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Home My WebLink About07-28-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDU~^-.L TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BROOKS CHERYL E 540 LEE WILLIAMS ROAD CARROLLTON, GA 30117-4902 ACN ASSESSMENT CONTROL NUMBER -- fold ESTATE INFORMATION: ssN: 175-34-s2g4 FILE NUMBER: 21 1 1 -0393 DECEDENT NAME: BROOKS THEODORE S DATE OF PAYMENT: 07/28/201 1 POSTMARK DATE: 07/18/201 1 couNTY: CUMBERLAND DATE OF DEATH: 01 /31 /201 1 AMOUNT 11145195 ~ 583.30 TOTAL AMOUNT PAID: REMARKS: SEAL CHECK# 1018 INITIALS: CJ RECEIVED BY: 583.30 i.~ rw~r~ n r n nwlrn C`Tf'] A C`~ A I Ir'_LJ REGISTER OF WILLS REV-1162 EX111-961 NO. CD 014772 REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 REV PENNSYLVANIA INHERITANCE INFORMATION NOTICE f~~Mdt71d A N D ~kTOF:u~YE~J~, ~"~CE /O~~ TAXPAYER RESPONSE TAX FILE N0. 21 11-0393 ACN 11145195 DATE 07-06-2011 ~'~':I I JUL 2$ Eli I?~ 2 l CLERK OE 4RPHl;,N`S COJRT CHERYL E BROOK 4440 VALLEY ST ENOLA PA 17025 EST. OF THEODORE S BROOKS SSN 175-34-8294 DATE OF DEATH 01-31-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. SOVEREIG N BANK 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 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 may be 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 believe the information ~s incorrect. please obtain written correction from the financial inctituti0^, attach a ccpy to th~,s `~~~ aid r~t4 ri ~~t to the above adtlress. Nlease call 717-787-8327 with Questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0921710712 Date 04-19-1997 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 $ 1 ~ 110 • 65 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 555.33 months of the decedent's date of death, Tax Rate X 15 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ 83 • 30 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESULT IN AN 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. C 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 information is incorrect and/or debts and deductions were paid. Complete PART ~ and/or PART ~ below. PART If indicating a different tax rate, Please state relationship to decedent: TAX RETURN - CALCULATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS EPAD 1 I 2 3 X 4 5 - 6 `~ 7 X 8 $ OFFICIAL USE ONLY ~]AAF PA DEPARTMENT OF REVENUE 1 _ 2 3 4 5 U 7 B PART DEBTS AND DEDUCTIONS CLAIMED neTF Pern PAYEE DESCRIPTION AMOUNT PAID IUTAL ~tncer on L1fIC ~ ui u,r ..~ ~~ - Under penalties of perjury, I declare that the facts I reported above are true, correct a ~) ' _ ~ Jn cgmplete to the best of my ttk''nowledge and belief. HOME (~~v ) ~ ~ / 7 ~~,' ~~ `,~9'(~S'1~~ W O R K C ~ TAXPAYER SIGNATU E TELEPHONE NUMBER DATE _._ -; ~, r: J { d...T 7 C1( J ` ~ ~~ ~J ~l { ._ ~, ~^ ~" ~- ~; ~~ - -,~,~ ,2 ~~ `-, ~) .~/ ~a .~ ~~ U~ .~~~ a iTT~ ~+ ~-~J L ~- J ~ fi dd ~~~ ,~ra;~,~-,~~~wr~~ l~(1~J!~~ \~,1,~f~nld~O JU 1:J~1J :~~ ~:~~ 8~ 14~~ Ii~:~ ~V ~~fIJJV v.w.. J .. ~,~ Ire ti•, tYz '~ .~},.yy. i7J tr I ~r•r '~ ~`• ~: ,. q~ ~sr~'` ,:;., , ~~ ~_ t.a.. ~C~ --, ~.,a f_t . 7 I~i`.3 CU tr W ~z z ~o u~ ~ ° w L ox z~ wWo~ Fzo~ ~." ¢ N m tV cv a ~ n ~' Q-O C ~~~ N 7 ca a~ L N ~ ~ ~ o ~ L ~ ~ N ~ ~ O U ~ ~~ ~ C M C lq ~ ~r ~-_ ~C~O ~ ~ U ~ ~ _ ~ ~ ~ ° ~ oQ c ~ ~ t ~ a> ~ a> -C m ~.~~ ~ ~ ~ a°i ~U•~ ~~U.-U