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Home My WebLink About03-03-09COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 010963 DORTY DECIE M 5231 WINDSOR BLVD MECHANICSBURG, PA 17055 ----~--- fold ESTATE INFORMATION: SSN: 188-i0-0676 FILE NUMBER: 2109-0202 DECEDENT NAME: CLEVER LEROY N DATE OF PAYMENT: 03/03/2009 POSTMARK DATE: 03/02/2009 COUNTY: CUMBERLAND DATE OF DEATH: 1 2/23/2008 REMARKS: CHECK# 4586 SEAL ACN ASSESSMENT AMOUNT CONTROL NUMBER 09105512 ~ 5450.09 TOTAL AMOUNT PAID: INITIALS: AJW REV-1162 EX111-96) 5450.09 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 C~ Lj'~p~ PD Box 280601 TAXPAYER RESPONSE ACN 09105512 HARRISBURG PA 17128-0601 DATE 01-27-2009 REV-1543 EX AFP (OB-OB) TYPE OF ACCOUNT EST. OF LEROY N CLEVER ~ SAVINGS SSN 188-10-0676 ~ CHECKING DATE OF DEATH 12-23-2008 ~ TRUST COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: N DECIE M DORTY REGISTER OF WILLS C7 ° ..o 5231 WINDSOR BLVD CUMBERLAND CO COURT HOUO r _ MECHANICSBURG PA 17055-3546 CARLISLE, PA 17013 ~ ~ ~-~ t-n.a ~ ..a.,. C ~. _.... X.~ _ ''7 '. f - t~ ~CJ7~ W ~.! ~1 C C._..~ ,~ PNC BANK NA provided the Department with the information below, which has been us alculat~ the %.;W°°~i potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/benefic of thi~•accour~t.,,-- If you feel the information is incorrect, please obtain written correction from the financial institution, attae~a copy to t~ form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth ~ Pennsylvania. Please caii CiI7) 7d7-8527 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0 0 0 0 31 1 0 0 242265 Date 06-21-2004 To ensure proper credit to the account, two Established copies of this notice must accompany ACCOUnt Balance 6 001 .21 payment to the Register of Wills. Make check ~ Payable to "Register of Wills, Agent". Percent Taxable X 50.000 ~ 0 ~ . 6 1 NOTE: If tax payments are made within three Amount Subject t0 TaX $ 3, months of the decedent's date of death, Tax Rate X 15 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due $ 450.09 nine months after the date of death. PART TAXPAYER RESPONSE ~ FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX A55E5SMENT A. I~ The above information and tax due is correct. I~ 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 Wills and an official assessment will be issued by the PA Department of Revenue. ONE 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 information 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 ONL Y ~ AAF relationship to decedent: PA DEPARTMENT OF REVENUE TAX RETURN - COMPUTATION DF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date tstabiished i 1 2. Account Balance 2 $ 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 +~ $ PART DEBTS AND DEDUCTIONS CLAIMED a DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true,,//corrf~ct complete to the bes,Y°'qf myJcnowledge and belief. unMr r ~~~i ~~/~1~ X .~ ~} ~~'~?~~/ WORK C ) _ %f -;~ -~ .r„nr rc~ counuc u~~unro Herr TOTAL CEnter on Line 5 of Tax Computation) $ ~" N n 'W.. yD" a ~ d 0. C O ~• ~ ~ d "C ~ O a ,, ~. w ~, ~- ~,-.. ~, ~ ~ ~.a. `., F ~ ,. u 'T......: > ~ ~ _... E' ~.:: ~._ ay ,: ~ ~ ~~ n., a \ i ~'Fr .. 1 ~ . -~ ~ ~, - Y; ~` r-y.,.. ~, ~$'~ •. ~~ ,` S ` \~ t t . ,.. µ y M .~ ` x ( ~ _ \~~~ `.~ _' _ ~~ ~ ~~ ~ ~ ~~ 55 :z~ ~a ~- ~~~ ~o~~ ~,f.,.- ~ . ~, , -; , ~._ s_ ~~_~,. ~-.. '~tia R~ b t, H `~d u~ 1j J'~ Zt