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Home My WebLink About11-15-10COMMONWEALTH OF PENNSYLVANIA REV-1162 EXf11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 013645 HEALY CAROLE 705 BENCRU AVENUE MECHANICSBURG, PA 17055 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold ---------- -------- ESTATE INFORMATION: SSN: 195-07-1392 FILE NUMBER: 21 10-1 130 DECEDENT NAME: VENESEVICH EVELYN DATE OF PAYMENT: 1 1 / 1 5/201 0 POSTMARK DATE: 1 1 /06/201 0 COUNTY: CUMBERLAND DATE OF DEATH: 09/25/2010 REMARKS: CAROLE HEALY SEAL CHECK# 880 10158430 ~ 54.70 TOTAL AMOUNT PAID: $4.70 INITIALS: WZ RECEIVED BY: GLENDA EARNER STR~-SRAl1C;H REGISTER OF WILLS REGISTER OF WILLS PENNSYLaANIA INHERITANCE TAX INFI~RMATION NOTI~GE BUREAU OF INDIVIDUAL TAXES ~,r~,+•. -,~__, AND Po Box z8o6o1 r '~",X~AYER RESPONSE HARRISBURG PA 17128-0601 ~ j REV-1543 EX AFP (OB-88)~ ``i ~V 1 , ~~. i, • FILE: N0. 21~ IC7 . ~i~J~. ,- 1 ACN 10158430 DATE: 10-13-2010 2010 ~~y 15 P~ 1~: 0 7 CLERK ~~ Ct~~AE~~~t~~ ,~~ ,~ ~ CAROLE HEALY 705 BENCRU AVENUE MECHANICSBURG PA 17055 EST. OF EVEL.YN VENESEVICHI SSN 195-07-1392 DATE OF DEATH 09-25-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST F CU 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. 181091-11 Date 02-16-2000 To ensure proper credit to the account, two Established copies of this notice must accompany 1 , 244. $2 payment to the- Register cif Wills. Make check Account Balance ~` payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 622.41 months of the decedent's date of death, Tax Rate )( . 045 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due ~` 28.01 nine months after the date of death. PART TAXPAYER RESPONSE FAIL1lRE TO RESPOND WILL RESULT IN AN OFF,ICII4L 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 C H E C K 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.~he above informs ion is incorrect and/or debts and deductions were paid. ``Y Complete PART ~2 and/or PART 3~ below. PART If indicating a different tax rate pl ase state relationship to decedent: ~~,r,~- TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ~Ne i. irate Establisned 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 DEBTS ONn ilFnllCTrnAlc ri er~rn DESCRIPTION AMf111NT PeTn Under penalties of perjury, I declare that the facts I have reported a-byove are true, correct and /,complete to the best f my knowledge and belief . HOME C ' ( ~ ~ ) ~~~ ~9Q , / ~ WORK C ~ ~.T 1 t~L l TAXPAYER S GNATURE TELEPHONE NUMBER DATE OFFICIAL USE ONLY ~ AAF PA DEPARTMENT DF REVENUE PAD 1 2 3 4 5 6 7 ~~ 7~n N ~ '~'! a A n ~~ y ~.C y (ti Z' 9~j '~ ~• .•t t,~~. ~' ~ r"'7 C,6~ {,~ t;v1 i t'' .,/ `.., ' ~ 1 a.... t°:! /V X - ~~ O ~' '_ tL~ ~.~- G V O c!~ ~~ ~ i) T V ~~, ~' ~~, .f~ ~. ;~ ~~ a„„ ; ~, .,' 'fir ;:r ~_ r „rs, ,Y . :r 1~;, „`~ ~~ j•~ ~ . r~ k y' ` _ ~ ~ ~ ~ .`s ~'~~ ~~~~ ~~~ ~~,~Y ti ~' ~i~ ta`~dsn v ;1 a