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Home My WebLink About01-04-10 (3)COMMONWEALTH 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 BOURINSKI VANESSA 1171 BOILING SPRINGS ROAD MECHANICSBURG, PA 17055 ACN ASSESSMENT CONTROL NUMBER fold ESTATE INFORMATION: ssN: FILE NUMBER: 2110-0002 DECEDENT NAME: BOURINSKI JOYCE DATE OF PAYMENT: 01 /04/2010 POSTMARK DATE: 1 2/31 /2009 COUNTY: CUMBERLAND DATE OF DEATH: 12/03/2009 REV-1162 EX111-96) NO. CD 012186 AMOUNT 09179998 ~ 56.86 TOTAL AMOUNT PAID: REMARKS: SEAL CHECK# 5531 INITIALS: CJ RECEIVED BY: 56.86 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES ~ j t ~ te~` ~~~ AND FILE ND . 21 rl ~ "- UQd PD Box 2BOeol _ ~ TAXPAYER RESPONSE ACN 09179998 WIRRISBURG PA 17128-0601 r.;,!Ci vs ,t:~.~•,e DATE 12-18-2009 REV-1543 IX AFP (OB-BB) 2010 JAN --4 PM i ~ 4 EST. OF JOYCE BOURINSKI (1L~R~ (~~ SSN ~~~',,~'~ v~U~ t DATE OF DEATH 12 - 0 3- 2 0 0 9 ~~~~~~~:*~,(~ ('.(~ }7A COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: VANESSA BOURINSKI REGISTER OF WILLS 1171 BOILING SPRINGS RD CUMBERLAND CO COURT HOUSE MECHANICSBURG PA 17055 CARLISLE, PA 17013 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU provided 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 infonation 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 call C717) 7B7-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 190277-00 Date 01-14-2000 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 g 914.64 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTES If tax payments are made within three Amount Subject to Tax $ 152 • 44 months of the decedent's date of death, X .045 deduct a 5 percent discount on the tax due. Tax Rate Any Inheritance Tax due will become delinquent Potential Tax Due ~ 6 • 86 nine months after the date of death. PART TAXPAYER RESPONSE A. ~he above information and tax due is correct. U~ Rewit p mrment 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. ~ The above informs ion 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 ~ ,, , 2 relationship to decedent: tx~'; 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 B PART nnTG porn PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID Under penalties of periury, I declare that the facts I have reported aJb~over~are tru®, corre~et~ ~~ eo a to the b st my kn ledge and SBf. HOME C f l f ) ~~~ "' ~a f WORK C ) ___ Tom, G~E,/lWC Al11MIICD neTF TOTAL CtnLer On Llne 7 vi ~mn vum)+u~m ~iu,u :. RJ w r W I1J r ^ ^ r r O -,~ w O '~ s ~~ u-t w r ~~ x' 3tn~ sc Vi 9~xr~j~ 3^> a~ ~b a a~z y V] ~ ~7~ O z m { n V O ~o 0 O 9on Z n -. Y za y ~ szrn~ ~ ~ ~n~d 1 C.U~~' ~~ ~,~~~ -~z~p ~~~~ tn' ~i°~~ ~~ ~z ~1.~ ~ w W ~ ~ ~ d a -~ m N a U ~ a ~ Cam, N W ~ ~ °Q$ S a ~ `~ ~'' N ~ cn ~ b~ w ,+ N t i M ,~ _ _ -~:~,,,~,_.~~ ____,_~..d«~,.,~ _,.-- --- _~- r a i i V 4 ti t i :~. °wi ~E '. ~, ~ ~`~.~ i~.ty t ;s^ .~ } "r e ~, . . i., ~ ~_,: `, ll~ AA ~~ }J ' ~ 201 AN -~+ PM i ~ 0 t CLERK C~ ~1S CUURT ~ ~RER'~C GC., ~'• ,`~ o ~ ~ ~. d~~~ i~ 1 ` ~ O ~~ ~ ~ ~ ~ ~~ ~ ,,, `~ ~ ~ ~ ~ ~ ~, b ~~ ~ ~~~ ~ ~~ m ~ °° oo: ~ Ir Ua..~. c ^~' ~' .-. o.:~ ~~~ ~ ~' _ ~ :. y~ 9 i w ~~ ~;