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Home My WebLink About09-12-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 014952 GRAHAM LARRY W 142 EASTERLY DRIVE MECHANICSBURG, PA fold 17050-7938 ESTATE INFORMATION: ssN: iso-is-s434 FILE NUMBER: 211 1-0959 DECEDENT NAME: GRAHAM HARRY W DATE OF PAYMENT: 09/ 1 2/201 1 POSTMARK DATE: 09/09/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 03/30/201 1 ACN ASSESSMENT AMOUNT CONTROL NUMBER 11138529 ~ 5164.65 TOTAL AMOUNT PAID: REMARKS: CHECK#567 SEAL INITIALS: CJ REV-1162 EX111-96) 5164.65 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 21_ } / BUREAU OF INDIVIDUAL TAXES ~ _ Ii ~ ~ ~`, Po Box zao6ol PECt~fLS~V~tl~cT - ~1r AND ACN 11138529 HARRISBURG PA lriza-0601 pEP,,~,,~rTOFRE„EN~E ; ; ` TAXPAYER RESPONSE DATE 06-07-2011 REV -19'43"~k AFP(05-I1) " '"~J ~~~' ~ ~ ~1 , i~ CL~~K ~'r {,~}L ~' .~ (`fly ~^~T V~l~ If"~-_' i fl,x ~ti ,t EST. OF HARRY W GRAHAM SSN 160-16-6434 DATE OF DEATH 03-30-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: LARRY W GRAHAM REGISTER OF WILLS 142 EASTERLY DR 1 COURTHOUSE SQUARE MECHANICSBURG PA 17050-7938 CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. PNC BANK NA 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 is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to tha above address. Please roll 71J-7A7-8?2?-with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 5110874131 Date 11-23-1998 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 $ 7,413.00 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 3, 706.50 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 $ 555.98 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 C 0 N E ~ an official assessment will be issued by the PA Department of Revenue. B L 0 C K g. ~ 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. dThe 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 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 1 ~1,a3-~i`iti8 z $ 'Z u! 1 ~ ,, G('~ 3 X ~ n , c~t5c~ 4 5 - i.l l ~ b 6 $ `3105'~~ ~v 8 $ , ~O~ ~~ PAD OFFICIAL USE ONLY ~ AAF PA DEPARTMENT OF REVENUE 1 2 3 4 5 6 7 8 PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID i CC C ~ r _G @f. ~ TOTAL CEnter on Line 5 of Tax Computation) S 4 '~ ~ ~6~. T- Under penalties of perjury, I declare that the facts I reported above are true, correct and c mplete to the best of y knowledge and belief. HOME C 111 ) ~~ ~ -~'`~ WORK C ) ~ ~ c~ ~-~- -cr TAXPAYER SIGNATURE TELEPHONE NUMBER DATE r ~`~ I '. 4 ~~ a - . v s r J 3 a" 9~ r.~ r-f..~a~ s .4}> • t qY t. L 'S..~ ~ Cll` =r_ PA ~,:: : - a ~.i ,.a ~~ ~~~- ~a, r. .~- ,~. ~:- f.~..: J~',:f .' i Y~i ~ V -A~ ~ )I ' r,•~ ` ~ !\ t t X iYf 3 ...t ~.%V i •.. ~` ~, . . ~/~' ~~ M d n 4 a ~ O~ ey i ~ a~ cs C7 ~ ~ ~W ~ CV U7 J ~ ~ viii