HomeMy WebLinkAbout12-15-06 (3)
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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
HAHN SUELLEN
612 LYMAN AVE
WOMELSDORF, PA 19567
__hun fold
ESTATE INFORMATION: SSN: 194-24-2208
FILE NUMBER: 2106-1063
DECEDENT NAME: BURKETT JANE F
DATE OF PAYMENT: 12/15/2006
POSTMARK DATE: 1 211 4/2006
COUNTY: CUMBERLAND
DA TE OF DEATH: 09/16/2006
NO. CD 007567
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $222.81
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: SUELLEN HAHN
CHECK#1003
SEAL
INITIALS: WZ
RECEIVED BY:
REGISTER OF WILLS
$222.81
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
r
',-~ ..~.......:...:..
Jl SUELLEN HAHN 15 (p 7 6O~~B67
ROBERT HAHN
PH. 610-589-2055 ~
612 LYMAN AVE ~
~ MELSDORF, PA DA . . i ~.
~
i ~~ r ata/ ~~~
~ rlM8IT' Bank. Portfolio Management Account
i MFMO:;;::;~ ~ 4-P~
I: 0 :1 . :1 0 2 g 5 5 I: g B ~ :1 ~ g 5 5 ? ~ II. .0 0 :1 --
1003
o?O~2.
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lVP
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
'*
6(Pr- {O~3
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21
ACN 06159508
DATE 12-05-2006
REY-1545 EX AFP 109-001
TYPE OF
ACCOUNT
o SAVINGS
o CHECKING
o TRUST
[Xl CERTIF.
~K~
EST. OF JANE F BURKETT
5.5. NO. 194-24-2208
DATE OF DEATH 09-16-2006
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS T-'n
m~m~~D p~: ~~~~~ ~USE,~.~:;....,.'..'~r..~~..~.~
: '-c:J C-, './
-c ~ ':',j \3
"; ~ (.n,.~~\
MEMBER~ 1ST FCU . . has prov~de~ the Depart.ent with the infor.ation listed below which h"!s:b8~ed i~.. '..'. ~.2.
calculatIng the potentIal tax due. TheIr records IndIcate that at the death of the above decedent, you were a Jol"~~wner/ben~ClarYOfi 1 '
this account. If you feel this infor.ation is incorrect, please obtain written correction fro. the financial in$U1:uti.on, attll!!Ji a ccip!j", <)
to this for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Ladii\Of the C~onwealth" '.
of pe~~~;~~;'E Q;~S~~"'i ";E~O;"';""~ b~ C;~~!IlR~~~R7~~!!~~DE FOR FILING AND PAYMENT IN;TRUCTION~
Account No. 203464-45 Date 08-31-2005
Established
SUE E HAHN
612 LYMAN AVE
WOMELSDORF
PA 19567
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
31,271.15
16.667
5,211.96
.045
234.54
TAXPAYER RESPONSE
To insure proper credit to your account, two
(2) copies of this notice aust acco~any your
pay_ent to the Register of Wills. Make check
payable to: "Register of Wills, Agentft.
Tax
x
NOTE: If tax pal/llents are .ads within three
(3) .onths of the decedent's date of death,
YoU uy deduct a 5% discount of the tax due.
Any inheritance tax due will bec~e delinquent
nine (9) .onths after the date of death.
PART
[!]
he above infor.ation and tax due is correct.
1. You .ay choose to re.it pay.ent 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 assess.ent will be issued by the PA Depart_ent of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
B. [J 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. [J The above infor.ation is incorrect and/or debts and deductions were paid by you.
You .ust co.plete PART ~ and/or PART ~ below.
If you indicate a different tax rate, please state your
relationship to decedent:
PART
~
TAX RETURN - COMPUTATION OF
LINE 1. Date Established 1
2. Account Balance 2
3. Percent Taxable 3
4. Amount Subject to Tax 4
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7
8. Tax Due 8
PART
I!l
DATE PAID
J2./J?>!6hj
DEBTS AND DEDUCTIONS CLAIMED
TAX ON JOINT/TRUST ACCOUNTS
x
x
PAYEE
I
TOTAL (Enter on Line 5 of Tax Computation)
DESCRIPTlON
~t;"O./4 d.LLJ('7~
AMOUNT PAID
..? .,;J ~. If I
I
$
perjury, I declare that the facts I
"led~e and belief.
have reported above
HOME (&'/0)
WORK ( )
TELEPHONE NUMBER
correct and
TA