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Home My WebLink About10-14-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: WILSON CAROLYN 20 N FRONT STREET WORMLEYSBURG, PA 17043 -------- fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) N0. CCI 015063 ACN ASSESSMENT AMOUNT CONTROL NUMBER ESTATE INFORMATION: ssN: iss-~2-as~o FILE NUMBER: 211 1-1085 DECEDENT NAME: WILSON PHYLLIS C DATE OF PAYMENT: 10/14/201 1 POSTMARK DATE: 1 0/ 1 3/201 1 couNTY: CUMBERLAND DATE OF DEATH: 09/20/201 1 REMARKS: CHECK# 8307 SEAL 11166255 ~ 5229.32 TOTAL AMOUNT PAID: INITIALS: DB 5229.32 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ;-~, PENNSYLVANIA INHERITANCE ~ INFORMATION NOTICE BUREAU OF INDIYIDUAL TAXES A N D PD BDX 2B0601 ~^.' ,: r,,.~n~ _ ~Va is HARRISBURG PA I~IZS-[fA~i~..,.-~'.'..oEPARtMe~tlFR~/~~e TAXPAYER RESPONSE ``~. .. 1 ,~ r•'~~i '~ REV-1543 ~% ~~RFP ~[05-11) j ` P 1 TAX FILE N0. 21 ~ ~ I - ~~ ~~ ACN 11166255 DATE 10-07-2011 CI_ERa` ~,`~ ~.;. o~~f-~t.,r.~ ~ ,~~~~T CLIh.,",~ ~ ~ - ~,,, ~a CAROLYN WILSON 20 N FRONT ST WORMLEYSBURG PA 17043-1327 EST. OF PHYLLIS C WILSON SSN 188-12-3670 DATE OF DEATH 09-20-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. FU LT ON 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 the above address. Please call 717-787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 1068-33244 Date 02-21-1966 To ensure proper credit to the account, two Established copies of this notice must accompany ACCOUnt Balance ~` 10,728.65 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $` 5, 364.33 months of the decedent's date of death, Tax Rate ~( ~4j deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ 241 .39 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 aricl 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 O N L Y filed by the estate representative. C. ~ The above informs ion is incorrIe~-ct~ and/or debts and deductions were paid. Complete PART 2~ and/or PART LJ below. PART If indicating a different tax rate, please state OFFICIAL USE DNLY ^ AAE relationship to decedent: PA DEPARTMENT DF REVENUE TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established 1 1 2. Account Balance 2 $ 2 3. Percent Taxable 3 X T,a 4. Amount Subject to Tax 4 $ Cl 5. Debts and Deductions 5 - 5 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 7 8. Tax Due 8 $ 8 PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above are true, correct and complete to the best of my knowledge and belief. HOME C`~~7 ) ~?j-~j~~~ 7,3~ ___ WORK (7! 7 ~ 7~b'~/' y'~/O-~~ X20>/ TAXPAYER S G ATURE TELEPHONE NUMBER DATE TOTAL (Enter on Line 5 of Tax Computation) S