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Home My WebLink About06-25-09 (3)COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0 60 1 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 01 1404 CLOUSER DOUGLAS G 1875 TOWN HILL ROAD YORK SPRINGS, PA 17372 fold ESTATE INFORMATION: ssly: is4-26-5o4s FILE NUMBER: 2109-0204 DECEDENT NAME: CLOUSER DAVID H DATE OF PAYMENT: 06/25/2009 POSTMARK DATE: 06/24/2009 COUNTY: CUMBERLAND DATE OF DEATH: 02/20/2009 ACN ASSESSMENT AMOUNT CONTROL NUMBER 09117551 ~ 5320.91 TOTAL AMOUNT PAID: REMARKS: CHECK# 7737 SEAL INITIALS: AJW REV-1162 EXI11-96) 5320.91 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES A N D Po Box zao6al TAXPAYER RESPONSE HARRISBURG PA 171z8-0601 REV-1543 EX I1fP (09-OB) FILE N0. 21 09-0204 ACN 09117551 DATE 03-19-2009 TYPE OF DOUGLAS CLOUSER 1875 TOWNHILL ROAD YORK SPRINGS PA 17372 EST. OF DAVID H CLOUSER SSN 184-26-5048 r,,~ DATE OF DEATH 0 2 - 2 0 - ~8j0 9 c~'.+ COUNTY CUMBERLANi~,,..0 "~ t_.. REMIT PAYMENT AND FORMS TO ~ ~ ~ ~ REGISTER OF WILLS ~~rn n;, CUMBERLAND CO COURT HO~S~ ~ ~ CARLISLE, PA 17013 r==, ACCOUNT SAVINGS CHECKING [] TausT CERTIF. c c ~, = .) --` c7O ~ ~~ -rI ~, - L ';~'~ p - ~--'s b ~ MEMBERS 1ST FCU provided the Department with the information below, which has been used in calculat ng 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 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 .~~„ Sylvania. T ease call (717) 7~7-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 113054-41 Date 02-05-1990 To ensure proper credit to the account, two Established copies of this notice must accompany $ 85,579.74 Payment to the Register of Wills. Make check Account Balance payable to "Register of Wills, Agent". Percent Taxable X 8.333 7, 131.36 NOTE: If tax Dayments are made within three Amount Subject to Tax $ months of the decedent's date of death, Tax Rate X .045 deduct a 5 percent discount on the tax due. 3 2 0 . 9 1 Anv Inheritance Tax due will become delinquent Potential Tax Due $ nine months after the date of death. P~T TAXPAYER RESPONSE 1 FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX A5SE55MENT A. The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain C H E C K 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. C 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 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 $ 5 6 $ 7 X 8 $ PAD OFFICIAL USE ONLY ~ AAF PA DEPARTMENT OF REVENUE 1 2 3 4 5 6 7 8 PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are//~~t~~ru//e, ~/c))orrect and co ete to the best of my knowledge and belief. HOME C717 ~ TQ(9'-"y~ ~~ ~~,~i?-~'-~e~, woRK c7~7 ~~d5 _~i~ ~ ~ /~~/~;4 TAYDAVCD (OAT CAIA TIIDC TOTAL cEnter on Line 5 of Tax Computation) $ UP RS Cl S~.f ~'E`rER - .- ~ ~-. r-~-y t, _1 ~ _ ,.. .~i i e. t ~ ~ ... ~~ V 2009 JU~125 ~~ 1~~ .~ ERIC ~~ 4~~~. ~ {~ ~"`. R ~~ 1 ~JO~~ Vvl ,~ LL v 1 ~~.. '.,p~ ~~... ~ r ~~ '~J g ~ ~ ~~ J ,~ ~ ~ ~ ~ ~~~ ,~ iri ( jai / ~ •r.i \~ i. „i ~..q `~l ~~ ~~ 3 4 ~ 4 iii ^^ V) ~ ~ ~` T