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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
NO. CD 008443
HARLES ELLEN J
131 N 24TH STREET
CAMP HILL, PA 17011
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
~~------ fold
07130594
$21.09
ESTATE INFORMATION: SSN: 091 -, 8-9483
FILE NUMBER: 2107-0702
DECEDENT NAME: SW A YER MALCOLM M
DATE OF PAYMENT: 07/24/2007
POSTMARK DATE: 07/23/2007
COUNTY: CUMBERLAND
DATE OF DEATH: OS/27/2007
TOTAL AMOUNT PAID:
$21.09
REMARKS: ELLEN J HARLES
CHECK# 7033
SEAL
INITIALS: OM
RECEIVED BY:
GLENDA FARNER STRASBAUGH.
REGISTER OF WILLS '"
REGISTER OF WILLS
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA l7l2B-060l
'*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 - 07 - 7 (j a.
07130594
07-06-2007
REV"lS43 EX NP <09.DI)
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I EtLEN~ J MARiES
131 Nc:z4TH ST U
CAMP RtLL PA 17011-3602
EST. OF MALCOLM M SAWYER
S.S. NO. 091-18-9483
DATE OF DEATH 05-27-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
[i] SAVINGS
D CHECKING
D TRUST
D CERTIF.
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PSECU has providad tha Dapartaant with tha info~ation listad balow which has baan used in
calculating tha potantial tax dua. Thair racords indicata that at tha daath of tha abova dacadant, you wara a joint ownar/banaficiary of
this account. If you faal this info~ation is incorract, plaasa obtain writtan corraction froa tha financial institution, attach a cOPY
to this fo~ and rat urn it to tha abova addrass. This account is taxabla in accordanca with tha Inharitanca Tax Laws of tha C~aonwaalth
of Pannsylvania. Quastions aay ba answarad by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 8103282698 Date 04-23-1992
x
2,960.26
16.667
493.39
.045
22.20
TAXPAYER RESPONSE
To insura propar cradit to your account, two
(2) copias of this notica aust acc~pany your
payaant to tha Ragistar of Wills. Maka chack
payabla to. "Ragistar of Wills, Agant".
Establish.d
Account Balanc.
P.rc.nt Taxabl.
A.ount Subj.ct to
Tax Rat.
Pot.ntial Tax Du.
x
NOTE. If tax payaants ara aada within thraa
(3) aonths of tha dacadant's data of daath,
you aay daduct a 5X discount of tha tax dua.
Any inharitanca tax dua will bac~a dalinquant
nina (9) aonths aftar tha data of daath.
Tax
PART
[!]
Tha abova info~ation and tax dua is corract.
1. You aay choosa to raait payaant to tha Ragistar of Wills with two copias of this notica to obtain
a discount or avoid intarast, or you aay chack box "A" and raturn this notica to tha Ragistar of
Wills and an official assass.ant will ba issuad by tha PA Dapart.ant of Ravanua.
[CHECK ]
ONE
BLOCK
ONLY
8. c:J Tha abova assat has baan or will ba raportad and tax paid with tha Pannsylvania Inharitanca Tax rat urn
to ba filad by tha dacadant's raprasantativa.
C. c:J Tha abova infor.ation is incorract andlor dabts and daductions wara paid by you.
You .ust co.plata PART ~ andlor PART ~ balow.
x
PART
~
TAX RETURN -COMPUTATION
If you indicat. a diff.r.nt tax rat., pl. as. stat. your
relatIonshIp to deced.nt:
OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. n.t. Est.blis....d
2. Account Balance 2
3. Perc.nt Taxable 3
4. A.ount Subject to Tax 4
5. Debts and D.ductions 5
'. A.ount Taxable ,
7. Tax Rate 7
8. Tax Du. 8
PART
[!]
DATE PAID PAYEE
x
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on LIne 5 of Tax Computation>
.
p.rjury, I declare that the facts I
.y knowl.dg. and b.1I.f.
have report.d above are tru.,
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DATE