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Home My WebLink About11-28-11FILE NO. 21 - ~,~~ ~~ BUREAU OF INDIVIDUAL TAX~S.~~ (~~ Po aox 2ao6o1 ~D ~/ ACN 11174889 HARRISBURG PA 17128 0601 ., oEpnR7MENTOF.gE~{E.1,uE TAXPAYER RESPONSE DATE 11-15-2011 REV-1543 EX ~FV (05-11) `i,~ c~ F! ~. „\ ~~. ,~ „~:? P, ELIZABETH V SWINGLE APT 3106 5225 WILSON LN MECHANICSBURG PA 17055-6668 EST. OF ELIZABETH V SWINGLE SSN 205-09-9634 DATE OF DEATH 09-13-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. CITIZENS BANK OF PENNSYLVANIA 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 ownerlbeneficiary 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 Delow 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. 6140804914 Date 08-13-2001 To ensure proper credit to the account. two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance $` 7 ~ 101.19 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are wade within three Amount Subject to Tax g 3,550.b0 months of the decedent's date of death. Tax Rate X , 15 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ 532.59 nine months after the date of death. PART TAXPAYER RESPONSE A t1R~ i"14 ~~b~' 0 XL~ ESU'L1 ; 1K - OF 3 ~ .TAX ~ ~5Sl~1ENT A. ^ The above information and tax due is correct. Remit payment to the Register of Wills with two c opies of this notice to obtain CHECK a discount or avoid interest, or return this noti ce to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. C 0 N E ~ ~ BLOCK B. 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 ~ OF~i°CIAL 4~5~~,~O1~L ~ ^ AAF 2 relationship to decedent: PA DEPARTMENT OF REVENUE TAX RE TURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS `'PAD LLNE 1. Date Established l 1 2. Account Balance 2 ~ 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ !+ 5. Debts and Deductions 5 S 6. Amount Taxable 6 $ (, 7. Tax Rate 7 X 7 8. Tax Due 8 $ 8 PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above are true, correct and complete to the best of my knowledge and belief. un-ar i ~1~ ~ At1Cl_ ~fJ ~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE ~~~`~~~~~ AND TOTAL CEnter on Line 5 of Tax Computation) S GOMMONW EALTH OF PENNSYLVAN{A DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT, 280601 HARRISBURG, PA 17125-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 015251 KELLER MICHELE R 1059 COUNTRY CLUB ROAD CAMP HILL, PA 17011 fold ESTATE INFORMATION: ssnl: ~s4-28-ai4i FILE NUMBER: 2110-0757 DECEDENT NAME: KELLER E ROBERT DATE OF PAYMENT: 1 1 /28/201 1 POSTMARK DATE: 1 1 /25/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 07/ 13/2010 REMARKS: RECEIPT TO ATTY CHECK# 501 1 SEAL ACN ASSESSMENT CONTROL NUMBER REV-1162 EX111-961 AMOUNT 101 ~ 5712.00 TOTAL AMOUNT PAID: 5712.00 INITIALS: DMB RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS JEROME J. McDONALD Attorney at Law 14 W. Christopher Ct. Phone (717) 566-2127 Hummelstown, PA 17036 Fax (717) 5b6-2127 November 25, 2011 Register of Wills Cumberland Countv Courthouse 1 Caurthouse Square Carlisle, PA 17013-3387 Re. E. Robert Keller Estate No. 21-10-0757 Dear Register, Enclosed you will find check No. 5011, in the amount of $712.00, in payment of the inheritance tax and interest due on the above referenced Estate. Please call if you have any questions. Very Truly Yours, ~~~~ rome McDonald Cc. Michele Keller Y _ rr ~-1 C _ « f '"1 (\ 7 t . f' .. ;: ~ _. -l ~l~ _.__. I1 ~• L~ T7 P+ Iv1 M• (D ii? t,? t~ N 1 1 ~. o ,~ UCDo ~ ~ ~ ~. ~ ~ a ~ ~ ~ ti ~ Q, _O ~ O ~ ~, w ~~~' v' W (~ `< ~ O V ~, ~. ~" O CD ~ ~a~ ~~~o o~~m ~~~~~ o~ a~ ~b o~ z w ~ r b $:. c°s w.± "'s r ~., ~. ,ti, `h`r ~ Lr~~ ~~:y` ,t~ ~~~ ~' Gsr W 2'~vr f~-~ .:ji ~y `Y', ~~ ~:~ •sM r