d.A-<?C6Z~'1( f-
AMOUNT PAID
'13. c;,,-~
I
TOTAL (Enter on Line 5 of Tax Computation)
I
$
perjury, I declare that the facts I
y knowledge and belief.
have reported above are true, correct and
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