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Home My WebLink About04-27-09COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT MERCURI CYNTHIA L 26 SADDLEBROOK LANE PHOENIXVILLE, PA 19460 fold ESTATE INFORMATION: SSN: isi-24-1301 FILE NUMBER: 2109-0017 DECEDENT NAME: HOSTETTER BETTY JEAN DATE OF PAYMENT: 04/27/2009 POSTMARK DATE: 04/24/2009 couNTY: CUMBERLAND DATE OF DEATH: 12/12/2008 REMARKS: SEAL CHECK# 734 REV-1162 EX111-96) NO. CD 01 1 163 ACN ASSESSMENT AMOUNT CONTROL NUMBER 09122480 ~ 5323.91 TOTAL AMOUNT PAID: INITIALS: CJ RECEIVED BY: REGISTER OF WILLS REGISTER OF WILLS 5323.91 GLENDA EARNER STRASBAUGH BUREAU OF INDIVIDUAL TAXES PD BOX 280601 HARRISBURG PA 17128-0601 my-1543 oc APP PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE AND FILE N0. 21 09-0017 ''~ _' ~ '..~'.T~-~~CP../~YER RESPONSE ACN 09122480 t, , DATE 04-06-2009 2009 ASR Z~ ~'~ ~ ~ ~ 36EST. OF BETTY J HOSTETTER SSN 191-24-1301 CL.Ej~~ ~~ DATE OF DEATH 12-12-2008 t (~{rlt T ~~1~H~~r";~ v~+t~Rt COUNTY CUMBERLAND /~ pq ~~ ~~ !~'~., ~~ REMIT PAYMENT AND FORMS T0: CYNTHIA L MERCURI REGISTER OF WILLS 26 SADDLEBROOK RD CUMBERLAND CO .,COURT HOUSE PHOENIXVILLE PA 19460 CARLISLE, PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. COMMERCE BANK HARRISBURG NA Drovided 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 frow the financial institution, attach a copy to this fore and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of rennsyivania. riease tali C7i7) 78%-BS27 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 513205112 Date 06-03-2000 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 $ 14 ~ 395.82 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are ^ade within three Amount Subject to Tax $ 7 ~ 197 • 91 months of the decedent's date of death, lrj deduct a 5 percent discount on the tax due. ~( Tax Rate , Any Inheritance Tax due will become delinquent Potential TaX Due $ 1 ~ 079 • 69 nine months after the date of death. PART TAXPAYER RESPONSE 1^ L ~ >, A. ~ The 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 interest, or check box "A" and return this notice to the Register of CHECK Wills and an official assessment will be issued by the PA 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 0 N L Y to be filed by the estate representative. C. ~he above informs ion is incorrect and/or debts and deductions were paid. ~ and/or PART ~ below. Complete PART 2 PART If indicating a different ta)yrat~~a a 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 PART DATE PAID PAYEE OF TAX ON JOINT/TRUST ACCOUNTS DESCRIPTION AMOUNT PAID _--~ _ TOTAL (Enter on Line 5 of Tax Computation) 8 Und penalti s of erjury, I eclar that the facts I have reported a/bo~ve are true, corre/c~t,,(a/~nl c plete to, t e e t of m kn wledg and belief. HOME CC/(/~,~~) /~~ ~ (.1~"`~ WO R K C ~~D) Zy l D-~~GO /S L~ ER IG ATURE TELEPHONE NUMBER t~0~ b°q 27 A~ ! I ~ 3b ,,, , , "^ ~'; ~;~URT ORP~ ~~~ ~ 0 x 0 U ~ M .^_ O ~ V ~ 3 ~ O ~ ~ ~. ~~+ ~ .4: v~ .~ v~ GL U U •,-e s;_i 3 :~ t':~ .~.. j rt .~ 3,_i +••.. i .~ O N ~ C ~ ~~= a ~ U ,~C Q ~ oa ~ ~ a; .a a '~ ~~ x c~ ~ e '~ o ~, ~o ,~ V N 0.