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Home My WebLink About07-14-09COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128.0601 RECEIVED FROM: REV-1162 EX111-961 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 01 1479 BHUT NIKHIL S 69 WEST VINE STREET SHIREMANSTOWN, PA 1 701 1-6345 "-'---- fold ESTATE INFORMATION: FILE NUMBER: DECEDENT NAME: DATE OF PAYMENT: POSTMARK DATE: COUNTY: DATE OF DEATH: SSN: 182-58-2500 2109-0645 BHUT SURESH D 07/14/2009 07/13/2009 CUMBERLAND 01/28/2009 REMARKS: ACN ASSESSMENT AMOUNT CONTROL NUMBER S 194.36 TOTAL AMOUNT PAID: CHECK# 3521 INITIALS: AJW SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU DF INDIVIDUAL TAXES A N D PD Box zso6ol TAXPAYER RESPONSE HARRISBURG PA 17128-0601 ftEV-1543 EX AFP (p8-OB) NIKHIL S BRUT 69 W VINE ST SHIREMANSTOWN PA 17011-6345 FILE N0. 21 O~~~n~'` ACN 09141429 DATE 06-29-2009 EST. OF SURESH D BHUT SSN 182-58-2500 DATE OF DEATH 01-28-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC BANK NA t_ ~ provided the Department with the information below, which has been"use potential tax due. Records indicate that at the death of the above-named decedent, you were a point owner/benelSj If you feel the information is incorrect, please obtain written correction from the financial institution, atta~ and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of _th~:~ F ennsy lvania. r'l ease call (7i7) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INS-~Qtt Account No. 000031400263270 Date 05-13-2005 Established Account Balance $ 8, 638.03 Percent Taxable X 50.000 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. r`a c.G7 -' in calc,Llating ,tyJei '_~9 ;.iary of(S,I1is a¢r~oumt: -a-Jcopy to thistfor,~j i~onweadi.h of - __: .. .F` _ 1 ~ .r 6~IONS ~ , To ensure proper crerli~~o the ac punt, -two -~- copies of this notice i~wlst accom~y ~e I"F payment to the Reg; r of Wills Make ;check Y payable to "Register of Wills, At". Amount Subject t0 Tax $ 4,319.02 NOTE: If tax payments are made within three months of the decedent's date of death, Tax Rate X .045 deduct a 5 percent discount on the tax due. Potential Tax Due $ 194.36 Any Inheritance Tax due will become delinquent nine months after the date of death. PART TAXPAYER RESPONSE 0 FAILU E TO FtfSPDND WILL RESULT IN AN DFFICIAL TAX ASSESSMENT! A. 1 it The above information and tax due is correct. LEI 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 C 0 N E ~ Wills and an official assessment will be issued by the PA Department of Revenue. BLOC 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. ~ The above information is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART ~ below. PART 1r inalcating 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 ~11~f0~ 2 ~ ,ll 4:~~JU ~~~ 3 5 LJ . ~• 4 $ ~~~~ 5 ~~ 7 X , (Jib S B $14~•3~, PAD OFFICIAL USE ONLY ~ AAF PA DEPARTMENT OF REVENUE 1 2 3 4 5 6 7 8 PART 0 DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE nFSf'arprrnti Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete t0 the best of my knowledge and belief. ~ ~ -~--~ , HOME (.~1~ ) X15-- ~4t` ~ r,. ~~ ~ ~ ~~/~( <'~~ WORK C ~1-? ) 477 ~ ~ ; --r' ~ ,~,,.: TAXPAYER SIGNATURE Tom, ~,,,,~.,~ ,,,,,,.,~ S~ . ~ S . `~~ ~' ~ - 5 -~ a ~ .r ~. ,.~. ..~ ,-~~ ,_,. f; i; S :;. t s,~;~ ~•.:~ rte, ,~ ~ °.~ ~ ~ ~. ;s ~-" ~. ~ (> ~` ~'i ~ ~, f ' - ~ ~:. ~ `~w ~ ~ = ~.w 9 ~, S~ r~+ ~' ~ f V f.,.:. i R Y=; ,':3 of -, 1~3 ~~~~ 5,~~~7 ~~~f0 h~ ~0I ~d~ ~ i ~lf~~' 6Q~1 .., ~;~ _~;-. ,u ~-~- -~ ti'~ ..