HomeMy WebLinkAbout07-06-11 (2)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
!REV-1162 EX111-96)
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CC) 014665
STANTON EMILY R
1455 AMHERST COURT
MECHANICSBURG, PA 17050
---- fold
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
---------- --------
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
1 1 144409 ~ $1 1 .25
TOTAL AMOUNT PAID:
REMARKS:
>11.25
CHECK#1005
INITIALS: DB
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
~~A~ PENNSYLVANIA INHERITANCE TAX
,,,,,~, `~ ~ ~ INFORMATION NOTICE FILE NO. 21 _ ~ ~ - ~...~~
,r. ~.
~' ~~~~~ ~ AND ACN 11144409
;A,~2~,MEF1T'bF,R~11EN1~~:. ~j TAXPAYER RESPONSE DATE 06-30-2011
REV-1543 EX AFP (OS-11)
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~. ~= a ~ .~C~L - ~ F~.: it ~ t~ ,,
CLERK ~~
o~~-~~N~~ couR~
SHARON L SEIBERT
5060 CAMBRIDGE BLVD
MECHANICSBURG PA 17050
EST. OF EMILY E SEIBERT
SSN 186-24-9487
DATE OF DEATH - 1
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
!''Q~`~~ ~ CHECKING
3-~~r ~'~ ~ TRUST
~J ~ CERTIF.
P S E C U provided the department with the information below, which was used in calculating 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 y0U are the SpOUSe of the
deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must
notify the deppartment of your relationship to the deceased by checking Box C in PART 1 below and writing ":spouse" in PART 2.
If you believe {he informatio^ is ;ncorrec±, please obtain written correction from the financial institution, attach a co~;~.y to this form and return
it to the above address. Please call 717-787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRU'~CTIONS
Account No. 0186249487-50 Date 07-08-1994 To ensure proper credit to the account, two
Established copies of this notice must accompany
payment to the Register Hof Wills. Make check
Account Balance $ 500.00 payable to "Register of I~lills, Agent".
Percent Taxable X 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 )( . 045 deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
Potential Tax Due $ i l • 25 nine months after the date of death.
PART TAXPAYER RESPONSE
a FAILURE: TO RESPOND 1~ILL.....RESULT IN AN''~FFICIAL 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 return this notice to the Register of Wills and
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 inheritance 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 $ 4
5. Debts and Deductions 5 5
6. Amount Taxable 6 $ $
7. Tax Rate 7 X 7
8. Tax Due 8 $ $
PART DEBTS AND DEDUCTIONS CLAIMED
3^
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare tha the facts I reported above re true, correct and
complete to the st of m knowledge an belief . HOME C~ ~ ) ~ ~~
AXP YER I N' TU - ~~ G TELEPHONE NUMBER DATE
TOTAL (Enter on Line 5 of Tax Computation) ~