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Home My WebLink About11-01-11COMMONWEALTH OF PENNSYLVANIA REV-1162 EX~11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 015157 STONEROAD DIANN S 251 BELLE VISTA DR MARYSVILLE, PA 17053 fold ESTATE INFORMATION: SSN: 774-20-3535 FILE NUMBER: 211 1-1 171 DECEDENT NAME: HUMMELL FLORENCE A DATE OF PAYMENT: 1 1 /02/201 1 POSTMARK DATE: 1 0/31 /201 1 COUNTY: CUMBERLAND DATE OF DEATH: 04/25/201 1 ACN ASSESSMENT AMOUNT CONTROL NUMBER 11160737 ~ 574.91 11160738 ~ 56.53 TOTAL AMOUNT PAID: 581.44 REMARKS: CHECK# 8838 INITIALS: HMW SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS :. ~~ ~~ BUREAU OF INDIVIDUAL TAXES ~ Po Box zmocol peen ~CV'dnTa LIARRISBIlRG PA 17128-0601 DEPARTMENT~~FAEVENUE NEV-1543 E% AFP c05-11) PENNSYLVANIA INHERITANCE TAX 4`,.- t ~IFORMA AND NOTICE FILE N0. 21'I/'ll~f `'r' ~ ACN 11160737 ~;~`'-;,~AXPAYER RESPONSE DATE 09-08-2011 CLERK iCF QRPN~~.~4'S CC',JRT DIANN S STONEROAD 251 BELLE VISTA DR MARYSVILLE PA 17053-9641 EST. OF FLORENCE A HUMMELL SSN 174-20-3535 DATE OF DEATH 04-25-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. PN C 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. 5070080694 Date 01-01-1979 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance 9, 988.00 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax $ 1 , 664.70 months of the decedent's date of death, Tax Rate X .045 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ 74.91 nine months after the date of death. PART TAXPAYER RESPONSE ^~ O FAILURE ~f0 RESPONDS IL~ ~, IN AN OFFICIAdOTAX ASSESSMENT A. I/I The above information and tax due is correct. LJ 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 and C 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 revorted and tax paid with the Pennsylvania inheritance tax return D N L Y filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART ~ and/or PART ~ below. PART If indicating a different tax rate, please state ~~~~~ QFFICI~\~~S~~NL~\.~....~ AAF relationship to decedent: PA DEPARTMENT OF REVENUE TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD 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 1 2 $ 3 X 4 5 6 7 X 8. Tax Due 8 PART 3^ 1 2 3 4 5 ~`~~ b 7 ` 8 DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) 5 Under penalties of perjury, I declare that the facts I reported above are true, correct 'alnld c mple o the f my knowledge and belief. HOME ~ ~~~ ) ~ ~~ ~ 7 \ ~ WORK (1~ ) TAX AYER SIGNATURE TELEPHONE NUMBER DATE i ~-~ ~ PENNSYLVANIA INHERITANCE INFORMATION NOTICE TAX _ I J ~/ /~~ UREAU ~ INDIVIDUAL raxES ~PO eox -10601 ~{~ "' • r• - , - = AND FILE N0. 21 / / HARRISBURG PA 17128-0601 l ,penrtsylvan~ --DEPARTMENT OFREVENUF, ~~ } ~ TAX PAYE R R E S P O N S E ACN 11160738 -- ""~'RfV-1 X43 EX`'AfP (-4+T1')' DATE 09-08-2011 TYPE OF ACCOUNT t> ~, ~~ t~ ( ~~~~'~' ~' Ffi `"~ ~-" EST. OF FLORENCE A HUMMELL ® savlNGs SSN 174-20-3535 ~ CHECKING C~~~~ ~F DATE OF DEATH 04-25-2011 ~ TRUST ORPH,h~~rS ~,~iURT COUNTY CUMBERLAND ~ CERTIF. i ~( Ctl''f°F""'' ~'t'~~~' rid FA REMIT PAYMENT AND FORMS T0: DIANN STONEROAD REGISTER OF WILLS 251 BELLE VISTA DR 1 COURTHOUSE SQUARE MARYSVILLE PA 17053-9641 CARLISLE PA 17013 PN C 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 y0U 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. COMrLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 5030052939 Date 11-04-1992 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance 00 payment to the Register of Wills. Make check 871 " . payable to Register of Wills, Agent". Percent Taxable X 16.667 Amount Subject to NOTE: If tax payments are made within three Tax $ 145 17 ' . months of the decedent s date of death, Tax Rate )( .045 deduct a 5 percent discount on the tax due. Potential Tax Due Any inheritance tax due will become delinquent $` 6 • 53 nine months after the date of death. PART TAXPAYER RESPONSE 0 ~ ~.~~~~ ~ ~~:. FAILURE T RESPOND. WILL RESUL~~ A~~ 0~ IAL TAX SSESSMENT :~~ c~\ A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or return this notice to the Register of Wills and 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 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 fPgD ~OFF~ICIAL USE ONLY ~ AAF PA DEPARTMENT OF REVENUE 1 z $ s X 4 5 6 $ 7 X 8 $ PART 1 2 __ 3._".__.__._._--; __... _- ~ .r 5 6 \\ • ~~ 7 DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above are tru~ey, corre t`~a plete the best of my knowledge and belief. HOME C ~ ~~ ) "(, ~~3~ ~~ DATE TOTAL (Enter on Line 5 of Tax Computation) S _~ ~~ ~~ ~. &~, ~~,' =° fj :f } ii1 •~+.. ~-•. ~.. ~.. ~.,. a :... :.. -.,. ~.. v ~Q ~• ~ ~ -. .--..~ <J 7 ....- ~~~~, ..r. ,, r, J ~ r; ~ ,i ~~, 'ri