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HomeMy WebLinkAbout07-07-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT HARTUNG THOMAS J 826 ANTHONY DRIVE MECHANICSBURG, PA 17050 -------- fold ESTATE INFORMATION: ssty: 202-20-727 5 FILE NUMBER: 211 1-0749 DECEDENT NAME: ARTZ JEAN J DATE OF PAYMENT: 07/07/201 1 POSTMARK DATE: 06/07/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 05/ 1 1 /201 1 REV-1 162 EX(1 1-96) NO. CD 014675 ACN ASSESSMENT AMOUNT CONTROL NUMBER 11134194 ~ $513.59 TOTAL AMOUNT PAID: REMARKS: $513.59 CHECK# 089 INITIALS: HMW SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE Y BUREAU OF INDIVIDUAL TAXES ~ - ~ ' ~ '~ _w! "~ ~ AND F I L E NO. 21 I~" ~~~~ Po Box 2so6o1 {~ ~` ~"'~"~'~ XPAYER RESPONSE ACN 11134194 HARRISBURG PA 17128-0601 ~ ~ ~ ;.?t+j ~. ,;;._.. ~ ._.,; ~';'~_.f ~~ DATE 05-20-2011 REV-1543 EX AFP (OB-08) ""dtt OR CLEPK Qf ~`'S COURT Ct)MF~D CCU . PA THOMAS J HARTUNG 826 ANTHONY DRIVE MECHANICSBURG PA 17050 EST. OF JEAN J ,ARTZ SSN 202-20-7215 DATE OF DEATH 05-11-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. MEMBERS 1ST FCU 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 ]oint 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. 17525 -11 Date 11- 09 -1992 To ensure proper credit to the account, two Established copies of this notice must accompany 9 1 3.9 7 payment to the Register of Wills. Make check Account Balance $ 3 4 ~ payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 17, 456.99 months of the decedent's date of death, Tax Rate )( . 045 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due $ 785.56 nine months after the date of death. PART TAXPAYER RESPONSE 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 LINE I. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 7 X + © ~ 8. Tax Due 8 $ Jr~.~• PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION y~/ AMOUNT PAID =~_ '~ ~ d w ui ~ . O " ~ ~ ~ o i' ~- c- e S`v . ~D • G o ~' D'+ O °'/' c- N ' C u ~d G~D+ Od std ~yy,•g~,~~..~ - TOTAL cEnter on Line 5 of Tax L'omputation) ~~ Under penalties of perjury, I declare that the facts I have reported above are true, correc~jt and complete to the best of my knowled a and belief. HOME C~/~ ;) ~3~ "~O i~ TARP YER SIGNA E TELEPHONE NUMBER DATE DATE PAYEE DESCRIPTION AMOUNT PAID PAID 5/25/11 Pulmonary & Critical Pulmonary Care $153.23 Care Medicine Assoc., P.C. 6/06/11 Phar Mercia Medications/Drugs $489.84 6/06/11 United Health Care Health Care Costs $181.00 6/09/ 11 Golden Living Nursing Nursing Home Final Payment $203.27 Home ~` ~~ ~ c7 c~ ~~~ ~., ~, ~' `~ ,; ~~~ ;. ~~ ~ ~~~ ~~~ ~~ ~ ~ ~`~ ~ ~ ~ v ~ ~ v `D n ~ ~ ~^ `. ~ ~ _~ ~._. %~ Q ~ ~~~ ~ \ ^ 1 $ ~ ~ v a; ~ ~ ~ ~¢~ ~ - ~ ~~ ~`' {~~ ~. ~ ~ ~r~ ~ ~~ ;~ ~ ~~ .~ ~ ~ _ ~~ ~, ~~ `~ ~~ ~ , ~ ~q ~ ~ ~ ~ ~ ~ ti ~ ~ r `. , ,: ~ .., L; ,~ c~ ,, ~~ ~~~~ ~ ,~~~Wtl~ ddl~~~~ S ~-~td~0 ~Q ~~31~ i; ,:,r,, ?~ r~ ~'~ i ~~ tl5 ~~3~~ ~ sv ~-i