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Home My WebLink About03-31-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 171 ZS-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ORNER JACK R 1 ASHLEY CT BOILING SPRINGS, PA 17007 -------- fold P',EV-1162 EX(11-96) N0. CD 014229 ACN ASSESSMENT A,MOUNT CONTROL NUMBER ESTATE INFORMATION: SSN: 196-14-2771 FILE NUMBER: 21 1 1-0414 DECEDENT NAME: ORNER BETTY M DATE OF PAYMENT: 03/ 31 / 201 1 POSTMARK DATE: 03/30/201 1 couNTY: CUMBERLAND DATE OF DEATH: 08/ 08/ 2010 REMARKS: SEAL CHECK# 3302 10160754 ~ $1 1 1.28 TOTAL AMOUNT PAID: $111.28 INITIALS: HMW RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS PENNSYLVANIA INHERITANCE TAX' INFORMATION NOTICE ,_, ;.,,F-- AND BUREAU OF INDIVIDUAL TAXES {~ ~`~"~~AYER RESPONSE PO BOX 280601 HARRISBURG PA 17128-0601 .,~ ~~ REV-1543 EX AFP (0 B-08 )~ t~ -.. ~ ~,., ,~= ~_~ ._ i ~ ~ .,,5; ~~` r~,` ~ 4 , t.._. - ; ; t ~ •~ ~ ----° .. ~. ,, ~ JACK _..t "' ~RNER ~_.._: ~~ r~ x:_: ~ ` 1 H L E~ BQ~~L I NG ~~NGS c . ~ ,.-, ~-J t~. ~` ,~'.. PA 17007-9435 EST. OF BETTY M ORNER SSN 196-14-2771 DATE OF DEATH 08-08-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS © CHECKING TRUST CERTIF. P NC BANK NA 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 point owner/benefic:iary of this account. If you feel the informatOVenaddress~r This accountoisataxabletin accordance with the InheritancenTaxtlawsnofathecCo'mmonwealthtofs form and return it to the ab PwnncyJvan;.a. Pleas? rill (7~?) 'R7-8327 :•'.t!: qu~sticr.~. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 000005140189215 Date 07-09-2009 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 $ 4,945.60 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 2, 472 • 80 months of the decedent's date of death, X . 0 4 5 deduct a 5 percent discount on the tax due. Tax Rate Anv Inheritance Tax due will become delinquent Potential Tax Due $ 111 • 28 nine months after the date of death. PART TAXPAYER RESPONSE 0 F/IILUtE TO RESPOND WILL RESULT IN AN OFFICIAL 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 a discount or avoid interest, or check box "A" and return this notice to the Register of C H E C K 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 informs ion is incorrect and/or debts and deductions were paid. Complete PART ~ and/or PART ~ below. PART If indicating a different tax rate, Please state OFFICIAL U5E 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 $ 4 5. Debts and Deductions 5 S 6. Amount Taxable 6 $ ~ 7. Tax Rate ~ X 7 8. Tax Due g '~` 8- PART DEBTS AND DEDUCTIONS CLAIMED ,,.rr nwrr~ PAVFF DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are trueG,~ correc~/t and r complete to the best of my knowledge and belief . HOME C ~9 ~ ) "` ~ ( 4a ~ ` ~, ~-XPAYER 'S`IGNATURE TELEPHONE NUMBER ATE FILE N0. 21 ACN 10160754 DATE 10-25-2010 IUTAL ltnier urn L111C ~ a,~ "`~~••,""`-"---••- - „~ ~~, , ;~363apd ssv 1SH~ i v;n R, A ~ ; .k, ~ ~ ~, ,. i 'f~. ~ 7 ~ SAA ~ T ~~~~ 4 tt ~ e LM i~ ~g ;~I t:~ J f 3 .. ,;~, ji(' !~t i,~l. •,.:, ;,,; .•:' ti:;.+ ~M { y~ s~ ~ ~~ ire` ~.. , ~~. r:` ,,, ;,,, { i.~::~ rs .~; '°•t;. ~~ .~r; :,,,r r~1 O fY.. O P-~ . ~ ~ ~"~ "~' ' I"'I U a ~ ~:. ~~ •M O r"'~ i"r1 N M ~ ~ U] cd O ~ ~ h ~ a~ r' • ri Cn 3 • y..i U Qv 0 0 ~ ~ a~ a ~ .-i ~ ~ •~ o ~ b0 U ~ N cd ~ ~ C. i~~ ~ r,e '~~''~t.i..i~ t ~~ ~~,_ `; S,M~-id~~~ ~. €~_ :~~ i~ f~i;~ ~'~ •r~ i °: .•.} x J , ~'' y,~ ,_ .