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Home My WebLink About01-06-09COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX111-961 N0. CD 010731 HARVEY L M JR 6601 CHAMBERS HILL ROAD HARRISBURG, PA 17111 -- fold ESTATE INFORMATION: ssN: FILE NUMBER: 2108-1282 DECEDENT NAME: STARNER KATHY H DATE OF PAYMENT: 01 /06/2009 POSTMARK DATE: 01 /05/2009 couNTY: CUMBERLAND DATE OF DEATH: 10/13/2008 REMARKS: CHECK#10620 ACN ASSESSMENT AMOUNT CONTROL NUMBER 08163381 ~ 518.07 TOTAL AMOUNT PAID: 518.07 INITIALS: CJ SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES `~?` PO BOX 280601 -- HARRISBURG PA 17128-0601 -- -~~~;-j' REV-1543 EX AF~Z1181~~E B)~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE pp ., AND FILE N0. 21~(~~'la.b~ ~'~-T',¢SCPAYER RESPONSE ACN osi63381 ~~'' DATE 12-23-2008 l '.. i ; ', i. ~.. . 209 JAS -6 PIS 12~ 37 Ctfi..fl~~ +.J~ ORP Q N~ ~ COt1RT MICHAEL HARVEY JR 6601 CHAMBERS HILL RD HBG PA 17111 EST. OF KATHY H STARNER SSN DATE OF DEATH 10-13-2008 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND (:0 COURT HOUSE CARLISLE, PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. SOVEREIGN BANK 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 ioint 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 Tax laws of the Commonwealth of Pennsylvania. Please call 1717) 7e7-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0571116868 Date 06-07-2002 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance $ 722 • 93 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax $ 120.49 months of the decedent's date of death, ~( I ~j deduct a 5 percent discount on the tax due. Tax Rate , Anv Inheritance Tax due will become delinquent Potential Tax Due $ 18 • 07 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESULT IN AN DFFICIAL TAX ASSESSMENT'' The A. above information and tax due is correct. ~ Remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid i nterest, or check box "A" and return this notice to the Register of C H E C K Wills and an official assessment will be issued by the F'A Department of Revenue. ONE C B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return D 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 relationship to decedent: TAX RETURN - COMPUTATION 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 OF TAX ON JOINT/TRUST ACCOUNTS PAD 1 2 $ 2 3 X 3 y $ 4 5 - 5 6 $ 6 7 X 7 $ $ 8 OFFICIAL USE DNLY U AAF PA DEPARTMENT DF REVENUE PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties o rjury, I declare that the facts I have reported abo/vie are true, correctaand complete to th be t of my knowl d and belief. HOME Cif // ) ~ ~~~~~ ~~ WORK ( ) ~ ~rS' ~~J TAXPAYER SIG E TELEPHONE NUMBER DATE TDIA~ CtnLer On Llne D OT lax ~.v mpu~a uun~ - ___ _ ;"`- _ _ ._~ ~~ - ,; ~ . ~~ v _. =_. ~ ~ Ali PM 12' 3~ ~ ~ ~'~ Z409 J "6 l.,~ -~ '°.~~ RPN~ ~ COURS iR Ci rw 'it t `F ~'~ E .`ry {~ ( ~A~\w\\ w. i v ~ `~ ' 'V ~p\~V~ey 1 r •~ l ~ i'~ ~1 ~~ 1:1 '\Tv ~ ld.. ~~ ~ ~ Tom! ~ j,~, (\~ ~j..j v ~~// ~I IOW ,~ .~ ~ a ~~ ~v ~~ ~z `~-