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Home My WebLink About04-01-10 (3)COMMONWEALTH OF PENNBVLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0801 RECEIVED FROM: TESLAR STEPHANIE N 412 N BEAVER STREET FLAGSTAFF, AZ 86001 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-t t62 EX111-961 N0. CD 012556 ACN ASSESSMENT AMOUNT CONTROL NUMBER ---'---- folE ESTATE INFORMATION: ssN: t93-36-445t FILE NUMBER: 2109-0838 DECEDENT NAME: TESLAR STEPHEN D DATE OF PAYMENT: 04/01/2010 POSTMARK DATE: 03/29/2010 COUNTY: CUMBERLAND DATE OF DEATH: O8/ 27/ 2009 10104441 ~ 5627.07 TOTAL AMOUNT PAID: REMARKS: STEPHANIE TESLAR SEAL CHECK# 218 5627.07 INITIALS: WZ RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES -~~r ni^,~,. '- ~ PO BOX 288681 •;t' t ~~" - k WIRRISBURG PA 17128-0601 - •, ~~, i -"aEV-,sas roc Acs toe-oe~ PENNSYLVANIA INHERITANCE T INFORMATION NOTICE AND TAXPAYER RESPONSE ZDIO dl'R - I AM 10155 CLERK OF aRPr~~~s cnuRT STEPHANIE N TESLAR 300 ADAMS RD CARLISLE PA 17015 FILE N0. 21 09-0838 ACN 10104441 DATE 01-21-2010 EST. OF STEPHEN D TESLAR SSN .193-36-4451 DATE OF DEATH OS-27-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS 70: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING ® TRUST CERTIF. BANK OF AMERICA NA provided the Department with the information below, which has been used in calculstinp the potential tax due. Records indicate that at the death of the above-named decedent, you wars a joint owner/beneficiary of this account. If you feel th• infonation is incorrect, please obtain wri ttan correction from the financial institution, attach a copy to this fon and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commom,ealth of Pennsylvania. Please call 1717) 787-Sb27 with qustiona. COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 91000082495668 Date 03-12-2008 T Account Balance Percent Taxable Amount Subject to Tax Tax Rata Potential Tax Due Established $ 4,180.47 X 100.00 $ 4,180.47 X .15 $ 627.07 o ensure proper credit to the account, two topics of this notice must aceomvanv payment to the Register of Wills. Make chock Davable to "Register of Wills, Apant". NOTE, If tax pavaents era made within throe months of the decedent's date of death, deduct a 5 portent discount on the tax due. Arty Inheritance Tax due will baco^e delinquent nine months after the data of death. A. ~ The above infonation and tax due is correct. Remit pavmant 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 Regist f C ~ ONE Wills and an official assessment will b• issued by the PA er o Department of Revenue. BLOCK ONL Y 8. ~ The above asset has bean or will be reported and tax paid with the Penns l i to be filed by the estate representative. y van a Inheritance Tax return C. ~ The above inforaa ion is incorr~ect and/or debts and deductions Complete PART 2 and/or PART IJ helow. were paid. PART TAX LINE 1. Date Esta611shed 2. Account Balance 3. Parcant Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due PART DATE PAID PAYEE DESCRIPTION'' AMOUNT PAID TOTAL (Enter on-Lino 5 of Tax Computation) a Under oonalties of perjury, I declmre that the facts I have reported above are true, correct and complete to the best of my knowlodga and belief. HOME ( ~ ~~ WORK ( ~ TAXPAYER SIGNATURE TELEPHONE NUMBER DATE If indicating a diffaront tax rats, pi&e a state relationship to decedent: RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 1 2 S 3 X 4 ~` 5 - 6 7 X 8 ~ DEBTS AND DEDUCTIONS CLAIMED