The URL can be used to link to this page

Home My WebLink About05-05-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT 13EV-1162 EX~11-96) NO. CD 014413 MILLS MARY S 90 SALEM CHURCH RD LOT 529 MECHANICSBURG, PA 17050 -------- fold ESTATE INFORMATION: ssrv: 202-20-~o4s FILE NUMBER: 211 1-0525 DECEDENT NAME: SAMPSON DAISY DATE OF PAYMENT: 05/05/201 1 POSTMARK DATE: 04/28/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 03/02/201 1 REMARKS: ACN ASSESSMENT AMOUNT CONTROL NUMBER 11126210 ~ $44.33 TOTAL AMOUNT PAID: $44.33 CHECK# 2870 INITIALS: HMW SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES `r PO BOX 280601 ` HARRISBURG PA 17128-0601 , ~,.. ; ` REV-1543 EX AFP (OB-08) PENNSYLVANIA INHERITANCE INFORMATION NOTICE ~__~ .... ,~~ AND '~ 'r ~fi'AXPAYER RESPONSE ~ `~ i.'J TAX FILIE N0. 21"'r~"~?~~t:~ ACN 11126210 DATE 04-19-2011 ~• ,i ~~~rniE( ~~~ n 4 ,f, MARY S MILLS LOT 529 90 SALEM CHURCH RD MECHANICSBURG PA 17050 EST. OF DAISY SAMPSON SSN 202-20-1048 DATE OF DEATH 03-02-201]'. COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. M & T 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/benefiiciary 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 l:ommonwealth of Pennsylvania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 9843866808 Date 03-11-2008 To ensure proper credit t:o 'the account, two Established copies of this notice must accompany Account Balance $ 1 ~ 970.18 payment to the Register of Wills. Make check payable to Register of kiiL-ls, Agent". Percent Taxable X 50.000 Amount Subject to Tax $ 985.09 NOTE: If tax payments are made within three months of the decedent's date of death, Tax Rate X . 045 deduct a 5 percent discount on the tax due. Potential Tax Due $ 44.33 Any Inheritance Tax due will- become delinquent nine months after the date of death. PART TAXPAYER RESPONSE 0 FAILf#RE T~ i~S<:°W~.~-L~° ~~~~~~~ , 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 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 ~ below. PART If indicating a different tax rate, please state ~~. relationship to decedent: ~°~ QFFICIAL USE Y~"`~' ~~-AF 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 - 5 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 7 8. Tax Due g $ 8 \\ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRTPTrnN ....,,,..r ... __ Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME ( ~/ •7) (~ , a TAXPAYER SIGNATURE WORK ( ~~ ~ 7 ~ ~ ~ Y~ id TELEPHONE NUMBER TE . -, ,.., ~ `J ' `_ f". ~' ~ ~ 1 ~ ~~ T~ ~ ~ ~ y Cl1P~'~'r-r_, ~-- - , PA i..:~ F•„i i •: } r i~i•i ~E! ~ iii c••~ s3 = - l'..i ~ r ,/ ~' r'n <y y'~ y ti ,t f ~ ~! '~ ~ ' `-~ ~'`~ ~: ~.• ~ ~ '~ ~ ,Vµ ~'f • ,~• ~'9"' ,",~ lw 1 ~ `h .. ~- YY Y~ v~. j ~;< ,,~ ~:v ~k 3 sy ~ 1. ~ r r- ._..... f~ _~ ~, ~.~' s fi ~, ~ J . ~ ~~±E ~~~~~ r x~ ~~ v '.~ ~ ~ ~ ~~. ;y s 1" ~ s ~ • a3n3aad v' r