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Home My WebLink About09-27-11REV-1162 EX111-961 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEP7.280601 HgRRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: OTT JOY A 116 W HUNTERIR 015 CARLISLE, PA _____-- told ESTATE INFORMATION: FILE NUMBER: DECEDENT NAME: DATE OF PAYMENT: POSTMARK DATE: COUNTY: DATE OF DEATH: SSN: 198-22-9919 2111-1011 GEORGE MILDRED G 09/27/2011 Og~27/2011 CUMBERLAND 08/16/2011 NO. CD 015004 ACN AMOUNT ASSESSMENT CONTROL NUMBER -------- $92.23 11159779 ~ - 5148.13 "11158655 ~ 11159780 ~ 522.55 TOTAL AMOUNT PAID: ARKS: JOY OTT HAND D ~LI1 EKED CORRECT REM ED CHECK ON 912 CHECK#1652 SEAL PENNSYLVANIA INHERI OFFCCIANR CEIPT E TAX INITIALS: HMW RECEIVED BY: 5262.91 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS 1 INHERITANCE TAX C! PENNSYLVANIA FILE NO' 11159780 °° INFORMATION NOTICE „~ ~ ,~ ACN 09_05-2011 ~~ ~~' DATE -_~ @t1t15~Y~i'll8 .,RESPONSE -- ~~C~s TAXPAYER- aF AcrouNT BURFI+U OF INDIVIDUAL p ENUE T Y P E PD BOX 280601 p,a~_ TMENTQF:BF.Y~ ~v~ gAVINGS 17128-ob - DEPAR L NARRISBURG PA REV-isaa Ez nFV `°s iii G GEORGE ~~ CHECKING ~ `, ~ ~ d3 EST . OI' MILDRED 198-22'9919 ^ TRUST 0g_1C- ~~ CERTIF. ~J ~~ J ~ ~ ~ ~ - SSN 2011 DATE OF DEATH r~ ~ "}'r ~~Ef'`` CUMBERLAND ~7 1~~.~~~ ~ `:,~ T u,t COUNTY FORMS T0: ~i lc~l.:r"• j.,~``; - ~`)I~;"S I ~ ORPq`t~`~ REMIT PAYMENT AND C~IR,'.`' ~. ~ pH Ci11w~C?FF REGIS"fER OF WILLS 1 COURTHOUSE SQUARE A OTT CARLISLE PA 17013 1~6 W HUNTER RD PA 17015-4342 CARLISLE tax dthe the inheritance of in calculating the spouse which was used if you are but you must information below. of this account.taX may be dues in ,ART 2• artment with aheoint owneribeneficiarYline, note no itln9 Spouse form and return provided the dep TeX DUe and wr copy to this on the Potential in PAR1 1 below attach a above named decedentbelowWere checking box. C_ ,nstitution. at the death of the from the financial PNG BANK NA Zero is reflected INSTRUCTIONS other than the deceased by - Records indicate that t0 correction two and any amount relationsheP$e obtain written of your. uestions. ND PAYMENT decease~he de artment ,s incorrect, p FOR FILING A to the accoun+ notify the information 787-8327 with Q S I DE credit If you believe Please call 717- REVERSE To ensure Proper accomp~~ny check address. * SEE 2002 this notice must above BELOW 04 - 18 - Wills. MaKe it to the copies of aster of LETE PART I Date to the Reg Agent"• COMP 1 payment „Register of Wills. 500385212 payable to three Account No- Established 1' 002 • QU made within If tax payments are death. $ Q ~ N07E: the decedent's date of due. 50.00 on dhe tax t glance X months of ercent discount become delinauen Account B 501 .00 deduct a 5 p due will t Taxable tance tax date death.-~ Any inheri the of percen to Tax $ .15 ~, after Subject X nine months Amount 75.15 Tax Rate $ RESPONSE Tax Due TAXPAYER ASSESSMENT Potential IN AN pFFICIAL TAX T SPOND WILL RESULT obtain P~ FAILURE TD RE this notice to ~ tax due is correct. two copies of yl s an with the Register of W 1 ^ The above informationthedRe9ester of Wills this notice to of Revenue. A. aYment to or return the PA Department return Remit p avoid interest. lvania inheritance ax will be issued b~c a discount oassessment aid with the PennsY an official reported and tax P CoNCK The above has been or will be E asset esentative. aid. C the rapt deductions were p BLOC K B ~ filed by estate incorrect and/or debts and ^ p,Ai ONLY 3 below. L USE ONLY The above inform~iand/or PART ^ OFFICIA REVENUE c• IIIJJJJ 2 Of- Complete PART PA DEPARTMENT please s a If indicating a different tax _ ~ p AD PART to decedent: JOINT/TRUST ACCOUNTS 1 ^ relationship TAX ON ~~ i TAX RETURN - CALCULATION Ol ~I 2 ~~ 3 LINE 1. Date Established 2 $ ~ II 4 ~_ Accour:t Balance 3 ~( ~ g- percent Taxable 4 $ 5 to Tax ~~ 6 4, Amount Subject 5 $ ~ 7 5, Debts and Deductions 6 Taxable ~( ~ `g 8 6, Amount ~ 7, Tax Rate B $ CLAIMED DEBTS AND DEDUCTIONS PA g, Tax Due AMOUNT PART DESCRIPTION PAYEE DATE PAID t~ s Tax Computation) on Line 5 of and T07AL (Enter are true, correc/~~ I reported abov C ~ / ~ , declare that the facts HOME er7ury' I e and belief. ~ D A Unde Pe alties of P of knowled9 WORK ~ NUMBER comp ate to the bas ~ TELEPHONE i -jI-ID ~ ~ PENNSYLVANIATIONENOTICEE TAX FILE N0. 21 779 •~!.~ INFORMA ACN 11159 }~ AND 09.05-2011 BUREAU OF INDIVIDUAL TAXES pennsyl~arn~lr~,.~~ ~ -~AXpp~''ER RESPONSE DATE Po Box 2BO6o1 .•~ TYPE OF ACCOUNT 17128-0601 DEPARTMENT OF'REVENUE ', I~_~.~ HARRISBURG PA -- ~ SAVINGS REV-1543 EX PFP (05-11) 4 ^, ~; J ` , ~ BEST ~ pF, MILDRED G GEORGE ~ CHECKING - 198-22-9919 ~ TRUST SSN Og_16-2011 CERTIF. u~~~~< ,J(„ DATE O1? DEATHUMBERLAND r}r;r-,L I ~ ~~; f ~~T COUNTY " ;~r~` ~ ~^~ ~;~aREMIT PAYMENT AND FORMS T0: CUB', , - ~ . ; REGISTER OF WgLUARE A OTT 1 COURTHOUSE Q7013 JOY CARLISLE PA 116 W HUNTER RD PA 17015-4342 CARLISLE the inherit0U5etof the in calculating the sP If you are but you must of this account. be due. in PART 2. provided the department with the information below. which was us ou were a joint owner/beneficiary note no tax may„Spouse" the Potential Tax Due line. to this form and return named dece en PNC BANK NA checking Box ~C in PART 1 below and writing that at the death of the above- t0 the deceased byect,on from the financial lnstitut~on. attach a copy amount other than zero is reflected below on INSTRUCTIONS Records indicate deceased and any our.relationshlp ~ ppYMENT the department of y lease obtain written cor AND notify the information is incorrect. P SIDE FOR FILING If you believe REVERSE credit to the account, two it to the above address. PleiseB`E1L07W7 ~F7SEEw,th question 1987 To ensure proper PART 06-29- of this notice must accompany check CpMpLETE copies of Wills. Make 9055 Date the Register Ayent". t No. 514042 payment to Accoun Established payable to "Register of Wills, 4 ~ 099.00 three $ [jQ,000 NOTE: If tax payments are made within Balance ~ months of the decedent's date of death, Account X the tax due. Taxable 2,049.50 deduct a 5 percent discoWill become delinnuent percent $ .15 tax due SUb7ect to Tax - Any inheritance the date of death. Amount X , 43 nine months after 307 Tax Rate $ potential Tax Due TAXppYER RESPONSE RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT PART T 0 1^ FAILURE of this notice to obtain is correct. copies of Wills and and tax due of Wills with two A ^ The above information ister this notice to the Register Remit payment to the Reg or return of Revenue. be issued by the PA Department tax return a discount oassessmenttwilltr lyania inheritance an official 2,nd tax Paid with the Pennsy CHECK or will be reported ONE ~ ~ The above asset has been C BLOC K B. filed by the estate representative. aid. and deductions were p ONLY C The above informs ion is incorre3t below. deb' s USE ONLY ~ AAF Complete PART 2~ and/or PART ~ pF F I C I AE ~ pF REVENUE lea~e s e I pA DEPARTMENT If indicating a different tax rate _ PART to decedent:-~~ o ACCOUNTS I PAD relationship JpINT/TRUST I - CALCULATION OF TAX ON TAX RETURN 1 Date Established •_,~._~.--~°-- 3 LINE 1 • 2 ~.__.----""'_'-- - 4 2• Account Balance 3 X _ 3, Percent Taxable 4 $ 5 4, Amount Subject to Tax - - 5 6 5, Debts and Deductions $ - 7 6 ~.~E _ - 6, Amount Taxable 7~ ' B 7. Tax Rate $ $ CLAIMED g. Tax Due DEBTS AND DEDUCTIONS AMOUNT PAID PART DESCRIPTION PAYEE DATE PAID ~ TOTAL CEnter on Line 5 of Tax Computation) true ~ rrect and .~ facts ]. reported above are , r I declare that the HOME ~ f perjury' a and belief. ~ der enalties my k owledg yJORK ~ D Ale a to the est TELEPHONE NUMBER _.....w T11R - - INHERITANCE TAX i ~ _ ~C I .., PENNSYLVANIA ACN 11158655 ~1~ INFORMATION NOTICE FILE N0. 21~ '""r ~~;"~' -, ~r 08-29-2011 BUREAU OF INDIVIDUAL TAXES pennsylvanla _ TAXPA~Y RESPONSE DATE Po Box zaobol E"~_ ~-'~ TYPE OF ACCOUNT HARRISBURG PA 17128-0601 DEPARTMENT OF REV ENUE REV-1543 EX PFP (05 11) ~ g AV I NG S .. ~ j. GEORGE ~ CHECKING '; ,, ! ::' ~ ,- ;',. ~ t -$~'p'. OF' MILDRED G SSN 198-22''9919 ~ TRUST 08_16-2011 ~ CERTIF. '~ ~1~ DATE OF DEATH CLERt~, ~..• CUMBERLAND ~R~'~-~r,,ri„4.', r,~,I~~TCOUNTY Cl~~, ; "i (', .''~ 'i'~MIT PAYMENT AND FORMS 70: REGISTER OF WILLS A OTT 1 COURTHOUPA SQ~~R3 JOY CARLISLE 116 W HUNTER ROADPA 17015 CARLISLE inheritance tax due. in calculating the the spouse of the which was used If you are but you must of this account. be due. in PART 2. the department with the information be ow. provided ou were a joint ownerlbeneficiarYline, note n0 taX may„Spouse" the Potential Tan PART 1 below and writing to th,s form and return named deceden . MEMBERS 1ST FCU reflected below on checking Box C. from the financial institution, attach a copy Records indicate thaa~o nteother thanezeroeis to the deceased by deceased and any our relationshePse obtain written correction INSTRUCTI~iNS notify the department of Y FILIYYG AND PAYMENT account, two If you believe the information is incorrect. P SIDE F(7R it to the above address. Please call 717-787'8327 with question . VERSE er credit to the _ BELOW * SEE RE.. 02-20_2010 To ensure prop ~ AFjT 1 of this notice must accompanMake check CuNiYLtTE Date copies of Wills. 3781-77 _ 05 payment to the Register Agent" AccOUnt No. payable to "Register of Wills, Established 6' 583 72 tax payments are made within three Balance '~ ~jQ . OOO NOTE: if the decedent's date of death. Account X .86 months of the tax due. Taxable 3 r 291 - deduct a 5 percent discount on delinquent percent $ tax due will become to TaX .045 _ AnY inheritance Amount SUb7eGt X nine months after the date of deat 148.13 Tax Rate $ Potential Tax Due TAXPAYER RESPONSE RESULT IN AN OFFICIAL TAX ASSESSMENT PART TO RESPOND WILL FAILURE to obtain and tax due is correct. copies of this notice and above information of Wills with two to the Register of Wills A. ^ The the Register this notice Remit payment to or return Department of Revenue. avoid interest be issued by the PA tax return a discount or lvania inheritance an official assessment will with the PennsY CHECK been or will be reported .and tax paid 0 NE ~ B ^ The above asset has C B L ~ ~ K the estate representative. aid. filed by debts and deductions were p ONLY r I ^ The above informZ land/or1PAR7re~ below. USE ONLY LJ AAF C• I OFFICIAL Complete PART I OF REVENUE tax rate, please state _ PA pEPARTMENT If indicating a different PART to decedent: ACCOUNTS '~ PAD relationship ON JOINT/TRUST - I TAX RETURN - CALCULATION OF TAX I 2 1 _ 1, Date Established $ I 3 LINE 2 - ~ 2. Account Balance 3 X I 4 s, Percent Taxable 4 $ - I 5 G. Amount Subject to Tax _ - I 6 5 _ 5. Debts and Deductions 6 $ 7 Taxable X ~~ ~ 6 6. Amount ~ 7. Tax Rate $ $ CLAIMED g. Tax Due DEBTS AND DEDUCTIONS AMOUNT PAID PART DESCRIPTION PAYEE DATE PAID s on Line 5 of Tax Computation) TOTAL CEnter true, correct and_~ that the facts I reported above ~ ! / ~ ~ ~ / /_'~ ~ ry, I declare belief. HOME ( "7" 7 Under ena ties of Per? k 1 dye an ( ) D AT E th best o,f mY WORK compl to t TELEPHONE NUMBER _.. r„o i.a• ....1 t ~~ Z..i• { Yi (.i.i it+ tt~~ [~\ •° l}.7 ,~ ~ l; r -' ~. n~~ r,,_ ~` i ,,; ~ my r c ~' c °' -d~9 ~,c C`~~ , ~~. `L 7 `• ~- •t k ~ 'TM ~ ~Ln .j .~ fJ ? 4j -' ~ c~.e ~{~. N' ~l r . L~ y^' , +-^. ~ ~ .:aF Y J: ~ ~. ~i