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Home My WebLink About1-16-08 REV-1162 EX(11-96) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 009185 RECEIVED FROM: SARAH E WAGNER 342 S MAIN STREET LEWISTOWN, PA 17044 ACN ASSESSMENT CONTROL NUMBER AMOUNT __n____ fold 08101031 $4.25 ESTATE INFORMATION: SSN: 211-42-9423 FILE NUMBER: 2108-0057 DECEDENT NAME: WAGNER GAINELLE E DATE OF PAYMENT: 01/16/2008 POSTMARK DATE: 01/08/2008 COUNTY: CUMBERLAND DATE OF DEATH: 11/11/2007 TOTAL AMOUNT PAID: $4.25 REMARKS: CHECK# 5725 INITIALS: CJ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS SEAL REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2B0601 HARRISBURG, PA 17128-0601 *' FILE ACN DATE NO. 21-08 ~ 57 08101031 01-03-2008 INF,QRt1ATION NOTICE ~..i-', AND TAXPAYER RESPONSE REV-1543 EX AFP (09-00> TYPE OF ACCOUNT 20D8 ..IAN 16 Pr112: 12 EST. OF GAINELLE E WAGNER Ci r-f','" S.S. NO. 211-42-9423 U::~t' OR::'.-U\.i:;\(Y"JeRATE OF DEATH 11-11-2007 . . . ",'> '., -: "e,oVNTY CUMBERLAND CU.: " i-:" REMIT PAYMENT AND FDRMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 [X] SAVINGS o CHECKING o TRUST o CERTIF. SARAH E WAGNER 342 S MAIN ST LEWISTOWN PA 17044 NDRTHWEST SAVINGS BANK has provided the Department with the inforution 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 tQ thi~ for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions .ay be answered by calling (717) 787-B327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 810107313 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART ill Date Established 07-13-1995 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". x 595.36 16.667 99.23 .045 4.47 TAXPAYER RESPONSE NOTE: If tax payments are made within three (3) months of the decedent's date of death. you .ay deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent nine (9) Months after the date of death. x A. ~ The above information and tax due is correct. 1. You may choose to reMlt payMent to the Register of Wllls wlth 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 assessment will be issued by the PA Department of Revenue. [CHECK ] ONE BLOCK ONLY B. [] 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. [] The above infor.ation is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART [!] TAX If you indicate a different tax rate, please state your relationship to decedent: RETURN - COMFUTATION OF TAX ON JOINT/TRUST ACCOUNTS I 2 3 X 4 5 6 7 X 8 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 PART [!J DATE PAID PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCR I PTI ON AMOUNT PAID TDTAL (Enter on Line 5 of Tax Computation) $ have reported above are true, correct and HOME (117) 21<,1"" <ti 2-8 WORK ( ) TELEPHONE NUMBER DATE Under penalties of perjury, I declare that the facts complete to the best of my knowledge and belief. TAXPAYER SIGNATURE r '7'! ..J 1"... m 7""i <! ! c. Q, (,", u ~ IX '"'\ ..,J (;'5 r:a t1l vi t-'O Z ~ ~ c! <( S :!: ,nlPnj !,i'\ I, S C7j) v,.\,., 01 LL.i IU (f) .~ W I X ,.. ;fi~Z 0 '> ~ 0 CO '..J- 0 Wc:e(f) cO a::~> N LLCC r:: O>X ,.. ..--~ <C ;::::CZ~"'D. W 0 ::E-Wco" I-LLOOa:: a::OZ~~ <C~~ CO D. c:e - OX (f) W W a:: -a:: Ca::WCOa:: c:e~::J:0c:e D.CO~D.::J: Q) '0 o o , 0- N CI o::t C') o j::: c o ;: C Gl == c( r- -"--. . (."'\ I'): 12 l " It..... ,URT ......t., n^ GU, rr-. -: " "