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Home My WebLink About11-20-09COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SIMONS LINDA L 335 MULBERRY DRIVE MECHANICSBURG, PA 17050-3141 fold ESTATE INFORMATION: ssrv: 203-05-6555 FILE NUMBER: 2109-0950 DECEDENT NAME: TOMLINSON PHILIP B DATE OF PAYMENT: 1 1 /20/2009 POSTMARK DATE: 1 1 /20/2009 COUNTY: CUMBERLAND DATE OF DEATH: 09/15/2009 REV-1162 EX111-961 NO. CD 012013 ACN ASSESSMENT AMOUNT CONTROL NUMBER 09170052 ( 5310.03 TOTAL AMOUNT PAID: REMARKS: CHECK#110 SEAL INITIALS: JN 5310.03 RECEIVED BY: GLENDA EARNER Sl~'RASBAUGH REGISTER OF WILLS REGISTER OF WILLS PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND F I L E HARRI~SBURG6PA 17128-0681 ^- „-~,- "`•, {"~~~~4tYER RESPONSE ACN - DATE REV-1543 EX 11FP COB-R~ ,, ~ :~ -; ;~ l?i~ 7i. ~:!lrv:i i!: ~: ~f:Lw N0. 21 09-0950 09170052 11-02-2009 7~a9 HQV ~Q ~~ Z' 4 SST. OF PHILIP TOMLINSON SSN 203-05-6555 CLERK~JF DATE OF DEATH o9-15-2oa9 OflPN~hl~S COURT COUNTY CUMBERLAND rf'~~r~~-~ f ++k_i (,f~ tip REMIT PAYMENT AND FORMS T0: KENNETH S BOLINGER VV f_f" REGISTER OF WILLS 1180 S CAMERON ST CUMBERLAND CO COURT HOUSE HARRISBURG PA 17104-2531 CARLISLE, PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING X^ TRUST CERTIF. PNC BANK NA provided the Departaent with the inforaation below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-naaed decedent, you were a point owner/beneficiary of this account. If you feel the inforaation is incorrect, please obtain written correction from the financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Coaaonwealth of Pennsylvania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 000031000330324 Date 09-12-2008 To ensure prover credit to the account, two Established copies of this notice ausit accoapargr Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due So PART CHECK ONE BLOCK ] ONLY payment to the Register of Wills. Make check payable to "Register of Wills, Agent". NOTE: If tax payments are wade within three months of the decedent's date of death, deduct a 5 portent discount on the tax duo. Any Inheritance Tax due will become delinquent nine months after the date of death. ~i.~,~i: '.. A. ~ The above inforaation and tax due is correct. Resit 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 Wills and an official assessment will bo issued by the PA Departaent of Revanua. B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the estate representative. C. ~ The above inforaa ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3^ 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 $ 7,252.33 X 100.00 $ 7,252.33 X .045 OF TAX ON JOINT/TRUST ACCOUNTS 1 2 ~ 3 X 4 +fi 5 - 6 +~ 7 X 8 PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID WORK ( ) TELEPHONE NUMBER DATE Under penalties of perjury, I declare that the facts I have reported above are true, correct and com(.ylpte to the. bast of my knowledge and belief. HOME C )