The URL can be used to link to this page

Home My WebLink About04-01-09COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 7 28-0601 PENNSYLVANI ECEIVED FROM: INHERITANCE AND EST OFFICIAL RECEI WIGGINTON JUDY S 13 HAZELWOOD PATH MECHANISBURG, PA 17050 _____ fold __________ ESTATE INFORMATION: ssN: 204-o3-s756 FILE NUMBER: 2109-0306 DECEDENT NAME: LOSH ROBERT A DATE OF PAYMENT: 04/01 /2009 POSTMARK DATE: 04/01 /2009 couNTY: CUMBERLAND DATE OF DEATH: 02/23/2009 TOTAL AMOUN REMARKS: CHECK# 6464 INITIALS: CJ SEAL RECEIVED BY: REGISTER OF WILLS R REV-1162 EX111-96) ATE TAX T NO. CD 011063 ACN ASSESSMENT AMOUNT CONTROL NUMBER 09117976 ~ 52,448.55 PAID: 52,448.55 GLENDA EARNER STRASBAUGH REGISTER OF WILLS _ _ __ _ _ _ PENNSYLVANIA NHERITANCE TAX INFORMATI N NOTICE AN FILE N0. 21-'~ ! -'d~~ BUREAU OF INDIVIDUAL TAXES Po Box zsB6o1 TAXPAYER RESPONSE ACN 09117976 HARRISBURG PA 17128-8601 DATE 03-24-2009 NEV•1543 E% AFP (09-Oe) TYPE OF ACCOUNT EST . OF ROBERT A LOSH ® SAVIN SSN 204-03-6756 ^ CHECK DAT OF DEATH 02-23-2009 ^ TRUST COU TY CUMBERLAND, ^ CERTI REMI PAYMENT AND FORMS T0: ** JUDY S WIGGINGTON REG STER OF WILLS 13 HAZELWOOD PATH CUM ERLAND CO COURT HOUSE MECHANICSBURG PA 17050-9155 CAR ISLE, PA 17013 PNC BANK NA provided the Department with the info mation below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named deced nt. 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 Pennsylvania. Please Ball :717) 787-8327 with questions. COMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FIL NG AND PAYMENT INSTRUCTIONS Account No. 000005005203061 Date 12-03-2008 To ensure proper credit to the account, two Established copies of this notice ^ust accompany payment to the Register of Wills. Make check Account Balance 57,824.00 ~` payable to "Register of Wills, Agent". Percent Taxable X 100.00 NOTE: If tax payments are made within three Amount Subject to Tax $ 57,824.OU 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 $ 8, 673.60 nine months after the date of death. PART TAXPAYER RESPO SE ' RESiJLT IN AN FALLURE~TO-RESPOND'<WILL OFFICIAL TAX A53ESSMENT 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 " " and return this notice to the Register of Wills and an official assessment will be is C ONE ued by the PA Department of Revenue. B L 0 C K B. ^ The above asset has been or will be reported an 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. e~, please state PART If indicating a different tax rat " QFFFCIAL U5E ONLY ^ AAF r. tC~: relationship to decedent: ~~~'r f'f7 PA DEPARTMEN? OF REVENUE TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCO NTS PAD LINE 1. Date Established 1 ~ ~ 1 2. Account Balance 2 $ r' ~- u ~ 2 3. Percent Taxable 3 X U 0.~ ~ 3 4. Amount Subject to Tax 4 $ ~~~- ~ d 4 5. Debts and Deductions 5 - S ~ g' Lid 5 6. Amount Taxable 6 $ ~~ ~ •~ ~ 6 7. Tax Rate 7 X . ~ '] 8. Tax Due 8 $ g ! Z --S`t] :. .z ~~g g PART DEBTS AND DEDUCTI NS CLAIMED 3^ DATE PAID PAYEE DESC IPTION AMOUNT PAID ~- ~t8 ~ TJisN.~-T tf4~ ~gCff c,~dtRf~~- L N~K~~N :~la. . ~/ 3 'f ~ ' ~ r ~ NsB~Re B• S Yc . ~ C /+- :{L,syNC6 ~ fF~S Ps Tfl L 3S. J ~ 3 'moo a C~Nrs cif L Z= R C S T~ d DR y A.~ ~ ~- `' S 3/~ S/ ~/7ME'S ~_ 8 ~s7 ~ :"Ta .^iY6 ~ (~S, ~ / O 8dV/~Sfs K MxG~E R TOTAL (Enter on Line 5 f Tax Computation) j', }j' O ~ e a I h v ep ~ e ~ o r t nd '~ Under penalties of perjury, I declare that h f cts a ec o ted above are tru r a complete to the best of my knowledge and belief. ~,- S' Fj HOME C '7/7 ) ~3 ~ d b ( ' 1 ~G ~ l,/: G WORK C ) ~~ / / C~c T PAYS SIGNAT TELEPHONE NUMBER DATE ING