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HomeMy WebLinkAbout03-25-09COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: REV-1162 EX111-96) PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 01 1042 JOHNSON LILLIE R 460 WHISKEY RUN ROAD NEWVILLE, PA 17241 fold ESTATE INFORMATION: sSN: 21o-i8-9583 FILE NUMBER: 2109-0287 DECEDENT NAME: JOHNSON EMORY G DATE OF PAYMENT: 03/25/2009 POSTMARK DATE: 03/25/2009 couNTY: CUMBERLAND DATE OF DEATH: 1 1 / 1 7/2008 REMARKS: SEAL CHECK# 4062 ACN ASSESSMENT AMOUNT CONTROL NUMBER 09107739 ~ 525.50 TOTAL AMOUNT PAID: INITIALS: CJ RECEIVED BY: 525.50 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS PENNSYLVANIA INHERITANCE T ~'ICETNFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES ~ ~~~~~~~~ AND l.y; , ~ PO BOX 280601 TAXPAYER RESPONSE HARRISBURG PA 17128-0601 FILE N0. 21-(~j-D2S~ ACN 09107739 DATE 02-10-2004 '~~Et~'~S~ EST. OF EMORY G JOHNSON r ','~~~5 _~'" ~ SSN 210 -18 - 9583 "~ '`' ~'~~~.~'~~ `"`''~ DATE OF DEATH 11-17 - 20 08 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: COLTON E JOHNSON REGISTER OF WILLS 460 WHISKEY RUN RD CUMBERLAND CO COURT HOUSE NEWVILLE PA 17241 CARLISLE, PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING © TRUST CERTIF. ADAMS COUNTY NATIONAL BANK provided the Department with the inforaation 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 point 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 Pcnrtsyl:•snia. Please call :717: 737-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 9627979 Date 10-0$-199b To ensure proper credit to the account, two Established copies of this notice must accompam Account Balance 566.56 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 100.00 5 6 6.5 6 NOTE: If tax payments are made within three Amount Subject t0 T2X $ months of the decedent's date of death, TaX Rate X . 045 deduct a 5 percent discount on the tax due. 2 5.5 0 Any Inheritance Tax due will became delinquent Potential Tax Due nine months after the date of death. P~T TAXPAYER RESPONSE 1 A. (~ The above inforaation and tax due is correct. ILA 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. BLOCK B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Taz return 0 N L Y to be filed by the estate representative. C. ~ The above informs ion is incorrrec~t and/or debts and deductions were paid. Complete PART 2~ and/or PART 3LJ below. PART If indicating a different tax rate, please state a 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 1 2 3 X 4 +fi 5 6 $ 7 X 8 PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) S 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. ~ ~ 7 r~ HOME C~/ 7 ) 7 7 Q ~/. cc' ir,.a~.r-~, WORK C ) 3ia ~-,~ ~ 9 TAXPAYER SIGNATU TELEPHONE NUMBER DATE r. ~ r= r.. r C ~ _. ~~ ~,~ -~~ ,~-c> ~ i `~' . ~ .. i. r..': ` ~ 4 ~ <-, `~ -~n ,~ A ; ~ r~ . ,~ ~ - ~ tY O v : ~ x ~ ~~ Y ~ ~ O M ~, ~ ~ aoc l 4 O ~ 1~ wa'~a i/w~ ~~~ 1 t s 1: /, W rf ~~ iYi .~ O ~ ~ ~ ~ Q d~ ,..a~~ -... r:~ iii E :~ !':~ tri I'' ~ •M t,,,l .~