HomeMy WebLinkAbout01-12-12COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX111 96)
NO. CD 015442
COOK MARY M
1113 NORTH HIGH STREET
DUNCANNON, PA 17020
------ fold
ESTATE INFORMATION: Ssrv: is8-32-4704
FILE NUMBER: 211 1-1294
DECEDENT NAME: STONER SHIRLEY C
DATE OF PAYMENT: 01 / 1 2/201 2
POSTMARK DATE: 01 /1 1 /201 2
COUNTY: CUMBERLAND
DATE OF DEATH: 1 1 / 1 2/201 1
REMARKS:
CHECK#1655
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
TOTAL AMOUNT PAID:
INITIALS: CJ
5350.44
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
~.
~' PENNSYLVANIA INHERITANCE TAX
BUREAU OF INDIVIDUAL TAxES •~ - -,,: INFORMATION NOTICE
Po Box zso6ol ~ ~~~ ~ " FILE N0. 21•-li-I~<~4
penbsylvama ~" AND
HARRISBURG PA 17128-0601 r _'6E6ARTMENT OF REVENUE ~ I ~' ACN 1 1177301
TAXPAYER RESPONSE
'; aey•.i5aa ex nFa cos-u, DATE 1 1 - 24 - 2011
a.
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MARY M COOK
1113 N HIGH ST
DUNCANNON
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PA 17020-1921
EST. OF SHIRLEY STONER
SSN 188-32-4704
DATE OF DEATH 11-12-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
RIVERVIEW NATIONAL BANK provided the department with the information below, which was used in calculatin
Records indicate that at the death of the above-named decedent
th
i
notifyethendepaartmentnofoyour relat
If you believe th
i
f g
e
nheritance tax due.
, you were a joint owner/beneficiary of this account. If yoU are the spouse of the
ionship tofthetdeceased by checki
n
l
T
l
n
t
o
y
t
e
n
ormation is incorre
it to the above address. Please call 717 ng
Box
C
in PART
l
below
and
writing
"spouse" in
ct, please obtain written correction from the financial institution
PART 2.
-787-8327 with
atta
h
ti
~
U
et
s
,
ques
c
ons.
a copy to this farm a
d
r
u
n
COMPLETE PART 1 BELOW
A * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTR~CTIuN~
ccount No. 3065633 Date 02-05-2008
To ensure proper credit to the account, two
Established
Account Balance copies of this notice must accompany
payment to the R
$
i
eg
ster of Wills. Make check
46,724.91
Percent Taxable X payable to "Register of Wills, Agent".
16.667
Amount Subject to Tax yQ 7, 787.64 NOTE: If tax payments are made within three
TaX Rate months of the decedent's date of death,
X
Potential Tax Due . 0 4 5 deduct a 5 percent discount on the tax due.
44 Any inheritance tax due will become d
$ 350
li
PART .
e
nquent
nine months after the date of death.
TAXPAYER RESPONSE
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT
A. ® The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obt
i
C H E C K
a discount or avoid interest,
or return this
notice to the a
n
Registe
f
C
0 N E ~
an official assessment will be
issued by the
PA Department r o
Wills and
of Revenue.
B L 0 C K
0 N L Y B. ~ The
fi above asset has been or will b e reported and tax paid with the Penns
l
i
le
d by the estate representative
. y
van
a inheritance tax return
C. ~ The above informs ion is incorrect and/or debts and deductions
Tf
Complete PART ~ and/or PART ~
below. were paid.
-• -~~~-~=~~~~y a airrerent tax rate, please state
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
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4
5
6 +~
7 X
8 $
OFFICIAL USE ONLY D AAF
PA DEPARTMENT OF REVENUE
PAD
1
2
3
4
5
6
7
8
rwrti
DATE PAID PAYEE
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation) g
Under penalties of perjury, I declare that the facts I reported above are true, correct and
complete to the best of my knowledge and belief.
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