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Home My WebLink About03-02-11COMMONWEALTH OF PENNSYLVANIA REV-1162 EX~11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INH ERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 014071 MCNICHOLS DIANE T 65 CARLA DR SHIPPENSBURG, PA 17257 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold ---------- -------- 11113495 ~ $28.93 ESTATE INFORMATION: ssN: 061-12-4540 FILE NUMBER: 211 1-0286 ~ DECEDENT NAME: TANTILLO ANNA C ~ DATE OF PAYMENT: 02 1 3 `Z,\l ~~~ POSTMARK DATE: 03/01 /201 1 ~ COUNTY: CUMBERLAND ~ DATE OF DEATH: 09/ 13/2010 ~ TOTAL AMOUNT PAID: $28.93 REMARKS: CHECK# 1333 INITIALS: DB SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES PO BOX 280601 ~~,(~(` nr ,;.. HARRISBURG PA 17128-0601 ~Tr~ ~~ ~ ~ ` Vi i :~_ ~ ~tEY X543 -E% A~R.~CO~,~eo}) tJ PENNSYLVANIA INHERITANCE INFORMATION NOTICE AND TAXPAYER RESPONSE TAX FILE N0. 21 •- ~~ -C~~~ ACN 11113495 DATE 03-01-2011 MFR 0 `~ ' ~~r- CU~~~~~~~~~~f~~~ ~'~( DIANE T MCNICH[)L~'`' P~ 65 CARLA DR SHIPPENSBURG PA 17257-8220 EST. OF ANNA C TANTILLO SSN 061-12-4540 DATE OF DEATH 09-13-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. FARMERS 8, MERCHANT S TRUST CO 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. 34-39003 Date 03-14-2003 To ensure proper credit to the account, two Established copies of this notice must accompany 3 8 5. 7 7 payment to the Register of 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 $ 192.89 months of the decedent's date of death, Tax Rate ~( ~ 15 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due $ 28.93 nine months after the date of death. P~T TAXPAYER RESPONSE 1 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. ~ 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 relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LIFE 1. late 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 Und penalties of perjury, I declare that the facts I have reported above are true, correct and co pl to to th.e best of my knowl dge and belief. H O M E C~~ ) ~ "'~ ~ ~ f. ~ ~ ~ ~~ WORK C `7/ ~ r~rl `' ~ ~ ~ TAXPAYER SIGNATUR TELEPHONE NUMBER D IUIHL ~tnier on ~lne 5 or lax Computation) $ r fOR'EVE[t 115A FIRS'{.-CLASS'. :4} "~ , X '~i ~rioa:: ~33 '~. i'. ,,y, f .. ' << ~,f • ~t ~ `'} } :< 1 FP s ~ ~11 y ':~ Y '~ v f t ,,...t .' ~' ., , ~ E y% ki ~,. ;_ ~,~ :;~. ~ ~~ ? r ~ ~ `~ ~ , } .a ~ .. ~~. - ,.sa ' 1 ,, r .# ~ ~ ~ ;';~ ~~ i ;< r "~ a ~' ~ ~~ \, ' ~_~ 1 ~ :„___-. ~`~, ..-,-_...G~ 0 r- N N r 4 to d- O ~ 3 Z~ N A ~~ p~tA 1 Z ~~i 1 i~ r,~t ~~ i i .~»!