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Home My WebLink About07-06-10COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX111-96) NO. CD 013020 BROSIUS DONNA L 6342 SOUTH POWDERHORN RD MECHANICSBURG, PA 17050 ACN ASSESSMENT AMOUNT CONTROL NUMBER fold ESTATE INFORMATION: ssrv: ~ a2-2s-s55s FILE NUMBER: 2109-101 1 DECEDENT NAME: BOHNER CLAYTON E DATE OF PAYMENT: 07/06/2010 POSTMARK DATE: 07/06/2010 couNTY: CUMBERLAND DATE OF DEATH: 10/16/2009 REMARKS: SEAL CHECK# 3833 10118860 ~ 5881.70 10118861 ~ 538.38 TOTAL AMOUNT PAID: INITIALS: CJ RECEIVED BY: 5920.08 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES rte, AND FILE N0. 21 09-1011 Po sox 2so6ol ~'~,'.~ t~AXPAYER RESPONSE ACN 10118860 HARRISBURG PA 17128-0601 " ' {~ "" ~ ~~ DATE 03-31-2010 REV 1543 EX~Y{FD (m3 m»'_e+ ... . 2Q10 JUL -b AM 9~ 20 EST. OF CLAYTON E BOHNER SSN 182-28-6558 DATE OF DEATH 10-16-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. CLERK ~~ ORPHt~;'S CCU~T CllM~~t~' an{~ ~;~ , ~A. DONNA BROSIUS 6342 S POWDERHORN RD MECHANICSBURG PA 17050 REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 MID PENN BANK 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, Dlease 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) 787-8327 with questions. COMPLETE PART 1 BELDW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 309002530 Date 05-19-2009 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 $ 19,593.25 payable to "Register of Wills, Agent". Percent Taxable X 100.00 5 9 3.2 5 NOTE: If tax payments are made within three Amount Subject to Tax $ 19, months of the decedent's date of death, Tax Rate ~( .045 deduct a 5 percent discount on the tax due. Anv Inheritance Tax due will become delinquent Potential Tax Due $ 881 • 70 nine months after the date of death. P~T TAXPAYER RESPONSE 1 FA=IL TD RE~PDND WILL SULT IN AN DF~'eICIAL TAX ASSESSMENT 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 Wills and an official assessment will be issued by the PA Department of Revenue. ONE BLOC 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 OFFIC~'"AL k15E DNLY AAF relationship to decedent: 2 PA D£PARTM£NT OF REYENU£ TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established 1 1 2. Account Balance 2 +~ 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ 4 5. Debts and Deductions 5 - 5 6. Amount Taxable 6 $ (, 7. Tax Rate 7 X 8. Tax Due 8 $ g , PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) S Und penalties of perjury, I declare that the facts I have reported a+b~ove are true, correct and c etc to the b t of myc knowledge and belief. HOME C //~ ) ~~/ '~' ~(~'~ TA oAVro CTCWATIIDC WORKrounur u)..oro „ ~~ BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 FILE N0. 21 09-1011 ACN 10118861 DATE 03-31-2010 PENNSYLVANIA INHERITANCE T INFORMATION NOTICE AND ~~;~- ~,~p~ TAXPAYER RESPONSE i~ i 2010 JUL -6 A~# 9~ 20 CLER'rC QF o~~aiv~s rou~T DONNA BROSIUS 6342 S POWDERHORN RD MECHANICSBURG PA 17050 EST. OF CLAYTON E BOHNER SSN 182-28-6558 DATE OF DEATH 10-16-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. MID PENN BANK 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 the Commonwealth of Pennsylvania. Please call (717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 901-675-9 Date 11-09-2004 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 5, 116.85 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject t0 Tax $ 852.83 months of the decedent's date of death, Tax Rate X .045 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due $ 38.38 nine months after the date of death. P~T TAXPAYER RESPONSE ~ FAILURE TQ RESPOy,IlILL RESULT IN AN OFFICIAL TAX A55ESSMENT A. II XThe above information and tax due is correct. ULJ Remit payment to the Register of Wills with two copies of this notice to obtain C H E C K a discount or avoid interest, or check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. ONE B L 0 C K B. ~ The above asset has been or wlll 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 OFFICIAL U5E QNLY [~ AAF relationship to decedent: PA DEPARTMENT OF REVENUE TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established 1 1 2. Account Balance 2 $ 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ [~ 5. Debts and Deductions 5 y 6. Amount Taxable 6 7. Tax Rate 7 X 7 8. Tax Due 8 $ 8 fl ~., PART DEBTS AND DEDUCTIONS CLAIMED a DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, cjr~ct ar~,d~ c lets to the st of gA1/ knowle ge and belief. HOME C ) WORK C ) D TOTAL (Enter on Line 5 of Tax Computation) 8