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Home My WebLink About08-09-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT JONES MICHELE 3610 ALBERTA AVENUE MECHANICSBURG, PA 17050 fold ESTATE INFORMATION: SSN: 180-28-5741 FILE NUMBER: 2106-0867 DECEDENT NAME: JOHNSTON LOUISE DATE OF PAYMENT: 08/09/201 1 POSTMARK DATE: 08/08/201 1 couNTY: CUMBERLAND DATE OF DEATH: 07/03/2006 ACN ASSESSMENT CONTROL NUMBER AMOUNT 11501714 ~ 5113.10 TOTAL AMOUNT PAID: REMARKS: CHECK# 1627 SEAL INITIALS: CJ RECEIVED BY: 5113.10 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REV-1162 EX111-96) NO. CD 014823 REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE FILE N0. 21 06-0867 BUREAU OF INDIVIDUAL TAXES AND ACN 11501714 PD Box 2eo6ol ~r TAXPAYER RESPONSE HARRISBURG PA 17128-0601 r~~ ``„~i ~ ~.,, ~ n DATE 08 - 10 - 2011 r.~~. '~-.REV r1543A, AEH.~tl~-00) CLERK ~JF GR,FH~'v'c ' `~`,~ 1.1~~~~t-~-~~~ i1'~J JONES MICHELE 3610 ALBERTA AVENUE MECHANICSBURG PA 17050 TYPE OF ACCOUNT EST. OF LOUISE JOHNSTON ^ SECURITY S.S. N0. 180-28-5741 ^ SEC ACCT DATE OF DEATH 07-03-2006 ^XTOCK COUNTY CUMBERLAND ^ eoNDs REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 MELLON INVESTOR has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a beneficiary of this asset. If you feel this information is incorrect, please obtain written correction from the transfer agent, 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. Questions may be answered by calling (717) 7B7-8327, COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 806197241857 To insure proper credit to your account, two (2) copies of this notice must accompany your payment to the Register of Wills. Make check DOD Valuation 2,513.44 payable to: "Register of Wills, Agent". NOTE: If tax payments are made within three Percent Taxable X 100.00 Amount Subject to Tax 2,513.44 C3) months of the decedent's date of death, you may deduct a 5% discount of the tax due. Tax Rate X . 045 Any inheritance tax due will become delinquent Potential Tax Due 113.10 nine C9) months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT BASED ON THIS NOTICE .... A. The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of C H E C K Wills and 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 to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART If you indicate a different tax rate, please state your relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSET(S~ LINE 1. DOD Valuation 2. Percent Taxable 3. Amount Subject to Tax 4. Debts and Deductions 5. Amount Taxable 6. Tax Rate 7. Tax Due 1 2 X 3 4 5 6 Y 7 PAD OFFICIAL USE UNLY U AAf PA DEPARTMENT OF REVENUE 1 2 3 4 5 6 7 8 PART 0 DATE PAID PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) $ Under penalties of p jury, I declare that the facts I have reported above are true, correct and comma plete~ the best of y knowledge and belief. HOME C ~ ~ ~-~ ~2 ~, ~_ WORK I~ I~ ~ - , TELEPHONE NUMBER DA E TAXPA ER SIGNATURE l USA FIR$ CL~~ ~'O VF~ f g;~ II~ ~'tr 5,•~< r ~,~~~~~ tf~~, 1' ;r~ #~ ~ 3 ,; ,_ ::~. ~^~` ,. k. yy.l'. M.• ' .. ~~Y~ ;•. P}~ %(.: _ t ~J /~ 'V ,) Ja-- .J -/ «(___.....~~~ J ~ JJ ~~ < a C~1/ ~r ~/ ~~ ~ ~ t YI~ j?~~ ~ ~, a;a c ¢' ~ =l ,. ; ti .y'oy Vi ~ V ~ rl.; j ~ L~4 R ~ : ~ irj L Lrb UMz, ~°~°:r, ~`d .1~ ('I .+.{ s...~ s~i