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Home My WebLink About12-07-10COMMONWEALTH 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 f3EV-1162 EX~11-961 NO. CD 013751 EVANS DENISE 21 BRAGG DR EAST BERLIN, PA 17316 -------- fold ESTATE INFORMATION: ssrv: 202-46-6269 FILE NUMBER: 21 10-1041 DECEDENT NAME: JUMPER CURTIS A DATE OF PAYMENT: 1 2/07/2010 POSTMARK DATE: 1 2/05/2010 COUNTY: CUMBERLAND DATE OF DEATH: 09/22/2010 REMARKS: ACN ASSESSMENT p,MOUNT CONTROL NUMBER 10163783 ~ 568.86 TOTAL AMOUNT PAID: $68.86 CHECK# 1478 INITIALS: DB SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIWiDUAL,'~i~b~fS ~ ,~. ;~ PO BOX 280601 ~ _ HARRISBURG PA 14~}•$8,-~ldl;- REV-154,1.• ~i,.~l~.'V OS-O8. 2~~0 ~~~ ~7 P~ 3y OZ ~h C~.ER'~. ~J~ UM~3~ ~~~ v v ~,.. C~JP~~~~~ ~~ :~~~~~y~~ ;1..; , JUSTIN C JUMPER 13 WEST SPRINGVILLE RD BOILING SPRINGS PA 17007 PENNSYLVANIA INHERITANCE TAX ~TNFORMATION NOTICE AND TAXPAYER RESPONSE FILE M0. 21 10-1041 ACN 10163783 DATE 11-04-2010 EST. OF CURTIS A JUMPER SSN 202-46-6269 DATE OF DEATH 09-22-2010 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 FCU provided the Department with the information below, which has been used inn 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 Pennsy]vania: Please call C717? 787-8327 with questicns. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 121250 - 00 Date 07-12- 1991 To ensure proper credit to the account, two Established copies of this notice muss: accompany payment to the Register o1F Wills. Make check Account Balance ~` 3, 221.11 payable to "Register of W:ills> Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax ~` 1 ~ 610.56 months of the decedent's date of death, Tax Rate ~( 0(~Rj deduct a 5 percent discounnt on the tax due. Anv Inheritance Tax due will become delinquent Potential Tax Due $` 72.48 nine months after the date of death. PaRr TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT A. }~ J The above information and tax due is correct. l~ 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 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 information 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 USE ONLY ` ~`` 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 $ C+ 5. Debts and Deductions 5 - 5 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 7 8. Tax Due 8 $ $ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, corrrect and complete to the best of my knowledge and belief . HOME C 7 ~ 7 ) ~~~ ~~ /<,~ L ~..- ., . a ~ .W.O~K C . ) _ ~._, TAXPAYER SIGNATURE TELEPHONE NUMBER DATE TOTAL (Enter on Line 5 of Tax Computation) ~ c.T,. r P~~ ~' Q~ ~~~Q ~~ -~ ,~ n ~ ~ ,~.J` '"` ,,~~~~ ~~~ ~? o `tD° N C~~D -~ ~ O 7~ ~ ~ ..~ ~ ~ N O ,p ~ ~ W ~ tD rn~~ ~ ~~ ~~ ~~~~ ~~ r -.] W