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Home My WebLink About03-25-10~"~'~T !; Ft~tST~~g55 ADRE ~~' _ t~~'. ", ...~ i .n.~ '.A+~ .~" ' ',~~. ~• J6 ~lf ~~ ., ~ ~ w ~1 ~ ~:~tF ~`~~ ' r' a~ ~ cw.xs i- ~ ~ c' .r ~ ..,..; . < a .5ryi%1M ,trot i~.°.7;d ~ ;~~ w~~,~ ~~ ~ .r .r.. M M~~ Mrs '~' ~~ C 'i^' ~ ~Y~ ~: n r ` ~ ~wY~~ .~iwM~ M ~ Cn '~ M: 1~1~ ,. ~ ., .. n~ ~ !sly. ~;.f \ i '~ w ' Q ..' ~ /.~ ~. le, ^~ ~' ;~~ ~ ~~\..../JJ ~ ~ ~ T ~L M ~~~ 1 ~w~ k f, r1 ~ ..T. "'~'~- ~ V J r <~~ ~ ~ ~ ~:~:~ ~ f+i ~'~~l I r .j.s ~. .~ ~~! ~~.. f ...d . - ~ _..I i ~'o .~l E I~.~w •~f ~~ 1l~J~J ~}ri V 7 ~ ~ ~E ~ ~._,) ^ ~ C ~i~.J %iU~~~,/ E jj11,,~~~ 7 ef~t~ !! Z ' ~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES _ AND FILE N0. 21 Ib O ~,p ~ Po BOX 280601 . ' ~!A~C~~YER RESPONSE ACN 10112271 HARRISBURG PA 17128-0601 - ~ ~ - „~ ,_~ ' DATE 03-05-2010 REV-1543 IX AFP C08-08~ ~ '~ ~ ' ~~ EST. OF CHARLES HILMER SSN 194-28-9332 DATE OF DEATH 12-12-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. ~'~ ;iii ~ .. 1-'/1[ ,~~ ;. ~, ~t + •~' ~' ~.. i ' CHARLES R HILMER III 25 N 2ND ST WORMLEYSBURG PA 17043 FULTON 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 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 arcordanca with the Inheritance Tax laws of the Commonwealth of Pennsylvania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 3622-45738 Date 12-17-2004 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 10 , 541 $3 Payment to the Register of Wills. Make check ' payable to "Register of Wills, Agent". Percent Taxable X 16.667 Amount Subject to Tax ~- 1 , 757.01 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 ~- 79.07 Any Inheritance Tax due will become delinquent nine months after the date of death. PART TAXPAYER RESPONSE A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or check box "A" and return this notice to the Register of 0 N E Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 C K B. ~ The above asset has been or will be reported and tax paid with th P 0 N L Y e ennsylvania Inheritance Tax return to be filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions id Complete PART 2~ were pa . and/or PART ~ below. PART If indicating a different tax rate, please state relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCO • ~~` UNTS ;~ LINE 1. Date Established 1 2. Account Balance 2 $ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 $ ~~ ~ ,~ f ~~ 5. Debts and Deductions 5 - ~~~ ¢• ' ~ •, 6. Amount Taxable 6 +~ ~° 4 ~` ~3, p 7 . T a x Rat e 7 X '~~`+ ~ f 'h 5 ~+ " .~' „~~y , ~ '~f` % ~ • ` f. .4. ;~ • f~~' ,~% z r ~ 8 . T a x D u e 8 $ ry . .. s , ~'.~i%fr~'` ~;~ ~.'~{/f~~.r~~ y ~.~. ;,_ . ` ,,f, p f ~ ri~•Tf/ hiJS7 ~~ .4! ~ J ` ~ , . .s ¢. ,~ffiy.~ ,~ , ,~ • f.~ , ~~ j t +:Ar,"n~ ~ u~'/~i~:•'• ~~:"/ ~ PART N.r, .r ~f F .!%S': :/ DEBTS AND DEDUCTIONS CLAIMED H` :/~`•/•:LY ::N• '.: ~'i Y :'1.5v ::6 a DATE PAID PAYEE DESCRIPTION AMfl11AIT Bern Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME C `~ 11 ) 713.. (yy'I~7 ;~•.~.-~ WORK C ) ,~ x y'io AXPAYER S GNATURE TELEPHONE NUMBER DATE .. ~.,~ \G11 LCI U:1 amine ~ or i ax computation) S COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: HILMER CHARLES R III 25 N 2ND ST WORMLEYSBURG, PA 17043 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1 162 EX(11-96) NO. CD 012513 ACN ASSESSMENT AMOUNT CONTROL NUMBER fold ESTATE INFORMATION: SSN: 194-28-9332 FILE NUMBER: 2110-0301 DECEDENT NAME: HILMER CHARLES DATE OF PAYMENT: 03/25/2010 POSTMARK DATE: 03/24/2010 COUNTY: CUMBERLAND DATE OF DEATH: 1 2/ 1 2/2009 10112271 ~ 579.07 TOTAL AMOUNT PAID: REMARKS: SEAL CHECK# 672 579.07 INITIALS: JN RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS