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Home My WebLink About01-17-12REV-1162 EX111-96) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT MAY DEBRA S 208 SENATE AVENUE APT 501 CAMP HILL, PA 1 701 1-2346 ------- fold ESTATE INFORMATION: FILE NUMBER: DECEDENT NAME: DATE OF PAYMENT: POSTMARK DATE: COUNTY: DATE OF DEATH: SSN: 243-30-2507 2111-1343 MAY GRAHAM H 01/17/2012 01 / 13/2012 CUMBERLAND 07/01/2011 TOTAL AMOUNT PAID: REMARKS: CHECK# 2837 SEAL INITIALS: CJ RECEIVED BY: NO. CD 015466 559.58 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ACN ASSESSMENT AMOUNT CONTROL NUMBER BUREAU OF INDIVIDUAL TAXES f'~~, PO BOX 280601 penrt~~lvania HARRISBURG PA 1712B-U601 DEPARTMEt~7 PF ~EYENVE REV-1543 ~E% AFP (05-11) PENNSYLVANIA INHERITANGE TAX INFORMATION NOTICE FILE N0. 21--II• ~?~~+ J ~ ~ l'•?' AND ACN 11158771 'TAXPAYER RESPONSE DATE 08-30-2011 EST. OF GRAHAM H MAY SSN 243-30-2507 r~~~`~ DATE OF DEATH 07-01-2011 C)~i~~i- ~ ~ ' ~ COUNTY CUMBERLAND ~I,,~ 4J'n REMIT PAYMENT AND FORMS T0: DEBRA S MAY REGISTER OF WILLS 208 SENATE AVENUE 1 COURTHOUSE SQUARE APT 501 CARLISLE PA 17013 CAMP HILL PA 17011 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 are the spouse 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 relationshease obtaenweCtteedo Ye honkfrio B~e Cnenc aARTnstibot~o aadttachi aiciopy toothie form aAoTreturn If you believe the information is incorrect. p it to the above address, rleane call ill-7~7-"0327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 9421-00 Date 05-02-1967 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 $ 2, 648.21 payable to "Register of Wills, Agent". NOTE: If tax payments are made within three Percent Taxable X 50.000 Amount Subject to Tax $ 1 , 324.11 months of the decedent's date of death, X . 0 4 5 deduct a 5 Dercent discount on the tax due. TaX Rate Any inheritance tax due will become delinquent Potential Tax Due $ 59.58 nine months after the date of death. PART 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 obtain a discount or avoid interest, or return this notice to the Register of Wills and C H E C K an official assessment will be issued by the PA Department of Revenue. BLOCK B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return C ONE 0 N L Y filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART ~ below. PART If indicating a different tax rate, please state OFFICIAL USE ONLY ~ AAF relationship to decedent: PA DEPARTMENT OF REVENUE TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD 1 LINE 1. Date Established 1 2. Account Balance 2 '~ Z _...-, -_. 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ 4 5. Debts and Deductions 5 5 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 7 8. Tax Due 8 '~ 8 DEBTS AND DEDUCTIONS CLAIMED PART PAYEE DESCRIPTION AMOUNT PAID DATE PAID TOTAL CEnter on Line 5 of Tax Computation) $ 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. H OME C ) WORK C ) rnvaAVFa cT[,NATURE TELEPHONE NUMBER DATE ~ ,~:.: " -{ TS it` A_ y. ~ , lr ~ M xx tt`- i : ' ~ ~ # ~M1 .r ~~: ~' +1 ~ '' 11` •. ,,' r • ~ • , ~~ • Ty~ 1 ~ ~ ~ ~ cx ~ , ~ ~ ~ ~~ ~x8 U c3 ~ C N U i ._, _ 1 ~~ ~~ ~ ~ •~ Y / ~ ~ ~~ ~ ~~ ~ ~~~ ^ V ~ ti 4^, Y r Y /'~ ~ + \ ~~ 1 4 ~~ V / / ~ t ' ~ _ y ~ y // ~~ y 1'J ~ f \~ v ~-7 e} p /' / C ) ~/ ""' P~ '"a „ ~ ,~~ vd ; „1~; -?~ j~ lJ ~ ~ i - 1 `~~ ij~