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Home My WebLink About10-06-10_ ~.. - _ - COMMONWEALTH OF PENNSYLVANIA - REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT MOTTRAM LAURA A 409 N MORRIS STREET SHIPPENSBURG, PA 17257 ACN ASSESSMENT CONTROL NUMBER fold 110154769 ESTATE INFORMATION: SSN: 225-25-2560 FILE NUMBER: 2110-1012 DECEDENT NAME: KARNES ERIC D DATE OF PAYMENT: 10/06/2010 POSTMARK DATE: 10/05/2010 COUNTY: CUMBERLAND DATE OF DEATH: 08/25/2010 REMARKS: SEAL CHECK#1677 TOTAL AMOUNT PAID: INITIALS: SAP RECEIVED BY: REGISTER OF WILLS N0. ~iCb 013456 AMOUNT ~ I 528.51 -y- T ~I i i--r T 528.51 GLENDA FARNE ' SI1 REGISTER OF WI L~5 ~, i BAUGH BUREAO OF INDIVIDUAL TAXES ~~ Po sox zso6ol HARRISBURG PA 17128-0601 Aiwa _ .. .,, REY-1563 EX AFP c3a-aa~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE AND FILE N0. 21 ~FI ,4h TAXPAYER RESPONSE ACN 10154769 ~~ DdrE o9-27-zolo 2010 OC ~ -- ~ AM 11= 59 ORPF' `~ ~ COURT CUMBE ~}D CO., P~ LAURA A MOTTRAM 409 N MORRIS STREET SHIPPENSBURG PA 17257 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. EST. OF ERIC D KARNES SSN 225-25-256 DATE OF DEATH 08-25-210 COUNTY CUMBERLAND'S REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 MEMBERS 1ST FCU provided the Department with the infonation below, which has bean potential tax due. Records indicate that at the death of the above-named decedent, you ware a joint owner/b If you foal the information is incorrect, Please obtain written correction from tho financial institution, a and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of Pennsylvania. these call (717) 787-832T with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INS Account No. 245905-01 Account Balance Percent Taxable Amount Sub~eet to Tax Tax Rate Potential Tax Due Date 01-24-2005 Established $ 570.13 X 50.000 $ 285.07 X .15 $ 42.76 1 in calculating th• iciary of this account. h a copy to this fort Commonwealth of _, ICTIONS To ensure proper cre it~to the account, two copies of this notic m~st accompany payment to the Repis •rof Wills. Mak• chock payable to "Register of,Wills. Agent". NOTE: If tax paymen s pre ^ade within three months of the decade t'p data of death, deduct a 5 parent d-sc¢unt on the tax due. Any Inheritance Tax ue!iwill become delinquent nine months after th dpte of death. A. k7f The above infonation and tax due is correct. LYJ Remit payaent to the Reaistar of Wills with two envies of this notice to CHECK a discount or avoid interact, or chock box "A" and return this notice to 0 N E Wills and an official assessment will be issued by the PA Department of I BLOCK ~ B. ~ The above asset has been or will be reported and tax paid with the Pennsvlvai ONL Y to be filed by the estate representative. C. ~ The above infona ion is incorrect and/or debts and deductions ware paid. Complete PART 2~ and/or PART ~ below. lire Register of Inheritance lax return PART If indicating a different tax rate, please state relationship to dacedant: TAX RETURN - COMPUTATION OF,TAX ON JOINT/TRUST ACCOUNTS.. LINE 1. Date Established 1 2. Account Balance 2 ~ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 ~ 5. Debts and Deductions 5 6. Amount Taxable 6 ~ 7. Tax Rate 7 X 8. Tax Due 8 ~ PART DEBTS AND DEDUCTIONS CLAIMED a DATE PAID PAYEE DESCRIPTION ~ AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) t Under penalties of perjury, I declare that the facts I have reported above are true, ¢orrect and complete to the best of my knowledge and belief. ,,,,..~ .---,--~ _ /]'717 2!]x/1 WORK C -] ~'] ) V'~~t- ~.. .._. (.' ~ ~ ~ ~F ~ ~ ~a ~. .r ~ l ~a41R ~~S~G1 ;lJ/J~ r • v' -~ ~? t cam,. ~ 3r G)~ v -~ ~.~27 ~ O I Lti ~ ~ ~~ ~g :1141tl 9- L~fl Q1~~ 1