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Home My WebLink About09-20-08COMMONNLEALTH OF PENNSYLVANIA DrFEP---ARTM-ENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 71 26-060 7 RECEIVED FROM: ACN ASSESSMENT AMOUNT CONTROL NUMBER SHELLEY PAULINE C 59 GREENSPRING DRIVE MECHANICSBURG, PA 17050 fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 010298 08501115 ~ $774.41 ESTATE INFORMATION: ssrv: isi-34-2046 FILE NUMBER: 2108-0744 DECEDENT NAME: LANTZY LOIS M DATE OF PAYMENT: 09/22/2008 POSTMARK DATE: 09/20/2008 couNTY: CUMBERLAND ~~ DATE OF DEATH: 07/03/2008 REMARKS: PAULINE SHELLEY CHECK#1162 SEAL REV-1162EX(11-96) .TOTAL AMOUNT PAID: INITIALS: WZ RECEIVED BY: REGISTER OF WILLS 5774.41 GLENDA EARNER STRASBAUGH REGISTER OF WILLS JF: :~ ~, .fir s a h t 1 t ~~ r~ ~~~ ~" r. ~:< ~~ x _, ~_ L,r 1,f A::f ~i dv R.. a 0 T" N~ ~ ~ N ~ ~ s. a ~ 0. N U c ." ti v ~ ~ 0.. ~~~ ~tJ l/) \y ^V 1. ``v v ~~ "V `~ V , ~~ ~> .. ~~ t '.} i'{'i j~~ {~.' ~;; ~ ~~:. .,..~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE FILE N0. 21 08-0744 BUREAU OF INDIVIDUAL TAXES Po eox 2socol AND ACN 08501115 HARRISBURG PA 171zs-0601 TAXPAYER RESPONSE DATE 09-09-2008 REV-1543A AFP (7-00) TYPE OF ACCOUNT EST. OF LOIS M LANTZY ^ SECURITY S.S. N0. 161-34-2046 X^ sEC ACCT DATE OF DEATH 07-03-2008 ^ sTOCK COUNTY CUMBERLAND ^ soNDs r-a REMIT PAY~cNT AND F~1S TD: PAULINE C SHELLEY REGISTER OF~I~pLS `~' 59 GREENSPRING DRIVE CUMBERLAND CO;OURT ~USE•° MECHANICSBURG PA 17050 CARLISLE, PA .~,7~ID_,13 ~ - r,,,~ ~--- N - r; ~: - ~3 ,_ WACHOVIA has provided the Department with the information listed below which has~en used "" calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a neficiary ggf~~~~this asset.' If you feel this information is incorrect, please obtain written correction from the transfer agent, attach a copy to this;fArm and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth o ennsylvania. puestions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 4950-2826 DOD Valuation Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due To insure proper credit to your account, two (2) copies of this notice must accompany your 20,379.50 payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". x 33.333 6,793.10 X ~~ NOTE: If tax payments are made within three C3) months of the decedent's date of death, you may deduct a 5% discount of the tax due. Anv inheritance tax due will become delinquent nine C9) months after the date of death. PART IA7CF'ATtK KtJI"UPIJt a FAILURE TO RESPOND WILL RESULT IN AN QF FICIAL TAX ASSESSMENT BASED ON THIS NOTICE A. The above information and tax due is correct. 1. You may choose to remit..paynent 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 CHECK Wills and an official assessment will be issued by the PA Department of Revenue. C 0 N E ~ B L 0 C K B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's repres entative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ^ and/or~:PART ^ below. PART If you indicate a different tax rate, please state your OFFICIAL USE ONLY ^ AAF relationship to decedent: PA DEPARTMENT OF REVENUE TAX RE TURN - COMPUTATION OF TAX ON ABOVE ASSET(S) =PAD 1 1 LINE 1. DOD Valuation 2 2 X t T bl P 2 . axa e ercen 3 t to Tax 3 t S bj A 3 . moun u ec 4 4. Debts and Deductions 4 - 5 t Taxable 5 A 5 . moun 6 6 X T R t 6 . e ax a 7 7 7. Tax Due 8 PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIP TION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best o my knowledge and belief. HOME C // / ) 6 9 ~ -,~.3 ~~ ~i,..~. ~ ~,/~~.,_ WORK C ) .~ DATE~~~ ~~