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Home My WebLink About11-18-08 (2)COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX111-961 NO. CD 010538 HOLTRY LARRY L 610 BRENTON STREET SHIPPENSBURG, PA 17257 -------- told ESTATE INFORMATION: ssN: is4-12-4ssa FILE NUMBER: 2108-0898 DECEDENT NAME: HOLTRY GALEN L DATE OF PAYMENT: 1 1 / 1 8/2008 POSTMARK DATE: 1 1 /1 8/2008 couNTY: CUMBERLAND DATE OF DEATH: 08/'27/2008 REMARKS: ACN ASSESSMENT AMOUNT CONTROL NUMBER 08151320 ~ 59,016.69 TOTAL AMOUNT PAID: 59,016.69 CHECK# 999 INITIALS: CJ SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER 01= WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-06D1 PENNSYLVANIA INHERITANCE: INFORMATION NOTICE AND -T,~-x,PAYER RESPONSE i ~_ ~,, REV-1543 EX I1FP ~~.~OBp;_ ~ ~ ,- " T FILE N0. 21 08-0898 ACN 08151320 DATE 11-04-2008 2Q08 ~UV 18 P~ 3~ 40 CL~~~;•; C~- FF^^ CAP' l.M ~I ~ ~1!~}lJilT LARRY L HOL'fRY - rA 610 BRENTON ST SHIPPENSBURG PA 17257 EST. OF GALEN L HOLTRY SSN 184•-12-4988 DATE OF DEATH 08-27-2008 COl1NTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 1ir013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. CITIZENS BANK OF PENNSYLVANIA provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Ta:< laws of the Commonwealth of Pennsylvania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRIIrTTf1hIC Account No. 6244107867 Date 12-27-2003 To ensure groper credit to the account, two Established copies of 1:his notice must accompany AccOUnt Balance $ 11 ~ 877.22 Payment to the Register of Wills. Make check Percent Taxable X 50.000 payable to "Register of Wills, Agent". Amount Subject to Tax $ 5, 938.61 NOTE: If tax payments are made within three Tax Rate X months of the decedent's date of death, .045 deduct a 5 percent discount on the tax due. Potential Tax Due $ 267.24 Any Inheritance Tax due will become delinquent nine months after the date of death. PART 1 TAXPAYER RESPONSE FAILURE 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 C 0 N E Wills and an official assessment will be issued by the PA Department of Revenue. ~ B L 0 C K D N L Y ~ B. The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax retur to be filed by the estate representative. n C. ~ The above information is incorrect and/or debts and deductions were paid. Complete PART a and/or PART ~ below. YAKI it indicating a tllfferent tax rate, please state relationship to decedent: TAX RETURN - COMPUTATION LINE i. 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 OF TAX ON JOINT/TRUST ACCOUNTS PAD 1 , 2 $ 2 3 X ~ 4 $ 4 5 - 5 6 $ 6 7 X ~ B $ 8 OFFICIAL USE QNLY Q AAF PA DEPARTMENT OF REVENUE PART DATE PAID PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRTPTTf1N -' - c ~ ur iax l.OmpUtaLlOrl) $ Under penalties of perjury, I declare that the facts I have reported above arE~ true, correct and complete to the best of my knowledge and belief. /,~~`~ ~~l~Uf~i ~ ~X~CllTD WORK C ) N~l9 // !'7 08 TAXPAYE SIGNATURE TELEPHONE NUMBER DATE