HomeMy WebLinkAbout07-06-11 (4)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: 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
REMARKS:
11144406 ~ ,3.49
FiE'V-1162 EX~11-96)
NO. CD 1014668
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
---------- --------
TOTAL AMOUNT PAID:
$3.49
CHECK# 1008
INITIALS: DB
SEAL RECEIVED BY: GLENDA EARNER STRA:SBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
J
~` ~~~~ PENNSYLVANIA INHERITANCE TAXI,
_ INFORMATION NOTICE ~--~'~
BUREAU OF INDIVIDUAL TAXES ~ ~l~' ~ ` ''`. r~"-~~•^1 I FILE NO. 21 -`
Po eox 2BO6o1 pe 4 ~~~~ `„~ ~F AND ACN 1114440b
HARRISBURG PA 17128-0601 DEP f(.E~i,JOPREVENUE +9!r-! ~ TAXPAYER RESPONSE DATE 06-30-2011
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RFV-15GS FY AFP (05-111
~'~ ~ ~ ~UL - ~ ~' I~ . C~ ,~
CLERK ~JF
ORPH~PJ'S '^pURT
Ct)MR P` ~~~~~;i ~^~ PA
TYPE OF ACCOUNT
SAVINGS
/~~~"?~ ~ CHECKING
l~•) ~C~ ~~~~~ TRUST
CERTIF.
SHARON L SEIBERT
5060 CAMBRIDGE BLVD
MECHANICSBURG PA 17050
EST. OF EMILY E SEIBERT
SSN 186-24-9487
DATE OF DEATH n;~-?~-1
COUNTY CUMBERLAND
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 calculai: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 t-e due, but you must
notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2.
if you be~ieve he information is ?nrorrPrt, plPgcP obtain written correction from the financial institution, attach a copy '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 INSTRUC TIONS
Account No. 0186249487-S1 Date 10-15-1979 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 $ 155.00 payable to "Register of IJills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments acre made within three
Amount Subject to TaX $ 77 • 50 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 r+ill become delinquent
Potential Tax Due $ 3 • 49 nine months after the date of death.
PART TAXPAYER RESPONSE
FAILURE Tfl #FESPDND WILL RESULT ~1N A#'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
C H E C K a discount or avoid interest, or return this notice to the Register of Wills anti
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 informa 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 $ b
7. Tax Rate 7 X 7
8. Tax Due 8 $ 8
PART DEBTS AND DEDUCTIONS CLAIMED
3^
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I reported above are true,/'corrltct and
omplete to the ! est of my knowledge and b ie ~ ~ OME C~~~- ) GG' ~Jr'~~~- ~T .~ -fir
WORK ( ~ ~_ -°!`~S- - C~
TAXPA SIGNA URE r~~ TELEPHONE NUMBER DATE
TOTAL CEnter on Line 5 of Tax Computation) $