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Home My WebLink About12-05-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: BROWN KRISTIN A 228 NORHT RACE STREET MIDDLETOWN, PA 17057 fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: ssN: 204-30-7433 FILE NUMBER: 211 1-0083 DECEDENT NAME: POGUE JUDITH E DATE OF PAYMENT: 12/05/201 1 POSTMARK DATE: 1 2/03/201 1 couNTY: CUMBERLAND DATE OF DEATH: 01 / 1 1 / 201 1 AMOUNT ACN ASSESSMENT CONTROL NUMBER 11003599 ~ 5969.65 TOTAL AMOUNT PAID: REMARKS: CHECK# 474 SEAL 5969.65 INITIALS: DMB RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REV-1162 EX111-961 N0. CD 015287 REGISTER OF WILLS `~ PENNSYLVANIA INHERITANCE BUREAU OF INDIVIDUAL T ~ INFORMATION NOTICE Po eox 280601 ~~ '.. ~pn.hg~{ij jja AND HARRISBURG PA 171za osg ~. oeaARTMENi,dE, NuE TAXP AY E R R E S P O N S E ~,. , ~.• REV-1543 E% AFP (05-11) TAX' ;FILE N0. 21 11-0083 ACN 11003599 jDATE 11-08-2011 EST. OF JUDITH E POGl1E CL~~~ {~~ SSN 204-30-7~i33 ORP~'h.~!'u f~,0,i~T DATE OF DEATH O 1 - 11.2011 G~~~j'~~" fi,yn ~ `~ ~~ COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: KRISTIN A BROWN REGISTER OF WILLS 228 N RACE ST 1 COURTHOUSE SQUARE MIDDLETOWN PA 17057-2242 CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. LINCOLN FINANCIAL ANNUITY 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 y0U 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 PAYMENT INSTRUCTIONS Account No. 924473096 Date O 1 - 11 - 2011 7o ensure proper credit to the account, two Established copies of this notice must accompany Account Balance 86, 191 .33 payment to the Register of Wills. Make check ~` payable to "Register of Wills, Agent". Percent Taxable X 25.000 NOTE: If tax payments are made within three Amount Subject to Tax ~` 21,547.83 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 $ 969.65 nine months after the date of death. PART TAXPAYER RESPONSE AIL E N LL SUi. N A~ FI SRSM T A. The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or return this notice to the Register of Wills and 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. 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 relationship to decedent: TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS EGAD 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 3 X G 5 6 $ 7 X a $ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the 'f acts I reported above are true, correct an/d/ c mplete to the best of my knowledge and belief . HOME C ~ ) ~~~' a~ Jy PAYER SIGNATURE TELEPHONE NUMBER D~ ICI~~ U~ t~LY\~~ PA DEPARTMENT OF REVENUE 1 2 3 _ -- 4 4 5 6 7 IUTAL ctnter on L1ne 5 of Tax Computation) S