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Home My WebLink About08-30-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: COULSON MICHAEL E 84 FRONT STREET WEST FAIRVIEW, PA 17025 fold ESTATE INFORMATION: ssN: 208-aa-5500 FILE NUMBER: 211 1 -0203 DECEDENT NAME: STEVENS CARRIE R COULSON DATE OF PAYMENT: 08j 30/ 201 1 POSTMARK DATE: 08/29/201 1 couNTY: CUMBERLAND DATE OF DEATH: 01 j26j201 1 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ACN ASSESSMENT CONTROL NUMBER REV-1162 EX111-961 NO. CD 014909 AMOUNT 11500864 ~ 5299.29 TOTAL AMOUNT PAID: REMARKS: 5299.29 CHECK#1173 INITIALS: HMW SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 r rat ,~ ,; i t~ ,~_ ,~-,- ~~`. ~'~'RE.Y-1543q AFP (]-OD )-~ INFORMATION NOTICE AND TAXPAYER RESPONSE FILE: ND. 21 11-0203 ACN 11500864 DATE: 04-21-2011 ~An ~~ ~ z`.. TYPE OF ACCOUNT ` EST. OF CARRIE R STEVENS ^ SECURITY C~ ~'R~ ~~ S.S. N0. 208-38-5500 X^ sEC Accr - ~~~°~~~ ~ rC~~)R? Q DATE OF DEATH O 1- 26 - 2011 ^ srocK 6a Ct1M~=~-..,I r~ r, n,^ COUNTY CUMBERLAND ^ BONDS , PA MICHAEL S COULSON REMIT PAYMENT AND FOR MS T0: 424 RIDGE AVE REGISTER OF WILLS ENOLA PA 17025 1 COURTHOUSE SQUARE CARLISLE PA 17013 FIDELITY 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) 787-8327, COMPLETE PART 1 BELOW ~ * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 73116 To insure proper credit to your account, two (2) copies of this notice must accompany your DOD Valuation 6,650.87 payment to the Register of Wills. Make check Percent Taxable payable to: "Register of Wills, Agent". X 100.00 Amount Subject t0 Tax 6,650.87 NOTE: If tax payments are made within three (3) months of the decedent's date of death, TaX Rate x . 045 You may deduct a 5% discount of the tax due. Potential TaX Due 299.29 A^Y inheritance tax due will become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE 0 FAILURE TD 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 C C H E C K a discount or avoid interest, or you may check box "A" and return this notice to the Register of 0 N E ~ Wills and 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 re orted and tax 0 N L Y p paid with the Pennsylvania Inheritance Tax return 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 ^3 below. PART If you indicate a different tax rate, please state relationship to decedent: your OFFICIAL USE ONLY ^ AAF TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSETCS) PA DEPARTMENT DF REVENUE LINE 1. DDD Valuation PAD 1 2. Percent Taxable 1 2 X 3. Amount Subject to Tax 3 2 4. Debts and Deductions 4 3 5. Amount Taxable 4 5 6. Tax Rate 5 6__X 7. Tax Due 6 7 7 8 PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) 8 Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME C ) TAXPAYER SIGNATURE WORK C ) TELEPHONE NUMBER DATE {..,. i ~: F~~i «s• ~ '~ ~ ~iq _ ~ ~ ~ S=~ ;'t~ + ' ~ ~ I \~% 11) "~ r ~~ ~ f /~, , _ ~ ^~^l f \ dd ;~ ~~.~ a~ ~~~~~ ~,.; . ;~, J r i -, . ~ .~ c ~~ ~ m ~ ~~ Y~ ~ c~ ~ c~~ v fD v c t. ;n ~~ ~~F yRJ t~ +,4T r.~ ~1 y~ SAS ~;A. ~' {^`~ 'y? .~.; +f. ,? .~ ~v .yia ?r..t '•`f"i ~.,f ~~. s t r