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Home My WebLink About11-18-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE. BUREAU OF INDIVIDUAL TAXES DEPT. 280801 HARRISBURG, PA 17128-0801 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DUPLICATE CLAY TERRY L 1485 HUNTLEY CT YORK, PA 17404 fold ESTATE INFORMATION: SSN: 168-24-4270 FILE NUMBER: 2111-1140 DECEDENT NAME: SIMMONS CAROLINE R DATE OF PAYMENT: 1 1 / 18/201 1 POSTMARK DATE: 1 1 / 17/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 10/ 16/2011 REMARKS: SEAL CHECK# 1 149 ACN ASSESSMENT CONTROL NUMBER REV-1182 EX111-961 NO. CD 015220 AMOUNT 11 170329 ~ $1,948.86 TOTAL AMOUNT PAID: S 1,948.86 INITIALS: HMW RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU Of INDIVIDUAL TAXES PD BDX 288601 pennsylV~ania HARRISBURG PA 17128-0601 OEPAgTMENT OF EVENUE REV-154; EX AFP (ti5.71) PENNSYLVANIA INHERITANCE T INFORMATION NOTICE AND TAXPAYER RESPONSE FILE N0. 21''I~~ I'~ ACN 11170329 DATE 10-26-2011 TYPE OF ACCOUNT LOI ~ ~~ i ~ ~ ' ' + `'" "~ EST. OF CAROLINE SIMMONS Q savlNSs SSN 168-24-4270 Q.tNECKINs ~'~ ARK OF DATE OF DEATH 1,0"r 1 f - ~`Q 11~.:, Q TRUST C;~1 .." ~~,(~hCO~iltr~ COUNTY. CUMS~RLA~1D, ~ CERTIF. C11~?~',' ' V-V~{L1 CO., i"A REMIT PAYMENT' AND FORKS T0: TERRY CLAY REGISTER.. OF ,wILI-«5, 1485 HUNTLEY CT 1 COURTHOUSE SQUARE' ,` YORK PA 17408-4440 CARLISLE PA 1T013 MEMBERS 1ST FCU provided the department with the information below, which was used in calcuLattnO the inheritance tex due. Records indicate that at the death of the above-named decedent, you were a point owner/beneficiary of this account. If you are. the .spouse Of the deceased and any amount other than zero is reflected below on the Potentlal Tax Due line, note no tax wtay be due. but yyou ^ust nottty the department of your relationship to the deceased by checking Box C in PART 1 below and wrlting "spoust"`in ~A'RT 2. If yyou believe the information is incorrect, please. obtain written correction from the financial institution, attach 8 copy to this-form and return it to the above address. Please call 717-787-8327 with questions. . - ~COl~RL€TE PART 1 BELOW * SEE'R'EYBI~SE tIDE FAR FI{.ING -AND ~PAYMfNT INSTRU&TI9NS Account No. 356509-41 Date 0 5-1 2-2009 To ensure proper credit to the sccount, two Established ,copies of this notice oust seeompsrgr payment to the Register of wills. Make check Account Balance 86, 615 .97 payable to ^Reeister of Wills, Agent^. Percent Taxable X 50 .000 NOTES If tax pa~rmanta are made within three Amount Subject to Tax $ 43, 307 .99 months of the decedent's date of death, Tax Rate ~( , Q({5 doduct a 5 percent discount on the toot duo. Argr inheritance tax due wil'1 become delinquent Potential Tax Due $ 1, 948 .$6 nine monthsaft~r the. date of death. ,, . . PaT , T ~? YER ' R SP NSE x~, ~ - . , ., •. . .. ue~,.~ ;.: < , A: They above inforidtiop and tax dpi~is tornct. `'-•` ~ i • ~" r , "R~mit payment to the Register ~-f..W~~l! wYth 4wo copies af; this- ootiu.too9hi~ain. C~EOK s discount or aVasd in#~i~st.. or re °Ei)u•~wotae to the Reeftter of Wills and' an officiaRt='a~`seasR~~n't wall be isaud~by'the PA Dapartae,Pt of Revenue. NE' [ BLOCK B. ~ The"above asset has been or will be reported and tax paid with the"Pennsylv6nib inheritance tax return ONLY filed by tn. estate representative. C. ~ The above info ion is incorr c and/or debts and deductions were paid. Complete PART ~ and/or PART 3~ below. PART If indicating a different tax rate, please state relationship to decedent: TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Data Established 1 2. Account Selangor 2 ~ 4. Amount Subject to Tax 4 5. Debts. and Deductions 5 - 6. Amount Taxable 6 ~ 7. Tax Rate 7 ~ 8. Tax Due B ~ PART DEBTS AND DEDUCTIONS 'CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEntsr on Lina b of Tax 'CofAputaitionl t , Under penalties 'a 'perdu I declare"that the facts-I reported aboro ~a~e'+true; corract~and " complete to the ba Y nowladge and belief. HOME C 1:~~ _) ~2'.~Z7• woRK c '?~~ ~ '1S'~ - ~F~3Z DATE i+`' ,hi ~../ 1Af W .wrr. r w Mlb~ W w i RYA. 4n a/M~ ~, w ~. w M~+^ .r r r w ..r w.+ 'w ~ _ ~'. -7,7 ,~ ~ r. c ' c i.' ~ -.,~ ,41~ '' F .+^' Li ,..per (,~. 4 ~?:,.. `l V -'a ' ^~ ~~ }} ~. ~ ~ ~ 't~ }~.. ~F G ~J to ~ r ~ ~ ~ , ~a ~. t, ~ ~ ~3 r. _ `J G ~ ~ ~ ~ s. ~~ ~ V ~ _ ~v ~~ 1~ ~ y ^ "' ~ t ';1~ .~F _9. r V LL r~. ~1 r-~-