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Home My WebLink About11-07-08COMMONWEALTH OF PENNSYLVANIA REV-1162 EX111-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DE~'~-c`O fTf~ HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 010514 MADIGAN-SEDOR HELEN 15501 WHITE WILLOW LANE ROCKVILLE, MD 20853 ~ -------- fold ESTATE INFORMATION: ssrv: isi-34-2046 FILE NUMBER: 2108-0744 DECEDENT NAME: LANTZY LOIS M DATE OF PAYMENT: 1 1 / 10/2008 POSTMARK DATE: 1 1 /07/2008 COUNTY: CUMBERLAND DATE OF DEATH: 07/03/2008 ACN ASSESSMENT AMOUNT CONTROL NUMBER 08149153 ~ S 132.64 TOTAL AMOUNT PAID: REMARKS: HELEN MADIGAN SEDOR CHECK# 1213 S 132.64 INITIALS: WZ sEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS "REGISTER OF WILLS PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 08-0744 PD Box zao6ol TAXPAYER RESPONSE ACN 08149153 HARRISBURG PA 17128-0601 DATE 10-21-2008 REV-1543 EX AFP (OB-08) TYPE OF ACCOUNT EST. OF LOIS M LANTZY ^ savINGs SSN 161-34-2046 ^ CHECKING DATE OF DEATH 07-03-2008 ~ TRUST COUNTY CUMBERLAND ^ CERTIF. REMIT PAYMENT AND FORMS T0: HELEN A MADIGANSEDOR REGISTER OF WILLS 15501 WHITE WILLOW LN CUMBERLAND CO COURT HOUSE rv ROCKVILLE MD 20853 CARLISLE, PA 17013 r? c :~ Q ~, ~._ , .~ c7 c~ ~ Q r ~ ~~ AMERICHOICE FCU provided the Department with the information below, which has beb~wrw~ in calculat}ry, the potential tax due. Records indicate that at the death of the above-named decedent, e13"`u"~9~ ` you were a joint owm iciar$Aef this-accdunt. If you feel the information is incorrect, please obtain written correction from the financial institutipn~ M ach a o~ry to this'it'8rm and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws o#~he Comme~ealth:q~# ~. - Pennsylvania. Please caii :717: 767-9527 with questions. --t7 ~.. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS r -, Account No. 2056-62 Date 03-10-2006 To ensure proper credit to the account, two Established copies of this notice must accompany AccOUnt Balance $ 1 , 105.37 payment to the Register of Wills. Make check payable to "Register of Wi:Lls, Agent". Percent Taxable X 100.00 NOTE: If tax payments are made within three Amount Subject to TaX $ 1, 105.37 months of the decedent's date of death, TaX Rate X . 12 deduct a 5 percent discount on the tax due. Any Inheritance Tax, due wi:Ll become delinquent Potential Tax Due ~` 132.64 nine months after the date of death. PaT TAXPAYER RESPONSE 1 FAILUI~,E TO RESPOND WILL RESULT. IN AN OFFICIAL TAX ASSESSMENT A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or check box "A" and return this notice to the Register of 0 N E Wills and an official assessment will be issued by the PA Department of Revenue. 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 estate representative. C. ^ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART ~ below. PART If indicating a different tax rate, please state OFFICIAL USE ONLY ^ AAF relationship to decedent: PA DEPARTMENT OF REVENUE TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Estaoiisned 1 1 2. Account Balance 2 +fi 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ 4 5. Debts and Deductions 5 5 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 7 8. Tax Due 8 $ 8 PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and om////plete to the best of my knownledge and belief. ~.~i.~n / 1 (~ ~! i~c4' H 0 M E C 3 ~' ~ ) ~l~ 7O ~P ..2, ~-l ~/ ~ ,!}-/t rte.-. WO R K C ) ER SI M1itK DATE IUTAL ctnter on Line 5 of Tax Computation) S F l y' R` .pp~ t Y'. c~ iC ;3M w°c N ~'3 ~~ xo~ y~ o ~~x M 0 ~3 a ~~~ i'~ !'~ k {~S 4