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04-18-11 (3)
COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280801 HARRISBURG, PA 17128-0601 RECEIVED FROM: HUGHES KENNETH 108 LEGATO AVE THOROFARE, NJ 08086 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ACN ASSESSMENT CONTROL NUMBER -------- fold ESTATE INFORMATION: sSN: 000-00-0000 FILE NUMBER: 2111-0445 DECEDENT NAME: HUGHES NEWTON S DATE OF PAYMENT: 04/18/2011 POSTMARK DATE: 04/14/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 01 /16/2011 REV-1162 EX111-96) NO. CD 014333 AMOUNT 11500754 ~ $38.75 TOTAL AMOUNT PAID: REMARKS: KENNETH HUGHES SEAL CHECK# 0618 INITIALS: WZ RECEIVED BY: 538.75 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS CDWNUIy1FALTN OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 INFORMATION NOTICE AND aFAXPAYER RESPONSE 211 #PR 18 AI II' 3U CLERK OF ORPHAN'S COURT CUMBERLAND GO , PA KENNETH HUGHES 108 LEGATO AVE NJ 08086 THOROFARE AMERIPRISE has provided the Dapartaent with the infonation listed below which has bean used in calculetinp the potential tax due. Their records indicate that at the death of the above decedent, you were a benef iciarfr of this asset. If You foal this inf creation is incorrect, please obtain written correction frog the transfer apant, attach a eopY to this fore and return it to the above adds ss. This account is taxable in accordance with the Inheritance Tax Laws of the CoNOnwealth of Pennsylvania. Questions eav b• anayBredbVSallinp 4717) 78I-832Z-. _-- - - ...~ orinm a a * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS wnr~~ ~ ~ •• . - --- To insure prover credit to Your aecoun , Account No. 930066061043004 (2) copies of this notice oust aceoeparo your payeent to the Register of Wills. Make check payable to: "Reeistar of Wills. Aesnt". DOD Valuation Percent Taxable Amount Subject to Tax Tax Rate potential Tax Due 4,532.00 X 20.000 906.40 x .045 40.79 REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 NOTE: If tax Payaents era aade within three (3) aonths of the decedent's data of death. you ^aY deduct a 5X discount of the tax due. Aro inheritance tax due will become delinquent nine C9) aonths after the data of death. ebova infonation and tax duois correct. aodiscountooreavoid iota a~st,nortvouhaay eheckrboz WAllandl return thisen tieehto the3Re03stert ofn Wills and an official essessaent will be issued by the PA Departaent of Revenue. PART If You indicate a different tax rata, please state your © relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSET(S) LINE 1. DOD Valuation 1 2. Percent Taxable 2 X 3. Amount Subiaet to Taz 3 4. Dobts and Deductions 4 - 5. Amount Taxable 5 6. Tax Rata 6 7. lax Due 7 PART DATE PAID PAYEE FILE N0. 21 ~~~8u~s ACN 11500756 DATE 04-04-2011 TYPE OF ACCOUNT SECURITY EST. OF NEWTON S HUGHES ® SEC AccT S.S. N0. 146-22-5851 srocK DATE OF DEATH 01-16-2011 CUMBERLAND ^ BONDS COUNTY DESCRIPTION AMOUNT PAID e TOTAL (Enter on Lino 5 of Tax Computation) ties of periury, I declare that the facts I have reportedOabove a/ro tlrue, correct and ,(~ best o_ f m~Mledpe and belief. HOME ~la~/ ) ~~b ! ~~~ 1. w WORK ~ ) TELEPHONE NUMBER DATE PURE C CHECK BLOCK B. ~Tha above asset has bean or will be reported and tax Daid with the Pennsylvania Inheritance Tax re urn ONE ONLY to be filed by the decedent's representetiva. C, The above inforation is inand/ort PARTori~ belawnd deductions were Paid by you. You gust eoaplete PART 2~