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Home My WebLink About10-14-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: SULLIVAN JERRY J 28 KENSINGTON DRIVE CAMP HILL, PA 17011 told ESTATE INFORMATION: FILE NUMBER: DECEDENT NAME: DATE OF PAYMENT: POSTMARK DATE: COUNTY: DATE OF DEATH: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SSN: 577-14-2125 2111-0345 SULLIVAN MAURICE M 10/14/2011 1 011 4/201 1 CUMBERLAND 02/15/2011 TOTAL AMOUNT PAID: REMARKS: JERRY SULLIVAN CHECK#111 SEAL INITIALS: WZ RECEIVED BY: REV-1162 EX111-961 NO. CD 015062 526.64 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ACN AMOUNT ASSESSMENT CONTROL NUMBER REV-1162 EX(11-96) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDU AL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: SULLIVAN JERRY J 28 KENSINGTON DRIVE CAMP HILL, PA 17011 ________ ,o,d ESTATE INFORMATION: FILE NUMBER: DECEDENT NAME: DATE OF PAYMENT: POSTMARK DATE: COUNTY: DATE OF DEATH: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SSN: 577-14-2125 2111-0345 SULLIVAN MAURICE M 10/14/2011 10/ 1412011 CUMBERLAND 02/ 15/ 201 1 TOTAL AMOUNT PAID: REMARKS: JERRY SULLIVAN CHECK# 110 INITIALS: WZ RECEIVED BY: SEAL N0. CD 015061 51,261.09 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ACN AMOUNT ASSESSMENT CONTROL NUMBER ________ U OF INDIVIDUAL TAXES ~~'' BURSA pennsyC~ania PO BOX 280601 f HARRISBURG PA 17128-06 01 DEPARTMENT C)F'REVEb1UE~ REV-1543 E% RFP (OS-111 ..., i ~ a~I~M PENNSYLVANIA INHERITANCE TAX FILE N0. 21 11-0345 '%~FORMATION NOTICE ~' ~ AND ACN 11166225 ,.c `'~AXPAYER RESPONSE DATE 10-06-2011 ~. ,1' ,. ~ E CA ., ~,n. ~~~ )~T , JERRY J SULLIVAN 48 KENSINGTON DR PA 17011-7912 CAMP HILL EST. OF MAURICE M SULLIVAN SSN 577-14-2125 DATE OF DEATH 02-15-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. ouse of the provided the department with the information below, which was used in calculating the inheritanOU mUStue. SOVEREIGN BANK note no tax may be due, but y ouse" in PART 2. Records indicate that atn~eO h P thanezeroeisareflectedtbe edwb°echeckingnBoxlbCTin, PARTllnbelowcandnwritingo spre a sp deceased and any amou attach a copy to this form and return notify the department of your relationship to the deceas Y If you believe the information is incorrect, please obtain written correction from the financial institution, it to the above address. Please call 717-787-8327 with questions. -.- nri nisi * SEE REVERSE SIDE FOR FILING AND PAYMENT IFiSTRUCYI0NSn1nt. two COMPLt ~ t rr~n ( ..__--- Date 01-26-1999 _.._ _-- To ensure Drover otice must accomvanY Account No. 1671014685 tabli E shed copies of this n payment to the Register of Wills. Make check t" s 56 ~ 048.66 . Davable to "Resister of Wills. Agen Account Balance X 50.000 NOTE: If tax vayments are made within ree f death Percent Taxable 024.33 28 , months of the decedent's date o nt on the tax due. Amount Subject t0 TaX $ ~ 15 deduct a 5 Dercent discou itance tax due will become delinquent Tax Rate X 4 ~ 203.65 AnY inher nine months after the date of death. Potential Tax Due TAXPAYER RESPONSE PART RESULT IN AN OFF ICIAL TAX ASSESSMEN FAILURE TO RESPOND WILL A. CHECK ONE C BLOCK B ONLY C ^ The above information and tax due is correct. Remit vayment to the Register of Wills with t.wo copies of this notice to obtain a discount or avoid interest, or return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. The above asset has been or will be reDOrted and tax Daid with t:he Pennsylvania inheritance tax return sled by the estate representative. ~he above informs ion is incorre3t belowr debts and deductions were paid. Comvlete PART ~ and/or PART FFICIAL USE ONLY ~ AAF If indicating a different tax rate,~D~le~se state 0 Pe nEPARTMENT DF REVENUE PART relationship to decedent: / /TRUST ACCOUNTS JOI - PAD TAX RETURN - CALCULATION OF TAX ~ ON 1 - LINE 1. Date Established 1 $ 0 - / / ~~P 1O 2 - 2. Account Balance 2 X 1 d /~~d (~ 3 - 3. Percent Taxable 3 $ ~ ~~~ D ~ 4 _ 4. Amount Subject to Tax 4 :..~..~iri ~~/l'~ 5 , 5. Debts and Deductions 5 $ 6 , 6. Amount Taxable 6 7 X ~ - Q-/ 7 & 7, Tax Rate $ y r ~ g. Tax Due $ ~ ` ' DEBTS AND DEDUCTIONS CLAIMED PART DATE PAID DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I repor HOME ~ ',~~t , e, ~`~Q / ~~ com t to the e t~j may ~owl~dge and belief . 10 /.Z2~~~ !/ v`~/' ~~ WORK C ~ TELEPHONE NUMBER