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COMM ONWEAl TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
PEARCE ROBERT D
171 BRINDLE RD
MECHANICSBURG, PA 17055
-------- 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
DA TE OF DEATH: 04/12/2007
REMARKS: ROBERT D PEARCE
CHECK#1094
SEAL
REV-1162 EX(11-96)
NO. CD 008243
ACN
ASSESSMENT
CONTROL
NUMBER
07123138
TOTAL AMOUNT PAID:
INITIALS: DM
RECEIVED BY:
REGISTER OF WILLS
AMOUNT
$23.07
$23.07
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES .
DEPT. 2B060l
HARRISBURG. PA 17128-0601.
7
-J
*'
FILE
ACN
DATE
NO. 21 ~l - &-(q
07123138
05-31-2007
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
REY-I543 EX In U9-01l
Pii I: 51
TYPE
EST. OF VIVIAN EICHELBERGER
5.5. NO. 192-30-1569
DATE OF DEATH 04-12-2007
COUNTY CUMBERLAND
OF ACCOUNT
[i] SAVINGS
o CHECKING
o TRUST
o CERTIF.
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 1ST FCU has providad tha Dapartaant with tha infor..Uon listed belllW which has boan usad in
calculating tho potontial tax duo. Thair rocords iridicato that at tho doath of tha abovo docodant. you woro a joint lIWnar/bonoficiary of
this account. If you fool this inforaation is incorroct. ploaso obtain writton corroction froa tho financial institution. attach a cOPY
to this fone and raturn it to tho abovo addross. This account is taxablo in accordanco with tho Inhoritanco Tax Laws of tho C~aonwoalth
of PonnsYlvania. Quostions aay bo answorod bY calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Ac.count No. 210596-00
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
PART
[!J
Date 10-24-2001
Established
To insure propor crodit to your account. two
(2) copios of this notico aust accoapany your
payaont to tho Rogistor of Wills. Mako chock
payabla to. "Rogistor of Wills. Agont".
1,079.18
X 50.000
539.59
X .045
24.28
TAXPAYER RESPONSE
NOTE. If tax payaonts aro aado within throo
(3) aonths of tho docodont's dato of doath.
you aay do duct a 5X discount of tho tax duo.
Any inhoritanco tax duo will bocoao dolinquont
nino (9) aonths aftor tho dato of doath.
Tho abovo infoneation and tax duo is corroct.
1. You aay chooso to roait payaont to tho Rogistor of Wills with two copios of this notico to obtain
a discount or avoid intorost. or you aay chock box "A" and roturn this notica to tho Rogistor of
Wills and an official assossaont will bo issuod by tho PA Dopartaont of Rovonuo.
[CHECK ]
ONE
BLOCK
ONLY
B. c=l Tho abovo assot has boon or will bo roportod and tax paid with tho Ponnsylvania Inhoritanco Tax rot urn
to bo filod by tho docodont.s roprosontativo.
C. c=l Tho abovo infone.tion is incorroct and/or dobts and doductions woro paid by you.
You aust c~phte PART 0 and/or PART I!J belllW.
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4
5
6
7 X
8
PART
[!]
TAX RETURN - COHPUTATION
If you indicate a different tax rate, please state your
relationship to decedent:
LINE l- Date Established
2. Account Balance
3. Percent Taxable
4. A.ount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
PART
I!I
DATE PAID PAYEE
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
I
TOTAL CEnter on Line 5 of Tax Computation)
.
rjury, I declare that the facts I
knowledge and belief.
haye reported abOYe)lre true, c~ct
HOME (7/7) tJ '7 .?t,// /
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