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Home My WebLink About11-03-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: DOMINIC PATRICIA A 3506 VILLAGE GREEN DR ROSWELL, GA 30075-4056 fold REV-1162 EX~11-961 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: ssN: ass-2o-4027 FILE NUMBER: 211 1-1 185 DECEDENT NAME: MCSHERRY WILLIAM R DATE OF PAYMENT: 1 1 /03/201 1 POSTMARK DATE: 1 0/31 /201 1 COUNTY: CUMBERLAND DATE OF DEATH: 09/23/201 1 ACN ASSESSMENT CONTROL NUMBER NO. CD 015163 AMOUNT 11166432 ~ 589.94 TOTAL AMOUNT PAID: REMARKS: 589.94 CHECK# 5542 INITIALS: DMB SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~... ~'( BUREAU OF INDIVIDUAL TAXES ( ` PD eox z8o6ol pennsylVanl~ HARRISBURG PA 17128-0601 DEPARTMENT OF REVENUE REV-1543 E% RFP (05 -11) PENNSYLVANIA INHERITANCE TAX l ~, ~-r- ~.NF~R~TION NOTICE FILE N0. 21 1~- ~\~ AND ACN 11166432 - -~ TAX+I~~YER RESPONSE DATE 10-07-2011 TYPE OF EST. OF WILLIAM R MCSHERRY CLEEsK C~~ SSN 166-20-4027 ~RpF(~N~~ vi~li+~T DATE OF DEATH 09-23-2011 (;tJ~~~~ l:~~,,~:n i;~1`~ P~ COUNTY CUMBERLAND ~Omc~~~L REMIT PAYMENT AND FORMS T0: PATRICIA DOMINIC~ REGISTER OF WILLS 3506 VILLAGE GREEN DR 1 COURTHOUSE SQUARE ROSWELL GA 30075-7649 CARLISLE PA 17013 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 Sp0U5e 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 PAYM~EhFT-~NST-RI~CTIONS Account No. 7388-42 Date 12-28-2004 To ensure proper credit to the account, two Established copies of this notice oust accompany payment to the Register of Wills. Make check Account Balance $` 39,972.69 payable to "Register of Wills, Agent". Percent Taxable X 5.000 NOTE: If tax payments are made within three Amount Subject to Tax ~` 1 , 998.63 months of the decedent's date of death, Tax Rate )( .045 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential TaX Due $` 89 • 94 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPONI..WILL RESULT IH N OFFICIAL TAX ASSESSMENT 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 an official assessment will be issued by the PA Department of Revenue. C ONE 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 TAX If indicating a different tax rate, please state relationship to decedent: RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 2. Account Balance ,,. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due 1 2 $ X 4 5 - 6 '~ 7 X 8 OFFi~~IAL USE ONL~~~~[~ AA PA DEPARTMENT OF REVENUE '" PAD 1 ~.W. 2 3 4' 5 6 7 \ 8 PART DEBTS AND DEDUCTIONS CLAIMED ^8 DATE PAID PAYEE DESCRIPTION AMOUNT PAID U r penalties of perj y, I declare that the facts I reported above ar7e/~trueQ(~co}rrect/ and ~~~~yFf-f--/-F- comp a to` the best/Jof knowledge and belief. HOME C~/~/ ) 7%G "(i~S~~ ~~~~ /~1///'"_ ~ W O R K C 7 7O ~ .S~ ~ ~ ~Z ~ Z _~~~12~~ TAXPAYER SIGNATURE TELEPHONE NUMBER AT ~~ TOTAL (Enter on Line 5 of Tax Computation? s ~ ~ ~ {1$A RST~LA55 F(~,REVE f i ?:, ;. ~ f t . ~ i . ~j` ~ ~` J .1. { s. . ,~ ~`~ ;Y p.. +~' n.:. ~ f. fY I '~ Y'; ~~i. ' _ j Y :J :, ~Y .'~ ~ VV ~ ~ ~ ~ w~ f!. b \ ~ti ~~ q 3~{ ~ )1( {{ !~i ..~.. 1,„1 1~~ 1.,•a ~~