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Home My WebLink About11-02-11 (2)COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: REV-1162 EXI11-961 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT LIGHTNER ANNA M 109 COCKLEYS DRIVE MECHANICSBURG, PA 17055 fold ESTATE INFORMATION: ssN: i77-i4-0983 FILE NUMBER: 211 1-1 180 DECEDENT NAME: BOSNJAK THOMAS M DATE OF PAYMENT: 1 1 /02/201 1 POSTMARK DATE: 1 1 /02/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 07/17/201 1 NO. CD 015158 ACN ASSESSMENT AMOUNT CONTROL NUMBER 11150361 ~ 515.67 TOTAL AMOUNT PAID: REMARKS: 515.67 CHECK#1404 INITIALS: DMB SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~ ~ ~ PENNSYLVANIA INHERITANCE TAXI U OF INDIVIDUAL CE INFORMATION NOTICE FILE No. 21 _ ~~_~~~(U BUREA ~ $-, ~ •' yii k~lni r AND Po eox zaocol L € HARRISBURG PA 17128-bd61 pen ~ a t~ ACN 11150361 . -i DEPARTME~TOI~FI~VENUE TAXPAYER RESPONSE DATE 07-28-2011 , ' '~' ` ,1 ~ REV-1543 EX ~AFP (05-I1) '. .ii~_I,-L iii=~4 ~.,, C! E~f~ i~~ ~ 11 ~`~ r~(~ '^'T o. ,rN ,r~. ~...~)~~J: ~ i Cll'`'r;= ~ ! (` ~~ ANNA M LIGHTNER 109 COCKLEYS DRIVE MECHANICSBURG PA 17055 Date 01-21-2005 Established $ 3,571.93 X 50.000 $ 1,785.97 X .045 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST F CU 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 I below and writing "spouse" in PART 2. If you believe the information )s 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. 227908-05 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due $ 80.37 To ensure proper credit to the account, two copies of this notice must accompany payment to the Register of Wills. Make check payable to "Register of Wills, Agent". NOTE: If tax payments are made within three months of the decedent's date of death, deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent nine months after the date of death. PART TAXPAYER RESPONSE FAIL ~TO R O ~WIL I FFIC L S ENT 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 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 reported and tax paid with the Pennsylvania inheritance tax return 0 N L Y filed by the estate representative. -- ---- f~-- -~ ----- C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART ~2 and/or PART 3~ 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 EST. OF THOMAS M BOSNJAK SSN 177-14-0983 DATE OF DEATH o7-17-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 ~~ OFF L USE ,pN1,Y A PA DEPARTMENT OF REVENUE OF TAX ON JOINT/TRUST ACCOUNTS AD 1 3 X 4 5 _ O r,.. 6 7 X ~ C7 8 1 2 , 3 \U f{ ' 5 6 7 \ 8 ~ ~~ ~..~y._> PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) S ~~ °J~C- z~ Un er penalties of perjur I ~lecl re that the facts I reported above are true, correct and ' mplete to th s f y kn 1 dge and belief. Q~i ~ .- HOME C - /~„ WO R K C ) ~/ /~ XPAYER SIGNATURE TELEPHONE NUMBER ATE / ~ 6'6 ~iu, e~C. ~~~ ~u ~1% ~,~t~e ~~~ ~«~ti ~~~ ~~.~ ~~~av l~s~.~~ ~~/. ~ ~ ~~~~ i 7~~ ~~ ~~: iy i~.s~ ~~ ~-~- f~~~. ~~, ~-