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Home My WebLink About09-06-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX~11-96) NO. CD 014932 WOLF LISA B 6353 STEPHENS CROSSING MECHANICSBURG, PA 17050 fold ESTATE INFORMATION: SSN: 202-20-3035 FILE NUMBER: 211 1-0942 DECEDENT NAME: BERZINCE NANCY DATE OF PAYMENT: 09/06/201 1 POSTMARK DATE: 08/29/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 05/ 1 2/201 1 REMARKS: CHECK#1263 SEAL ACN ASSESSMENT AMOUNT CONTROL NUMBER 11152935 ~ 5255.27 TOTAL AMOUNT PAID: INITIALS: DB 5255.27 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ;, PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES A N D PD BDX ZBU601 pennsyP~vania HARRISBURG PA r71za-0601 oePnaTMervTO,~,gFyENUe. - ~_,~,C~CXPAYER RESPONSE 'i, REV-1543 E% ~RP r05 -~1)' „~~ ~ CLERK CF ORPHAr~~S r~! lRT LISA BERZINECWOLFE 6113 WESTOVER DR MECHANICSBURG PA 17050 FILE N0. 21 - ~ t' `~y ACN 11152935 DATE 08-15-2011 j EST. OF NANCY BERZINEC SSN 202-20-3035 DATE OF DEATH 05-12-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. M & T BANK provided the department with the information below, which was used iri 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 Sp0U5e 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 is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return ~t to the above address. Please call 717-787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 462942 Date 07- O L - 1968 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 $ I 1 , 345.40 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax ~` 5, 672.70 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 $ 255.27 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 C H E C K a discount or avoid interest, or return this notice to the Register of Wills and 0 N E an official assessment will be issued by the PA Department of Revenue. 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 tiled 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 DF REVENUE TAX RE TURN - 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 $ i (, 7. Tax Rate 7 X 7 8. Tax Due 8 $ g PART DEBTS AND DEDUCTIONS CLAIMED ^3 DATE PAID PAYEE DESCRIPTION AMOUNT PAID TAXPAYER~SIGNA URE TELEPHONE NUMBER DATE TOTAL CEnter on Line 5 of Tax Computation) S Under penalties of perjury, I declare that the facts I reported above are^-true, correct and complete ~o /the best of my k/notw/led a and belief . HOME C ~ ~ 1 ) 7ti ~ fc~'._L~L} t/` I ' ~t/l~'7~~-C_ tJ ~/VrL~ WORK C `']f'7 ) ~7_71'l ~C~i~~=~1~ USA'FIM1$T y.Ay~, ~~N~. 'fR a ~' ~~ J ~~ V J i p ~ '~ ~7 'f f`. •~ ,~ ~=,: ' 1 .. f (' / { / ~ 1 ~ ~ `~ f----- a ~ . ~~ ~' <`~ _ ~y ---- ,~ ~--` .. _~~ ~~ ~ j~-- -,`~ ,~ ~~ --~.-. ~ ~ ~ ~, _./~ ~! ~ ~~3 (~~ .~ `~ ~~ ~^ mac "~f ~• - Q ~ ~~ ~ i ~ ~ ~ ivf ~ . (1_ r.~ _ is Do~~ ~' O m V ~ ~ t ~~~