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HomeMy WebLinkAbout10-13-11CO"/1MONWEALTH OF PENNSYLVANIA DEF'AR`MENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HAFIR158URG, PA 17128-0601 RECEIVED FROM: REV-1162 EX(11-96) PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 015058 SICO DANIEL 844 ALLENVIEW DR MECHANICSBURG, PA 17055 ---'--- fold ESTATE INFORMATION: FILE NUMBER: DECEDENT NAME: DATE OF PAYMENT: POSTMARK DATE: COUNTY: DATE OF DEATH: SSN: 109-20-8934 2111-1081 SICO LUCILLE C 10/13/2011 10/12/201 1 CUMBERLAND 09/08/2011 REMARKS: ACN ASSESSMENT AMOUNT CONTROL NUMBER TOTAL AMOUNT PAID: CHECK#1003 INITIALS: HMW SEAL RECEIVED BY: 5426.32 GLENDA EARNER STRASBAUGH REGISTER OF 'WILLS REGISTER OF WILLS ~~~~~~ '~ PENNSYLVANIA INHERITANCE TAX BUREAU DF INDIVIDUAL TAxES ~~ INFORMATION NOTICE Po sox 2eocol pe~tfsy-tvana -~'.;F. 0~ AND FILE N0. 21 -~~' /~~/ HARRISBURG PA 17128-0601 DE PAR~NfENr OF REVEN UE ~.~~~ ~ n TAXPAYER RESPONSE ACN 11163457 REV-1f 5_43 E% pFP -(05-11) ~ v~J DATE 09-27-~n1I ' ti=~6 I: F {4~ ~.: ~ EST. OF LUCILLE C SICO C1Cr~~ f1r SSN 109-20-8934 ORp~,~P~.~ ,`J~~J,~; DATE OF DEATH 09-08-2011 C~~~~~~~~, ~:,~,~ ~~-n, ~~ COUNTY CUMBERLAND DANIEL SICO REMIT PAYMENT AND FORMS T0: 844 ALLENVIEW DR REGISTER OF WILLS MECHANICSBURG PA 17055-6183 1 COURTHOUSE S(~UARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS © CHECKING TRUST CERTIF. FULTON BANK NA ecords indicate that at the death of the above-named decedent, you were a provided the department with the information below, which was used in calculating the inheritance tax due. deceased and any amount other than zero is reflected below on theDPotentialb Tax~DueylinehlnoteDno taxlmay be due, but notify the department of you are the spouse of the t your relationship to the deceased b y checking Box C in PART 1 below and writing spouse" in PART Zust If you believe he 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 717-7g7-g327 with questions. CUMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 3624-75525 Date 03-22-2011 Established To ensure proper credit to the account, two Account Balance copies of this notice must accompany $ 9,972.31 payment to the Register of Wills. Make check Percent Taxable X payable to "Register of Wills, Agent". Amount Subject to Tax 100.00 9,972.31 NOTE: If tax payments are made within three Tax Rate X months of the decedent's date of death, Potential TaX Due 15 deduct a 5 percent discount on the tax due. $ 1 , 4 9 5.8 5 Any inheritance tax due will become delinquent PART nine month:: after the date of death. 1~ TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT A• ~ The abov e information and tax due is correct C H E C K Remit payment to the Register a di . of Wills with two copie scount or avoid interest, or return th s of this notice to obtain C 0 N E an official assessment will be is issued b th notice to the Register of Wills and BLOCK y e PA Department of Revenue 0 N L Y B ~ The above asset has been or will b e . reported and filed by the estate representati tax paid with the Pennsylvania i ve . nheritance tax return C• ~ The above informs ion is incorrect and/or debts and deductions were paid. lll"""-""' Complete PART 2~ and/or PART ~ below. PART If indicat;nn ~ a:~~___ relationship to decedent` ~d~,~lease state TAX RETURN - CALCULATION LINE 1. Date Established 2. Account Balance S. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX 0 JO NT/TRUST ACCOUNTS 1 3~v7uZ ~i i OFFICIAL USE ONLY ~ AFA AA DEPARTMENT OF REVENUE PAD 1 2 3 4 5 6 7 8 2 3 X 4 ~` .~ y~ ~ i ~y~3~7~ ~- ~ ~ Ci ~/ s $ yam( ~ DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION TOTAL (Enter on Line 5 of Tax Computation) Under penalties of $ perjury, I declare that the facts I reported above are true, correct and c to to the bes~f my knowledge and belief. 1 7! 7 ~ ~~~ ~ /~: HOME ( -) a~ ~ -- I XPAYER SIGNATURE WORK ( ~ DATE DATE PAID PAYEE L ~ W 1 S ' '"' F- Y ~ _ ~O ~ L~~ N ~ N ~N, a~no~V~.~ ~~ via ~_'_ = i ~~ o ~ = o 2~ 1 f OAT 13 P;~~ I;~ ~ Ci I - _- _~ -- ~ M F RK OF CI ~ = o _ _ _ -.. °~y '= _~_ _._-- ~; `, PA C w y I, n , ~ W J 7 0 ~ ~~ ,,~ 6 .~...~ m - cr ` ~ ~ ~ ~ 1" ~ _ _ ______- m ,._, _ ~ C~ ~ ~ ~~ ~-~-- - m ~ .~ ~~ mo ~ Q' o o ~ ~ s a ~ I ~ ~- ~ J~ t`'l tj~ ~ ~, v° ~ ~_; , o ,.~ : ~:~ 0 `+ v !., 4 [~- ~ ~.. .r..i M ~_ 0 ~¢ Qa on o~~~ ~ ~_ '~ ~ Q ~ ~ ~ Q 60 i r ~~~~`~ J.~ ~~ 4~~ ;~~ ~~~