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Home My WebLink About12-16-11COMMONWEALTH OF PENNSYLVANIA REV-1162 EX111-961 DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 015346 MAY FRANCES T 67 DORY LANE CLAYTON, NC 27520 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- folE ESTATE INFORMATION: ssN: 2a3-3o-2507 FILE NUMBER: 211 1-1343 DECEDENT NAME: MAY GRAHAM H DATE OF PAYMENT: 1 2/ 1 6/201 1 POSTMARK DATE: 12/14/2011 COUNTY: CUMBERLAND DATE OF DEATH: 07/01 /201 1 TOTAL AMOUNT PAID: 11158768 ~ 516.54 11158770 ~ 54.69 REMARKS: FRANCES MAY 521.23 CHECK#1122 INITIALS: WZ SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS , ti BUREAU OF INDIVIDUAL TAXES Po Box 26gco1 HARRISBURG PA 17128-0601 ~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 21 _ !/- /3y~ en~~'TIr~f/'y~l_~'"~ ~}''~'~j~'B'~(~. AND ACN 11158768 iPARTPiERT CF`AEVENbE '~~~}~~ "'I AXPAYER RESPONSE DATE OS-30-2011 REV-1543 ~iFP :,'[03j-~!~~ '~~t ~,_J ''! 1 ~~C ~ ~ f ~ f~~ Jb C~~RK ~~ QRPHa.N'S ~O~RT CIJ~~P,~"" ,~P ~ '~~` PA FRANCES T MAY 67 DORY LANE CLAYTON NC 27520-4452 EST. OF GRAHAM H MAY SSN 243-30-2507 DATE OF DEATH 07-01-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FLU Drovided the department with the information below, which was used fn calculating the inheritance tax due. Records indicate that at the death of the above named decedent, you were a point owner/beneficiary of this account. If y0U are the SpoUSe of Lhe deceased and any amount other than zero is reflected Delow on the Potential Tax Due tine. note no tax may be due. but you must notify the department of your relationship to the deceased by checking Box C 1n 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 farm and return it to the above address. Please tali 717-787-8327 with Questions. COMPLETE PART 1 BELOW iE SEE REVERSE SIDE FDR FILING AND.PAYMENT INSTRUCTIONS Account No. 8751-00 Date 08-31-1966 7o ensure proper credit to the account, tvo Established copies of this notice Bust accoeparry punt to the Register of Wills. Make check Account Balance $ 2, 205.24 payable to "Register of Wills. Agent". Percent Taxable X 16.667 NDTEI If tax paysents are aada within three Amount Subject to Tax $ 367.55 aonths of the d¢cedent's dat• of death. Tax Rate )( .045 deduct a 5 percent discount on the tax due. Any inheritance tax due will Decoae delinquent Potential Tax Due $ 16.54 nine months after the date of death. PART TAXPAYER RESPONSE CHECK ONE [ BLOCK ONLY above inforoation and tax due is correct. Remit payaent 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 an official assessment will ba issued by the PA Department of Revenue. B. ~ The above asset hes bean or Mill be reported and tax paid with the Pennsylvania inheritance tax return filed by the estate representative. C. ~ The above into PART l C t a Son is incorr et and/or debts and deductions ware paid. ~ and/or PART 3~ below e omp e . PART If indicating a different tax rate, please state to decedent: relationshi p TAX RE TURN - CALCULATION OF TAX ON JOINTlTRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 $ 3. Portent Taxable i X 4. Amount Subject to Tax 4 $ 5. Debts and Doductions 5 6. Amount Taxable 6 $ 7. Tex Rate 7 X 8. Tax Due 8 $ PART DEBTS AND DEDUCTIONS CLAIMED DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above /y ru eL, (pmt complete io the bast of m~yyknowledge and belief. HOME C~/ ~ ) J~p' ~V /~ -\ ~~!/ > >q,c~ WORK C ) li-'I ~~ ~ ,N~ 7~t ER SIGNATURE TELEPHONE NUMBER DATE "1i BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 ~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE NO ~ennsyl ~ AND AcN DEPARTMENT OF E f ' ""r ify~-~AYER RESPONSE REV-la4i E%~FP <~Cl{1... , : .-. `~~~ ~ `., DATE 21 -~I - // /~ 11158770 08-30-2011 :` ~ I I E.iw.~ C E1 F~ (~: ~~ EST. OF GRAHAM H MAY SSN 243-30-2507 CI.ER~; C~ DATE OF DEATH 07-01-2011 ORPHAN ~ CJURT COUNTY CUMBERLAND Cl1~~P~--,,. H~` ~ +`i'1 nA RENIT PAYMENT AND FORMS TD: FRANCES T MAY L~ r'li REGISTER OF WILLS 67 DORY LANE 1 COURTHOUSE SQUARE CLAYTON NC 27520-4452 CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. 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 ere the 5pou5e of the deceased and ppang amount other than zero 1s reflected De1oW on the Potential Tax Due line, note no tax may be due, but yAou must If youybelh eveethert n~ormatfon~srinco aect~please obtain weG tte ed oryect on kfrom Bhe Cnanc aARins tit ut~an aatta h ai ~opyt to0this'form andTr turn it to the above address. Please tall 717-787-8327 with questions. COMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 8751-11 Date 09-15-1980 7o ensure proper credit to the account, two Established conies of this notice must accomvany Account Balance ~ 6 2 5. 8 9 payment to the Register of Wills. Naka check '• payable to Reeister of Wills, A6ent•'. Percent Taxable X 16.667 Amount SubjOCt to Tax ~ 104.32 NOTE, If tax payments are made within three months of the decedent's date of deeth, Tax Rate X . 0 4 5 deduct a 5 percent discount on the tax due. PotOntial Tax Due $ 4 . 6 9 Arty inheritance tax due will become dalineuent nine months after the date of death. PART TAXPAYER RESPONSE A. 1 yTha above inforaation and tax due is correct. ~LI Reeit payaent to the Register of Wills with two copies of this notice to obtain C H EC K 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. BLOCK 0 N L B. ~ The above asset has been or will be revorted and tax Daid with the Pennsylvania inheritance tax return Y filed by the estate representative. C. ~ Ths above info a ion is incorrect and/or debts and deductions were Daid. Complete PART ~ and/or PART 3~ below. PART Lf indicating a different tax rate, please state relationship to decedent: TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. DatO Established 1 2. Account Balance 2 ~ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 S 5. Debts antl Deductions 5 - 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due g PART DEBTS AND DEDUCTIONS CLAIMED 3 DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) g - UndOr penalties of perjury, I declare that the facts I reported above true, c o a complete to the best of my knowledge and belief. HOME ) _d ~+~- ~., WORK ) ~ _ _ ~/ \~ 'T74XPAYER SIGNATURE TELEPHONE NUMBER DAT ~J `... --... b v Y` V QJ e° ~~ M (`~ 0 ` \ \Q~