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Home My WebLink About06-05-07 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 PEARCE ROBERT D 171 BRINDLE RD MECHANICSBURG, PA 17055 ___n___ fold ESTATE INFORMATION: SSN: 192-30-1569 FILE NUMBER: 2107-0549 DECEDENT NAME: EICHELBERGER VIVIAN DATE OF PAYMENT: 06/05/2007 POSTMARK DATE: 06/04/2007 COUNTY: CUMBERLAND DATE OF DEATH: 04/12/2007 NO. CD 008246 ACN ASSESSMENT CONTROL NUMBER AMOUNT 07123142 I $149.29 I I I I I I I I TOTAL AMOUNT PAID: $149.29 REMARKS: CHECK#1096 SEAL INITIALS: CJ RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2B0601 HARRISBURG. PA 17128-0601 '* FILE ACN DATE NO. 21 ~lJ1- '54~ 07123142 05-31-2007 INFORMATION NOTICE AND TAXPAYER RESPONSE RE'Y~15'iS EX AFP (09.00) TYPE OF ACCOUNT o SAVINGS iii CHECKING o TRUST o CERTIF. ~~-!~r,~ r"l 0~ ,> 'j EST. OF VIVIAN EICHELBERGER S.S. NO. 192-30-1569 DATE OF DEATH 04-12-2007 COUNTY CUMBERLAND .) ROBERT D PEARCE 171 BRINDLE RD MECHANICSBURG PA 17055 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1 ST FCU has provided the Departnnt with the inforMation listed below which has been used in calculating the potential tax due. Theil' 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 for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Com.onwealth of Pennsylvania. Questions .ay be answereD by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 210596-11 Date Establ1shed 10-24-2001 To insure propel' credit to your account, two (2) copies of this notice .ust acco.pany your pay.ent to the Register of Wills. Make check payable to: "Register of Wills. Agent". Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART ill x 6,984.36 50.000 3,492.18 .045 157.15 TAXPAYER RESPONSE NOTE: If tax pay.ents are made within three (3) .onths of the decedent's date of death. you May deduct a 5X discount of the tax due. Any inheritance tax due will beCOMe delinquent nine (9) Months after the date of death. x A. ~e above inforMation and tax due is correct. ~ 1. You may choose to re.it pay.ent to the Register of Wills with two copies of this notice to obtain a discount 01' avoid interest, 01' you .ay check box "A" and return this notice to the Register of Wills and an official asseSSMent will be issued by the PA Depart.ent of Revenue. [CHECK ] ONE BLOCK ONLY B. [] The above asset has been 01"will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. C. [] The above infor.ation is incorrect and/or debts and deductions were paid by you. You .ust co.plete PART ~ and/or PART ~ below. OF 1 2 3 4 5 6 7 8 TAX ON JOINT/TRUST ACCOUNTS PART ~ T.AX If you indicate a different tax rate, please state your relationship to decedent: RETURN - COMPUTATION LINE l. 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 PART !!I DATE PAID PAYEE x .. x DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) . Under penalties of perjury, I declare that the facts ~~ledge and belief. TAXPAYER SIGNATURE ~ have reported above are true, correct and HOME (//7) ~97~/~ WORK ( ) TELEPHONE NUMBER DATE r-- ~~. ~ - .- - - - - = j - - ~ - ..~ - =:& ;~~ ~ == ,I; I ( ~ - Q.. --- ~ - , t9 - ~ f', ~ - , ~ ~ :> IV) - to ~ ~ r.tJ J~ ...... - - ~ - i-I Z ....... \" IX ~ ~ ~ l' - et - ( 6 'J... ~ ....... - ::r: ~ q~ i I en Co') \~ ('-I ,. ~ '.1 - ~ J~ . . .....,- '" , 0- n . 'l:I!. -.... .,.., ~ U.., " .~ ~ (:;. ~ I \!) .... (.) -- ~ ~ I') .', .J:...._ . \J '. ,;~ ~ 0 -" J ,~ I':' ,...... 'M c~_""1 () , , () I'" -. '-.~ .,... VI '" o l'- ro CI) 0.. u"O ~ a ~ e> ~Q),g :a ~ 0=,- t:';:: fa (1)i:O..c: .g-~ ,~ ~~