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Home My WebLink About01-11-10 (2)COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT FRY SUSANNE K 148 PENNSYLVANIA AVE. CARLISLE, PA 17013 fold ESTATE INFORMATION: ssN: X96-~s-6398 FILE NUMBER: 2106-0073 DECEDENT NAME: ALEXANDER DAVID M DATE OF PAYMENT: 01 / 1 1 /201 0 POSTMARK DATE: 01 /09/2010 couNTY: CUMBERLAND DATE OF DEATH: 1 2/31 /2004 REMARKS: SEAL CHECK#1065 AMOUNT ACN ASSESSMENT CONTROL NUMBER 09179489 ~ $109.70 TOTAL AMOUNT PAID: 5109.70 INITIALS: DM RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS I REV-1162 EX(11-961 N0. CD 012216 PENNSYLVANIA INHERITANCE T INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AN D PO BDX 280601 TAXPAYER RESPONSE HARRISBURG PA 17128-0601 REV-1543 IX /iFP COB-08) +. ,.,. ~ ~_: __~ ~ r ~.> ;`S~USANNE ' ~ ~_' ; ,~ONOD7QUI ~ `;1~NITZ57 I~BL I~E J ~ ~: Li.:_ ~~EWV~LE U:=i=::: ~- u ~, o tV U ESTS PA 17241-9490 EST. OF DAVID M ALEXANDER SSN 196-16-6398 DATE OF DEATH 12-31-2004 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. PNC BANK NA 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 point 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 fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pennsylvanic. Plecse call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE, SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 000005140179826 Date 09-01-1972 To ensure proper credit to the account, two Established copies of this notice gust accompany payment to the Register of Wills. Make check Account Balance 14,626.75 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTES If tax payments era made within three AmOUnt Subject to TaX ~ 2,437.84 months of the decedent's data of death, Tax Rate X , OCFS deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due ~ 109.70 nine months after the date of death. PART TAXPAYER .RESPONSE 0 ~, 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, ar 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. C ONE B L 0 C K B. ~ The above asset has bean or will be reported and tax paid with the Pennsylvania Inheritance Tax .return.. 0 N L Y to ba filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions ware 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 PART DATE PAID PAYEE OF TAX ON JOINT/TRUST ACCOUNTS p~3 1 2 ~ 3 X 4 5 - 6 7 X 8 $ _ -- DESCRIPTION FILE N0. 21 06-0073 ACN 09179489 DATE 12-14-2009 AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) 8 Under penalties of perjury, I declare that the facts I have reported above are true, correct and com lete to the best o my wledge and belief. HOME C ~/ ~) ~ ys 9~a ~ a WORK C ) -di~ pevFR STGNATl1RF TELEPHONE NUMBER DATE