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Home My WebLink About12-22-11 (2)COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280801 HARRISBURG, PA 1 7 1 28-0801 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT KAUFFMAN BARBARA J 6214 CHARING CROSS MECHANICSBURG, PA 17050 fold ESTATE INFORMATION: SSN: 210-26-2037 FILE NUMBER: 2111-1364 DECEDENT NAME: COULTER LOTS C DATE OF PAYMENT: 12/22/201 1 POSTMARK DATE: 12/21 /201 1 COUNTY: CUMBERLAND DATE OF DEATH: 1 1 /22/2011 REMARKS: SEAL CHECK# 520 ACN ASSESSMENT CONTROL NUMBER REV-1182 EX(11-96) NO. CD 015383 AMOUNT 11181081 ~ 51,375.24 TOTAL AMOUNT PAID: INITIALS: HMW RECEIVED BY: 51,375.24 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES PO BOX 280601 penns~ HARRISBURG PA 17128-0601 DEPARTME REY-1563 EX~ A CLARK ~~ E~JM~?~RI_~~C~ C~ , PA BARBARA J KAUFFMAN 6214 CHARING: CR[)SS MECHANICSBU,RG PA 17050-5205 EST. OF LOIS C COULTER SSN 210-26-2037 DATE OF DEATH 11-22-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. FULT ON BANK NA 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 Point owner/beneficiary of this account. If you are the SpOUSe of the deceased and any amount other than zero 1s 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, Dl ease 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. COM!'tETE PART I BELOW * SEE REVERSE SIDE FOR" FiLINB...AND PA1fME1iT i#STRUCTI-ONS- - Account No. 3623-51319 Date 09-10-2007 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance 80, 168.82 p~^ent to the Resister of Wills. Make check payable to "Register of Wills, Agent^. Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART CHECK ONE BLOCK ONLY PENNSYLVANIA INHERITANCE TAX r~I`~~ INFORMATION NOTICE FILE N0. 21 _~"±+"~~'i~F'~p-XPAYERNRESPONSE ACN 11181081 DATE 12-13-2011 ~.p,. (~ X 50.000 $ 40,084.41 X .045 $ 1,803.80 NOTE: If tax payments are made within three months of the decedent's data of death. deduct a 5 percent discount on the tax due. Argr inheritance tax due will become delinquent nine months after the date of death. above information and tax due is correct. Remit payment to the Raeister of Wills with two copies of this noticerto obtain a discount or avoid interest, or return this notice to the Register of Wills snd an official assessment will be issued by the PA Department of Revenue. B. ~ Th• above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return fled by the estate representative. C. The above informs 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 relrtionship to decedent: TAX RETURN - CALCULATION OF TAX ON LINE 1. Date Established 1_q 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 Rata 7 X DATE PAID PAYEE DESCRIPTION AMOUNT PAID PART DEBTS AND DEDUCTIONS CLAIMED 3^ Under penrltes of perjury, I declare that the facts I reported above era true, corroat and complete to the bestj~of rRy7knowladge and belief. HOME C ) -3 S ,f'~6fi~11'ld~n. ~- ' /1 ~.L +~`~"'~ WORK C ) 1 O TAX YER SIG UR ~'~"~ TELEPHONE NUMBER D E -; i t 1 ... t~ 4 4) ht Vr1Y v ti ~4r. 4 M h~ ry.., ter."".. iy.r w rr ~. i WW +.: L `rb ~ ~ `.-~ ~_ C.` M't ~, -y L ~.. ~ ~:'f ip.r.~ y-~..1 - ,..~ ? ~~ f L ~ ~ W ] ~.. yI(~ i:. j 7 e J {Fn ` Mr, .d ~ ?~ 1 y~ IW x,. ¢ ~~ r i,`~y r $ gg ~ 8 ~; , Ftt.,..k;~: ~ Yi i tt 6. ff ; ~~E ~~t: jjf;`~~ X ~~i 4y i T . .t.M1.~ S