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Home My WebLink About04-16-08 COM.MQ.NWEALJ:H OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT STINE KENNETH L 318 WILDWOOD LANE NEWVILLE, PA 17241 _nnn_ fold ESTATE INFORMATION: SSN: 203-10-2645 FILE NUMBER: 2108-0108 DECEDENT NAME: STINE SAMUEL L DATE OF PAYMENT: 04/16/2008 POSTMARK DATE: 04/15/2008 COUNTY: CUMBERLAND DATE OF DEATH: 09/26/2007 NO. CD 009572 ACN ASSESSMENT CONTROL NUMBER AMOUNT 08103037 I $384.50 I I I I I I I I TOTAL AMOUNT PAID: $384.50 REMARKS: KENNETH STINE CHECK# 2164 SEAL INITIALS: WZ RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 ~ 0<6 - 610'i( 08103037 01-22-2008 REY~15li3 EX AFP (09-00) TYPE OF ACCOUNT EST. OF SAMUEL L STINE S.S. NO. 203-10-2645 DATE OF DEATH 09-26-2007 COUNTY CUMBERLAND t--.) REMIT PAYMENT AND F~S TO: REGISTER OF W~LS co CUMBERLAND CO~OURT flnUSE, CARLISLE, PA;U']13 :?{.1 .. rrl ;:~~ ,,;"'- ,~3~ o SAVINGS o CHECKING o TRUST IX] CERTlF. KENNETH L STINE 318 WOLDWOOD LANE NEWVILLE PA 17241 01 ):::l!o :x ~.\5 -.- ADAMS COUNTY NATIONAL BANK has provided the Department with the information listed below which :h'lS:tieen used-:;; r calculating the potential tax due. Their records indicate that at the death of the above decedent, you were ~int owner/~efidll';~ ;~.f~ this account. If you feel this information is incorrect, please obtain written correction from the financial institution,~ach a Copy~' to this form and return it to the above address. This account is taxable in accordance wIth the Inheritance Tax Laws ot the Lom.onwealth of Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS I Account No. 160431 Date 08-06-2002 Established 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". Account Balance Percent Taxable Amount Subject to Tax Tax R,lte Potential Tax Due 17,088.74 X 50.000 8,544.37 X .045 384.50 TAXPAYER RESPONSE NOTE: If tax payments are made within three (3) months of the decedent's date of death, you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. PART [!] [CHECK ] ONE BLOCK ONLY A. [] The above information and tax due is correct. 1. You may choose to remit payment 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 assessment will be issued by the PA Department of Revenue. 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 information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART [!] DATE PAIID ~ DEBTS AND DEDUCTIONS CLAIMED PART ~ If you indicate a different tax rate, please state your relationship to decedent: TAX LINE RETURN - COMPUTATION OF 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 4. Am,ount Subject to Tax 4 s. Delbts and Deductions 5 6. Amlount Taxable 6 7. Ta:K Rate 7 8. Ta:K Due 8 TAX ON JOINT/TRUST ACCOUNTS X x PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) * Under penalties of perjury, I declare that the facts complete to the best of y knowledge and belief. have reported above are true, correct and -/76,..'77Q3 HOME WORK ('7Q ) ( ) 4-lr-01 nAT!: TFI FPJ..InNF NIIMRI=~ ~ ~ 'r.~ N t'. . ",,"\ i#,' ,. t (j., . . t~ ~ '~ tl. Vl t . ti~..tt, tt ;t \f\ !!to . ;00\ ~.. . \ \ .\ ~ '" -::> ? .~ ~ ') c V\ 0 ~ '- -, Q o ~ o ~ .-"'j. .> 0/ .k -$ "'" .. ..... If""\ ") ~ 0 cJ.. ~ ~ ;s~ ~..J. \ \K~9" <. 3 ~ ~ ..--. - .-::;. ~ ) .-S J ~QJ '.~ ....:a. s ~.' .s; ....-..'" . '..v. ",'1 ~ ~ cI\ - I:) (' .-.. \ .-.. -:. .-.. - -:. .-.. ~ ~ .-.. -:. ~ ~ ~ ~ ~ ~ ~ ~ ::; ~ .:;::. .-.. :. - - d 0" .::2 .,.. ...- ~ 6 o .,.-l ."'\ 'f\ ,,~\ \~ i'~ i'\:>. . " \~~ -\: N .,.-l ."'\ ,,~ \'" .,.-l