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Home My WebLink About09-13-11REV-1162 EX(11-96) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: DUMONT CYNTHA 436 C STREET CARLISLE, PA 17013 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ACN ASSESSMENT CONTROL NUMBER fold ESTATE INFORMATION: ssN: i 62-32-4905 FILE NUMBER: 211 1-0965 DECEDENT NAME: FOREMAN JOYCE A DATE OF PAYMENT: 09/13/2011 POSTMARK DATE: 09/13/2011 couNTY: CUMBERLAND DATE OF DEATH: 08/ 24/ 201 1 NO. CD 014961 AMOUNT 11159994 ~ 523.95 TOTAL AMOUNT PAID: REMARKS: SEAL CHECK# 99 INITIALS: CJ RECEIVED BY: 523.95 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS -~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE ' FILE N0. 21 "~~ -~~ ~~ BUREAU OF INDIVIDUAL TAXES T''.(~~' _ :` i ((''~~ AND ACN 11159994 PD BOX 280601 p~n-sylVan~a .`~ LJ~' HARRISBURG PA v12B-o6o1 oEP,tr~iat~~oF;a€yeNUE ",;; , ~ TAXPAYER RESPONSE DATE 09-05-2011 REV-1543 EX AFP (OS -11) ~ '~- '! i "`~ "~ ~ `~ -' ~' EST. OF JOYCE A FOREMAN SSN 162-32-4905 CLERK n~ DATE OF DEATH 08-24-2011 ORPH.ati;'c t,~ ' r i (;~{~ COUNTY CUMBERLAND v~l~~'%I ~~"!I C',!'; J (~,(~ P~ REMIT PAYMENT AND FORMS T0: CYNTHIA M FOREMANDUMONT REGISTER OF WILLS 436 C STREET 1 COURTHOUSE SQUARE CARLISLE PA 17013 CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS © CHECKING TRUST CERTIF. MEMBERS 1 ST FCU 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 notefyethendepartmentnof your relationship tofthetdeceased by checkingnBox1CTin PARTilnbelowtandcwritingy"spouse" bntPART lust If you believe tthe information )s incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. Please call 717-787-8327 with questions. COMPLETE PART I BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 312620-11 Date 02-29-2008 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 , 064.36 payable to "Register of Wills, Agent". NOTE: If tax payments are made within three Percent Taxable X 50.000 Amount Subject to Tax $ 532.18 months of the decedent's date of death, X . 0 4 5 deduct a 5 percent discount on the tax due. Tax Rate Anv inheritance tax due will become delinquent Potential Tax Due $ 23 • 95 nine months after the date of death. PART TAXPAYER RESPONSE D FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT A. ~y~ The above information and tax due is correct. of i this notice to obtain L~ Remit payment to the Register of l es Wills with two cop / discount or avoid interest, or return this notice to the Register of Wills and C H E C K a an official assessment will be i ssued by the PA Department of Revenue. C ONE et has been or will be reported and tax paid with the Pennsylvania inheritance tax return B L 0 C K B. ~ The above ass 0 N L Y filed 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 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 2 $ 3 X 4 $ 5 6 `~ 7 X 8 $ PAD 1 2 3 4 5 6 7 8 OFFICIAL USL PA DEPARTMENT OF ONLY ~ AAF REVENUE DEBTS AND DEDUCTIONS CLAIMED PART DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) ~ Un penalties of perjury, I declare that the facts I reported above are true, correct and mp ete .o the b st q,~JO~knowledge~a~lief. HOME C ) ~ ~ R /`~ ~C~/r ~ i'~ '" l~i~ WORK C ) 9 / 1 ' ~ TELEPHONE NUMBER DA E TAXP ER IGNATURE ;~ ~, 4~ '~ ~ `. {:. ~ s f d ,~ ~~ ~~ ; J ~ ~(i: t .a,f ~^. ~' i+v ! ~~ 'M ~ 0?3 \ x" ~ ~..,j d~ i 1-- ~~ i ~ \~^ \_ VV7 t 1 2 t 'v ~ `~ s l~~ iV~~ ~,~~K~1d~0 s a` °V ~ ~ ~ t ~~\ - ~ .. ~ ~ ~~ j{,,.~~ ~~ ~, n J 7'J '~- i i.~= ''t~ 1j ~~ a ~?? :•4 i'•..