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Home My WebLink About11-07-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: WOLF PHILIP BRACKEN 124 RADER AVENUE COGAN STATION, PA 17728 fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX111-961 NO. CD 01 5172 ACN ASSESSMENT AMOUNT CONTROL NUMBER ESTATE INFORMATION: ssrv: 199-34-9504 FILE NUMBER: 211 1 -0970 DECEDENT NAME: WOLF ROGER ANDREW DATE OF PAYMENT: 1 1 /07/201 1 POSTMARK DATE: 1 1 /04/201 1 couNTY: CUMBERLAND DATE OF DEATH: 08/07/201 1 REMARKS: CHECK# 3353 SEAL 11502644 ~ 5660.54 TOTAL AMOUNT PAID: INITIALS: DMB RECEIVED BY: 5660.54 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 ~~ ; ~; ~~ 'REV-I543P..AF.~ (]-00) INFORMATION NOTICE AND TAXPAYER RESPONSE FILE N0. 21 11-0970 ACN 11502644 DATE 11-03-2011 n; L i n r- 'v r 1 ~ C'~F'~-' C, J1 F - ~ .:~~T `~ ~~~ r HEATHER A LEBLANC 248 RIDGE RD COGAN STATION PA 17728-9734 TYPE OF ACCOUNT EST. OF ROGER A WOLF ^ SECURITY S.S. N0. 199-34-9504 X^ sEC ACCT DATE OF DEATH 08-07-2011 ^ srocK COUNTY CUMBERLAND ^ eoNDs REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 AMERIPRISE has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a beneficiary of this asset. If you feel this information is incorrect, please obtain written correction from the transfer agent, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. puestions may be answered by calling (717) 787-6327. --- COMPLETE PART I BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 000027213776102 To insure proper credit to your account, two (2) copies of this notice must accompany your DOD Valuation 9,270.64 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 4, 635.32 (3) months of the decedent's date of death, Tax Rate X 1Fj you may deduct a 5i discount of the tax due. Any inheritance tax due will become delinquent Potential TaX Due 695.30 nine (9) months after the date of death. PART TAXPAYER RESPONSE 1^ FAILURE TO RESPON~ WILL RESULT IN AN OFFICIAL TAX ASSESSMENT`BASED ON TNIS NOTICE C H E C K 0 N E BLOC K ~ 0 N L Y A. ~he above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice t:o the Register of Wills and an official assessment will be issued by the PA Department of Revenue. g. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ^3 below. PART If you indicate a different tax rate, please state your OFFiCLAL USE ONLY ^ AAF relationship to decedent: PA DEPARTMENT OF REVENUE TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSET(S) PAD LINE 1. DOD Val uation 1 1 2. Percent Taxable 2 X 2 3. Amount Subject to Tax 3 _ ~ 3 4. Debts a nd Deductions 4 - 4 5. Amount Taxable 5 5 6. Tax Rat e 6 X 6 7. Tax Due 7 7 PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reporte_d/Jabove//~~``,,re true,, correct and co plete to the best of my k wle a and belief. HOME C ;SSG') ~7~-Q'~,-: `f %(„~ WORK ( ) t~/UD/2C}/~ XPAYER SIGN RE TELEPHONE NUMBER DATE r ~~;,~ ~° "° ~ r '„'. ia.. L- ~'". h- PN k 574.x+5 .i;.. r'~ Y:. r~y ~ ~ Pu ~'. ti ~ c~° M O ~ Ca ~ o. ~ r Z a w ~>~ g a.~ e~ m g ~~ c ',~~u _-t ~ ~ e ~ .. ~ f t r4 , ~ ~ ~'•S n ~~ ti, T G~_~\i ~ -~.