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Home My WebLink About06-08-10COMMONWEALTH 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 OHARA ELAINE A 715 E WINDING HILL ROAD MECHANICSBURG, PA 17055 -------- fold ESTATE INFORMATION: SSN: 210-40-1856 FILE NUMBER: 2110-0587 DECEDENT NAME: OHARA MICHAEL L DATE OF PAYMENT: 06/08/2010 POSTMARK DATE: 06/07/2010 COUNTY: CUMBERLAND DATE OF DEATH: 03/09/2010 REV-1162 EX(11-96) NO. CD 012868 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ $393.62 TOTAL AMOUNT PAID: REMARKS: $393.62 CHECK# 2876 INITIALS: SAP SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS PENNSYLVANIA INHERITANCE TAX _ j~[ INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES V- 1-~j~ i, ~ AND FILE PD BOX 280601 ~ t~t~i~Iit~XPAYER RESPONSE ACN HARRISBURG PA 17128-Ob01 t y.o, DATE REV-1543 EX AFP (08-OB) ra ..- . _. N0. 21 `-~~ ~ ~~ 10116649 03-22-2010 .~ _. -t~~ ~ ~~t ~,~ i EST. OF MICHAEL L OHARA SSN 210-40-1856 DATE OF DEATH 03-09-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SgUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. ** ELAINE A OHARA 715 E WINDING HILL ROAD MECHANICSBURG PA 17055 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 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 accordance with the Inheritance Tax laws of thw Cammnnweal.th (~f Pennsylvania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 13671-41 Date 03-23-2009 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance 494 29 17 payment to the Register of Wills. Make check . , payable to Register of Wills, Agent . Percent Taxable X 100.00 Amount Subject to Tax $ 17 494 29 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 $ 7 8 7.2 4 Any Inheritance Tax due will become delinquent i n ne 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 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 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 PART DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts complete to t/fhe b/east of my knowledge and belief . -GL r V--~~,~-qn,L. ATURE OF TAX ON JOINT/TRUST ACCOUNTS have reported above are true, correct and HOME C 71 ) ~~ ~ ~'~ ~ 7 Jn WORK C TELEPHONE NUMBER DATE TOTAL CEnter on Line 5 of Tax Computation) S .~ -1 'k .'y `a~ii USA Yd~~Sn'-G+-s : ~SJ ~3xR r ~. .~ ,,f'~' i. ~-y .'~~. y '. A ' ~~,; :; '~;.: s:~;°~ s~: a' -' ~;~ 4; -~:; :.~ J' r '¢+ ~~ .S .r' ~; 'i; ' ~' ' `' ~, •~ .. ,.: ~: C"V~ ~~ r. ~- ~ ,.. . s~ !., t... a .~. _ ~_-~. ~. ~ e.>_= .... C ~. ~ s :`: _ =.1 ~.._ - { ~.- ~ ~r. v~ v~ -o ° ce! ^r ~, X'~ O.~ ~ c 5~ off. ti :~ .~ N ~~~. ~~ ~' ~~ ~~ UG ~::~ 0 N 1 ~- V 1 wG~~~ J ~ C'• Uhf ,:_ w.. :r A 3~3 ii; _. j't i':} t;;; .~..~