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Home My WebLink About12-13-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT RE\/-1162 EX(11-96) N0. CD 015323 MCMICHAEL JEREMY J 2194 CANTERBURY DR MECHANICSBURG, PA 17055 fold ESTATE INFORMATION: ssN: is~-2s-a2ss FILE NUMBER: 211 1-1329 DECEDENT NAME: ZOLTEWICZ LEO DATE OF PAYMENT: 1 2/ 1 3/201 1 POSTMARK DATE: 1 2/12/201 1 couNTY: CUMBERLAND DATE OF DEATH: 1 1 / 1 8/201 1 REMARKS: CHECK# 4959 SEAL ACN ASSESSMENT AMOUNT CONTROL NUMBER 11179759 ~ 52.65 TOTAL AMOUNT PAID: INITIALS: DMB 52.65 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~. ~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 21 1 BUREAU OF INDIVIDUAL TAXES ~ ~` ,~.~ 1 PD BDx 266601 Pennsylvania AND ACN 11179759 HARRISBURG PA 17126-0601 DEPARTMENT OF REVENUE TAXP AY E R R E S P O N S E DATE 12-06-2011 REV-1543 EX AFP f05 -11> TYPE OF ACCOUNT EST. OF LEO ZOLTEWICZ ® SAVINGS SSN 161-26-8236 ^ CHECKING DATE OF DEATH 11-18-201 ^ TRUST COUNTY CUMBERLAND ' yQ "-"` ^-EE~F. :. -u c - REMIT PAYMENT AND FORMS T0: I-n .L.. (7 ~.,'3 JEREMY J MCMICHAEL REGISTER OF WILLS -''~.:' __ 2194 CANTERBURY DR 1 COURTHOUSE SQUARE `~~~? G MECHANICSBURG PA 17055-5767 CARLISLE PA 17013 ;"~`.~'`` -,,. t_.1 ., --l7 ~, 3, ~ ~ l.v) t"r"I - R _~ MEMBERS 1ST FCU 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 PAYMENT INSTRUCTIONS Account No. 214407-0 0 Date 02-20-2002 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 $ 352.82 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax $` 58.80 months of the decedent's date of death, Tax Rate X .045 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential T0X DUe $ 2.65 nine months after the date of death. PART TAXPAYER RESPONSE ~OIiI~ i~iL OF L T SMENT A. ~Fhe above information and tax due is correct. LuJ Remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or return this notice to the Register of Wills and CHECK an official assessment will be issued by the PA Department of Revenue. C 0 N E ~ 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 inforna ion is incorrect and/or debts and deductions were paid. Complete PART 2~ 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. Date Established 1 2. Account Balance 2 $ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 X 8. lax Due 8 '~~~I1L U LY~ ~ AcA~ PA DE3'AitTMEN3. OF REVENUE ~ AD i 2 5 \~ 6 7 r..~ . PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above are true, cor`r1ect and ca plete to the best of my knowledge and belief. HOME C 7~7 ) 7%--i0~5 ~~~/~°~iG~~~ WORK C ?~? ) ~~- Dlc:~,S 6Z-6l-~' TA AVER S GNATURE TELEPHONE NUMBER DATE TOTAL (Enter on Line 5 of Tax Computation) 8