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Home My WebLink About12-02-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPi.260801 HARRISBURG, PA 77128-0601 RECEIVED FROM: MCCOY BETH ANN 5 CLEMSON DR CAMP HILL, PA 17011 NO. CD 015301 fold ACN ASSESSMENT AMOUNT CONTROL NUMBER ESTATE INFORMATION: SSN: 158-28-1569 FILE NUMBER: 2111-1310 DECEDENT NAME: MATKOVICH KATHLEEN P DATE OF PAYMENT: 12/07/201 1 POSTMARK DATE: 12/01 /2011 COUNTY: CUMBERLAND DATE OF DEATH: 10/24/2011 11174009 ( 555.33 11174010 ~ 555.33 REV-1182 EXI11-98) TOTAL AMOUNT PAID: REMARKS: SEAL CHECK# 3147 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT INITIALS: HMW RECEIVED BY: 5110.66 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS PENNSYLVANIA INHERITANCE TAX ~~~/O INFORMATION NOTICE FILE No. 21'`~_ BUREAU OF INDIVIDUAL TAXES ~ r PO BOX 2B0601 ~ r'! r Pennsylvania -~~C~~~ ~, ~- D acN 1 ~ 74oa9 HARRISDUR6,PA .17128-0601 DEPAHTMEwT#flEVENUE ~C'1 ! fiA~t'~-~i. RESPONSE ~.~ ~ DATE 11-10=2D;11 REY-1565 EX 11FP (t5-11) '. ~~~aJ '~ TYPE.OF ACCOUNT a.~ll ~~~ ^~ ~~ E5~'~i OF KATHLEEN P MATKOVICH sAvlllss SSN 156-28-1569 GNE.CKING ": ~~ DATE OF DEATH 10-24-2011 ~ "'[~ TRUST ~~~~5 ~~OUHTY CUM$ERLAND ~ CERTIF. a~'Rt,~D ~,~,. ~IIT PAYMENT AND FORMS T0; BETH A MCCOY REGISTER OF WIi.LS , , 5 CLEMSOW DR I COURTHOUSE. SQUARE ,r .. CAMP HILL ~ PA 17011-7619, CARLI&LE PA 17013 .MEMBERS 't ST FCU provided the department with the inforwation below, which was used in calculating the inhlrltance..itax due. RecprA3~lsdiC,ete that et the death of the above-named decedent, you were a point owner/beneficiary of this dtcount. It y0y, pre the. SF01~$e.Ot the decepssEsi pnd:aAy aawupt.other than zero is reflected belol1~~ on the Potential Tax Due line, note no tqx aay be due but ou iust notify thA deppart~ient of your relatlohship to the dbceased by checking Box C in PART 1 below and Writing "sp~buseA in P~RT 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.. - _ _ COhP'LE~E PART 1 BELOW lE SEE ifEVE1~E SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 116947-00 Date 09-29-199.0 To ensure prpper credit to'the account, two Established copies of this notice dust accawosty; ~, Account Balance 7,377.29 Daywegt tp the Reeistpr of Wills: Nako chock payable to "Register of Wills. Aesnt". Percent Taxable X ~ 16:66'7 - NOTE: If tax payaents.are made within three Amount Subject to Tax g 1,229.57 wonths of tlw decedent's data of dasth, Tax Rata X , QYfrj deduct a 5 oirdent'diseount `en" th~'tax duf: ' 55.33' Arpr inheritance taz due wili bteome dRiliPiqusnt Potential Tax Due ~ nine wonths`aftar tl16 date of death. ~. 1 A. The above inforwatioo and tax due is correct: ~ , ' = - ~ Rgit paywent to the ReQiste~ of Wills with two copies of this notice to obtain CHECK' a discount or avoid ;nterest, or returh" thistinetieo to the Register' of Wills and' ONE an official assn;sent will-be issued by the PA Departwent of Rwenue. [ BLOCK ] ,, B. ~ Tha above asset has bean or will be reported and too( paid with the Pennsylvania inheritance tax return ONLY filed by the estate.",reDresentative. C. ~ The above inforR~ion is ieesrrzct and/or debts and deductions ware Daid. - Cowplate PART 2 and/or FA[#T. 3 below. ,. '~ ., ;' a ,.~ 2. ,• ,. ~_.... pA it indicat~tr-0 a different fix rage, please state" ' ~rslatlvnaYlilp tb "doce8on#. .TAX RETURN ~ CI~L,CUkATION OF' TAX ON JOINT/TRUST ACCOUNTS: ~l~~E, 1. Dsto ElsYib'its,bad;. _° ~ -w'1 , ,~, '' 2. AcCOUn~ Balance 2 ~ c ,` "i 4. Amount Subfsct to Tax 4 5. Debts and'Deduetions 5 6..Aaount Taxable 6 $ 7. -.Tax Rats 7 X 8.. Tax, Duo" 8 ~ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT-PAID Under penalties of par~ury, 1< d~csr• that the facts I reported abaVe arp true, oprra¢t"a d cdi.~lste-to the bast of uiY kho-iledge and belief. HONE C'~{~ 1= ~3~1 `~i~. WORE C, ..~ ~ ._.. TA AY S3 NATUR TELEPHONE NUMBER A PENNSYLVANIA INHERITANCE TAX I 6uREAU OF INDIVIDWL TAXES n ~ Y INFORMATAINODN NOTICE FILE N0. 21 "''"` ~ ~-J~IO NARRIS8ZUR66F'A .17128-0601 P~~SY ~' ~1~~~' A ACN 11174010 oEPANTMENT OF u~,'. ~~ ~, inn L;~PAYER RESPONSE REV-1511 E% RF~~'v ••, ~^ ~ Pf~•. DATE l I-10-2011 TYPE OF ACCOUNT ~~~j ~~~ _~ PR ~~ ~ ~ EST. OF KATHLEEN P MATKOVICH ~ $AVIN6S SSN ' 156-28-1569 ^ CNECKING Ci~.ERK (~ DATE OF DEATH 10 - 24 - 2011 0 TRUST //~~OF~HAN~S~~CURT COUNTY _ ,CUMBERLAND. ^ CERTIF. 1a1~~_~1j ~„ ~ REMIT PAYMENT AND FORNS TOc DONALD..... S MCCOY REGISTER OF WILLS 5 CLEMSON DR. 1 COURTHOUSE SQUARE CAMP HILL PA 17011-7619 _ CARLISLE PA 17013 _ ; MEMBERS 1ST FCL- provided the department with the information below, which was used in calculating the inheritance. tax due. Records indicate,thalR-at ,the-de8th of..the above-named decedent, you werea point owner/beneficiary of this account. If you are Lhe Sp~u~e .Of the decea;ed an9 any aarount other than zero is reflected below on the Potential lax Due line, note no tax say be due: but yyou Must notify the e~tartsent of youF relationship to the deceased by checking Box C in PART l below and rrtting "spouse" in PA12T'2. If you believe the information 1s incorrect, please obtain written correction from the Yinancial 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 R`E TERSE SIDE FOR FI~IN6-~PAYI~~1~ INST~tUC~IO~iS~ Account No. 116947-00 Data 09-29-199D To ensure propor~credit to the aeeouot, two .Established copies of this notice Riust aceo*parar Account Balance 7, 377.29 vavment to the Resister of Wills. ` Make check payable to ^Register of Ylills, Ayent^. Percent Taxable X 16 . d67 NOTE: If tax payments are made: within three A~gount Sub9ect to Tax ~ 1 ~ 229.57 months of the decadent'; date of death,:'' Tax Rata )( , 8[+5 deduct a 'S percent discount on tM tsx' due: Aro inheritance 4ax dw dill beeou delifia4ent - POtential 7ax.Due ~' 55.33 nine months after'thi'~date of death. ' PAar _ ;~ ~ AX YE-R ~ SE •. ~, . 0° A; ~)( The above infonstion and tax due is correct. ~G~` Remit psymsn! to tM Ro03sl~.er of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, oF.`'roturn this ngtice'to the Register of Wills end ONE an official assessment will be issued by the PA Department of Revenue.. [ BLOCK B. ~ The above asset has bean or will ba roported and tax paid with tM. Pennsylvania inheritance tax return 0„NLY, filed. by the estate representative. C. ~ The abovq infornation is i~eorr~e and/or debts and deductions were paid. , Complete PART 2 and/or PART 3 below.- " p~~ If'indicatin>a a different tax rata, please state <,5 ra~.aflonsh`!p to deeettahte T~1X't~ilf1~1 - CALCUL~ITION OF TAX: ON JOINT/TRUST ACCOUNTS >. lrINE'"1. Data Established'- ~ „ .1::. _ .. .. _,~ . _ .. ~`, 2. Account Balance.. 2 ~ _~_. __-3..:... ~.. 4. Amount Sublect to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 ~ 7. Tax Rata 7 X $. Tax Due 8 ~ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOt1NT PATD UndeC_pehd;tins,o<f perjury, I dsclarr• that the facts I reported above are true, correct and e e to "th st ^y knowiodpe and belief. HOME C'~t'~' )_'+~~1-~,58~1 ~ ~ =. WORK t ; ) tl ~o ~io~t T R SI NAT RE TELEPHONE NUMBER D~~~. i smdvyn. i g ~ -y3-i 3V5f1 ~,(.~ y~~. fYR ~r LR• ~~ ~~- ~~ . ~ ~~ ~? ~~ f {~,i ~~ t~~ ~: •uN ~+ ~' ~, ~ ~~ ~, ~ ~ ' .~ ~ k, !. C:C L:i.3 Ck1 ~ w, Q ~ + q~ ~.J vJ '~ 0. ttom~.. ~ .C3 C7G ~~~ ~~ ..'+, .~~: .+: ... ...: ,~ w w ti w w w ~... r. +~r i w .s r~ ~ i ~r