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Home My WebLink About06-13-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 014567 MARPOE BRYAN KEITH 1416 RITNER HWY SHIPPENSBURG, PA 17257 -------- fold ACN ASSESSMENT AMOUNT CONTROL NUMBER 1 1 136931 ~ S 1,422.85 ESTATE INFORMATION: ssN: 180-01-9730 FILE NUMBER: 211 1-0670 DECEDENT NAME: BLACK THELMA A DATE OF PAYMENT: 06/ 13/201 1 POSTMARK DATE: 06/ 10/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 05/ 12/201 1 REMARKS: CHECK# 934 SEAL TOTAL AMOUNT PAID: INITIALS: HMW REV-1162 EX(11-96) $1,422.85 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 r~~ i~k(.~i~ . u~ ~d~i~ REV-1543 EX AFP (OB-08) PENNSYLVANIA INHERITANCE INFORMATION NOTICE ;' .,: AND TAXPAYER RESPONSE J~ i TAX F I L E N 0. 21 `"'~' ~ ~ " ~~~~ ACN 11136931 DATE 05-30-2011 ~i ! JEI~ 13 P 2~ ~ v CLE~ ~'~ aRP,~'~ ~;~'v'Ri Gt~~~?~~~~4r~ ~`J., PA PHYLLIS L MARPOE 1416 RITNER HWY SHIPPENSBURG PA 17257 EST. OF THELMA A BLACK SSN 180-01-9730 DATE OF DEATH 05-12-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. 0 RRST OW N 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 C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 33665 Date 02-21-1995 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 19, 969. $9 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 9, 984.95 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 1 , 497.74 nine months after the date of death. PART TAXPAYER RESPONSE 0 ~ ~ ~ ~~ 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 ~~ \~ ~ \\, e UiNE i. Date Established l ~ •^ ~ ~~,~ ~~ ~ 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 g $ •\ PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PArn 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 C 7~~ ) 53~~~YQ~ WORK C ) i0~u~1 PAYE SIGNATURE TELEPHONE NUMBER DATE IUINL ltnLer On Llne 5 of Tax Computation) S i ~ s.' ~T! T "i. • j~ !~`~ F V ~~1 ~ T 1 ~ ~f~! ~ ~Vli ~ ~ ~~ 1 i ~ L.' iJ ~ ~ ~ ~ s ~ (`' C(.ERK ~F ~ ~ T~ r ., a ORPHAN'S ~U~ ~~T 3 . - -~ ~ ~ ~ .-~ -~ c~ m P~ ' p't ~ ~ ~~ •~ t ;..i. +~~ Gt~} ~ f,~,~ ~.s} ~Z f'~i ~ ~ ~ ~ ~ ~ ']~~ ^~,^ • - V ' ("r1 / v` ,' \~eA` V ~~ O V ~ \ J L~~ V ~ ~, ~~~ . ~~ `~~ f~ ~'~.: ~~ ~ ~r Y ~~~ S; . ~.. i %; a'ti k . r.. :;~ 'Nr N' It >_ l ~ ('•r r 'f4~ t} ~. S~ Y:' Z A'.: ¢•yr ~`.~ i~~~'~s M~~ , µ"{ .,~a i ;~`; ~ ~r~ ~ ~~~ t f~ ,#.,! ~ r