HomeMy WebLinkAbout07-06-11COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
STANTON EMILY R
1455 AMHERST COURT
MECHANICSBURG, PA 17050
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ESTATE INFORMATION: SSN: 186-24-9487
FILE NUMBER: 211 1-0668
DECEDENT NAME: SEIBERT EMILY E
DATE OF PAYMENT: 07/06/201 1
POSTMARK DATE: 07/05/201 1
COUNTY: CUMBERLAND
DATE OF DEATH: 03/ 19/201 1
AMOUNT
ACN
ASSESSMENT
CONTROL
NUMBER
1 1 144410 ~ $1 1 .25
TOTAL AMOUNT PAID:
REMARKS:
SEAL
CHECK# 1004
;11.25
INITIALS: DB
RECEIVED BY: GLENDA EARNER STFIASBAUGH
REGISTER OF WILLS
RE`J-1162 EX(11-96)
NO. CD i~ 14664
REGISTER OF WILLS
;.~ ~~
~~ PENNSYLVANIA INHERITANCE TA
.,~._._, .,;-`'~E ~ INFORMATION NOTICE FILE NCO. 21 ~-- ~~ - l.~i.~'~
BUREAU OF INDIVIDUAL TAXES r i ~.~"~ ,.' ;! i AND
Po eox Zso6ol pe ~~~; , ~,,~ ~ ~ ACN 11144410
HARRISBURG PA 17128-0601 DEPART ;oF~~~.~uE.,I .~'!?'.a-`~ TAXPAYER RESPONSE DATE o6-30-2011
REV-1543 EX AFP (05-11)
C~.ERK n~
QRPH~'S CURT
,, .,
CIJME~~P`. ~.`~~r~, r~ , PA
SHARON L SEIBERT
5060 CAMBRIDGE BLVD
MECHANICSBURG PA 17050
TYPE OF ACCOUNT
EST. OF EMILY E SEIBERT ^ SAVINGS
$$N 18b-24-9487 ,C. ~.~~~ ^ CHECKING
DATE OF DEATH =nz -" -'°11 ~S! ~ ~_~G t) ^ TRUST
COUNTY CUMBERLAND ~ CERTIF.
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
P S E C U provided the department with the information below, which was used in calculat:inq the inheritance tax due.
Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you are the Spouse of the
deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax ma;y be due, but you must
notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "s;pouse" in PART 2.
If yo~~ believe he information is incorrect, pl*'a'SQ obtain written correction from the financial institution, attach a cc,;y '.c this form and return
it to the above address. Please call 717-787-5327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCT"IONS
Account No. 0186249487-51 Date 07-08-1994 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 $ 500.00 payable to "Register of 1Jills, Agent".
Percent Taxable )( 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 250 00 months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
Potential Tax Due $ 11 • 25 nine months after the date of death.
PART TAXPAYER RESPONSE
FAILURE TO RESPOND WILL RESULT IN A1~1 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 return this notice to the Register of Wills and
C H E C K 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 iinh~eritance tax return
0 N L Y 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 OFFICIAL USE ONLY ~ AAF
relationship to decedent: PA DEPARTMENT OF REVENUE
TAX RETURN - CALCULATION 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 $ ~+
5. Debts and Deductions 5 - 5
6. Amount Taxable 6 $ 6
7. Tax Rate 7 X 7
8. Tax Due 8 $ 8
PART DEBTS AND DEDUCTIONS CLAIMED
3^
HATE PAiD PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury,~I declare that the facts I reported above a)re true, correct <and
plete to the best of y Howled and belj~ef~. HOME C"~/ ~ ) ~~c~~~~"~
~; ~ ~ WORK t )
T AYE SIGNATURE ~°~ TELEPHONE NUMBER DATE
C,~ ~- -
TOTAL CEnter on Line 5 or iax <,ompuLaLioni +~