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Home My WebLink About01-03-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SALES CAROLE 54463 AURORA ST SHELBY TOWNSHIP, MI 48316 -------- fold ACN ASSESSMENT CONTROL NUMBER AMOUNT 10136450 ~ 51,655.07 ESTATE INFORMATION: ssN: 383-40-0536 FILE NUMBER: 2110-0503 DECEDENT NAME: ORLOWSKY JAMES M DATE OF PAYMENT: 01 /03/201 1 POSTMARK DATE: 01 /03/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 04/ 18/2010 REMARKS: CHECK# 1391 SEAL TOTAL AMOUNT PAID: S 1,655.07 INITIALS: HMW RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REV-1162 EX(11-96) NO. CD 013846 REGISTER OF WILLS PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES A N D PO BOX 28060,1 TAXPAYER RESPONSE HARilriSBURG PA 17128-0601 REV-1543 EX AFP (OB-08) FILE N0. 21 10-0503 ACN 10136450 DATE 06-29-2010 CAROL SALES 54463 AURORA ST SHELBY TWNSHP MI 48316 EST. OF JAMES M ORLOWSKY SSN 383-40-0536 DATE OF DEATH 04-18-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. ORRSTOWN 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. 143000914 Date 07-02-2007 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 $ 27, 584.57 payable to "Register of Wills, Agent". Percent Taxable X 50.000 AmOUnt Subject to Tax $ 13 792 29 NOTE: If tax payments are made within three , . months of the decedent's date of death, Tax Rate X , 15 deduct a 5 percent discount on the tax due. Potential Tax Due $ 2, 068.84 Any Inheritance Tax due will become delinquent nine months after the date of death. P RT TAXPAYER RESPONSE A 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 ~~~~ ~`:%'.f ~f. relationship to decedent: ~. ~_, _.;' ~.~ TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS :k;f,~~ ` ~~ LINE 1. Date Established 1 ~ y `~ ' ~ ~ Jy/+ ly f,I.yi,. ,y~;~:V:~, ` 2. Account Balance 2. $ ~ 7 s~ ~. ~ 7 %fi{h1,F~' fl '~%'i'!`~~y~.`~' ~ r '~: 3. Percent Taxable 3 X _ ~ ~ `10 __f ~ .~ . Vii`' 4. Amount Subject to Tax 4 $ ~'~, ~ 9a • .~ 9 ., ~ .f. 5. Debts and Deductions 5 - - © -' '~', 6 . Amount Taxable 6 $ / ..~ ~ 7 ~~• ~ 7 ~ ~~ 7. Tax Rate 7 X / ~ c~0 8. Tax Due 8_ $ /ra S+s", Gq 7 ~~ <+~,,. PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID .. ~~" ~•~. I declare that the facts I have reported above are true, correct and ' 4dge and belief . HOME C `~ ~~) 7 ~ ~ -- /D / U WORK C ~.'~'~ ~ ) ~' 7 ~ 7 c:~ ~ -Z TELEPHONE NUMBER DATE TOTAL CEnter on Line 5 of Tax Computation) S ~~ ~~ ~ ~.:. , t,t ~ ~"~ ~1 ~ ~ ~ Ai; ~.- .,~ - r f., _,,; . '~ . ~=+ + ~. w ~ ~ ~`~ ~ ~ - ,`~~ "~ ~ 2t~ ~~ ~_ ti 0 M Q~ ~ . ~"T/ ~,. 3 ..t• V ~ r •'t, ~. ; w~ {ry4 .~~~ '+yM~t T`~ %~ {~{ ~.,~C '~ t •~ (~ } ~ ~- r~ w ~ ~ ~ •. ~~ ~~ r ~ ~ .~ M w 4 ~~ ~~ w.~. ~" ~~ h f T~'y ~~ .~~ w ~~, ~ ,~ ,,, ~; ;~~,, s ...~ k r ` 4 ow w `(• ~ t M """""\\V77 ~M1 1 1~~ y ~~ W .." a . ~~ 'S~ N+ ., ~ .1 ..1. ~Mwf~ •'.' i~ 1wM~ •te ~~ ••,,9 ~"~n v Y~ :.y MYM •~ ` ,~ t .~.rr. .Y...r. w+w.. ~ccd ~ .