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Home My WebLink About01-06-12COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280607 HARRISBURG, PA 17128-0801 RECEIVED FROM: REV-1182 EX111-98) ' PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT FELLENBAUM PATRICIA 44 WHIPPORWILL DRIVE LANCASTER, PA 17603-9687 NO. CD 015424 ACN ASSESSMENT AMOUNT CONTROL NUMBER fold ESTATE .INFORMATION: ssN: o1s-2s-s3os FILE NUMBER: 2111-0750 DECEDENT NAME: BLUBBER ELAINE D DATE OF PAYMENT: 01 /06/2012 POSTMARK DATE: 01 /04/2012 COUNTY: CUMBERLAND DATE OF DEATH: 06/14/201 1 11183444 ( 5229.13 TOTAL AMOUNT PAID: REMARKS: SEAL CHECK#1009 INITIALS: HMW RECEIVED BY: REGISTER OF WILLS 5229.13 REGISTER OF WILLS PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 21 11-0750 BUREAU OF INDIVIDUAL TAXES Po sox zao6ol P~~~~~ }~~ AND ACN 11183444 W-RRISBUR6 PA 17128-0601 OEPAai7jM~eblT~oiA6YENUE ~'~ ~ TAXPAYE R R E S P O N S E ~, '~.~I ! C DATE 12-22-2011 ~~ 1 ~r?~ '~ ~~ ~~ ~~ CLERK ~;" iQF~PcF-IAN`S ~G~RT Ctl~F'r?I t~h#R ("?f} Pi PATRICIA K FELLENBAUM 44 WHIPPORWILL DR LANCASTER PA 17603-9687 EST. OF ELAINE D BLUBBER SSN 019-28-9308 DATE OF DEATH 06-14-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. SOVEREIGN BANK 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 spouse of the deceased and any amount other than zero 15 reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department of your reTatlonshlp 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 form and return it to the above address. Please call 717-787-8327 with questions. CflMPL~fif PART 1 BEL011 ~ -SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 2891025385 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART CHECK ONE BLOCK ONLY To ensure proper credit to the account, two copies of this notice wust accowpany paywent to the Register of Wills. Make check payable to "Register of Wills, A6ent". NOTE: If tax paywents era Bade within three months of the decedent's date of death, deduct a 5 percent discount on the tax duo. Any inheritance tax due will becowe delinquent nine wonths after the date of death. E A. ~i Tha above inforwation and tax due is correct. yLSI~ Resit paywent 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 assesswent will be issued by the PA Departwent of Revenue. B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return filed by the estate representative. C. ~ The above inforwa ion is incorrect and/or debts and deductions were paid. Coeplete PART 2~ and/or PART ~ below. PART If indicating a different tax rate, please state a relationship to decedent: TAX RETURN - CALCULATION LINE I. Date Established 2. Account Balance 3. Percent Taxable 4. Amount. Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due PART DATE PAID PAYEE Date 09-04-1981 Established $ 3,055.00 X 50.000 $ 1,527.50 X .15 $ 229.13 OF TAX ON JOINT/TRUST ACCOUNTS 1 5 - 6 T X 8 ~ DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID Under penalties of perjury, E declare that-the facts`I reported above are true(, arrect and mpi to to the st of IRy knorrledye and bel3of . HOME C ~t tT ) ~f ~d~- arI'#'~ I ~ ~ ;J" ~~ ,~ WORK ( ) TAXPAYER SIG TURE TELEPHONE NUMBER DATE ~b ~~ ro ,~ ~ ~ p o~ w ~~ M~ r",,~ ',.~ ~, ~/ (~ ~v f .~ ~ r a ~' ~ .~.. .... .~. .... 4 ~= ~~ G.s~ l.is~'~ `~a~eNi IJ .rrr l~i i~4/ c]r~Vi 1U~~ ~_ !'~ -} .`." ~U ~~~ t~ Ti r- ~: ~ ~} f 4°`~ w~i ~ ~ ' ~ ~ eh ¢ `~ t ~ - 6 Si V ~ i»' if f i 1 +,;_~~ ~ ~ ,`~'-~`' ~, }i-1 ~ t;~~J ~~' ,~ ... - - -- --- --- -