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Home My WebLink About01-17-12 (2)COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 2 8-0601 RECEIVED FROM: PENNSYLVANIA INHERI~'ANCE AND ESTATE TAX OFFICIAL RECEIPT OROURKE JACK R 3710 CONWICK DR SOUTHPORT, FL 32409-1669 REV-1162 EXI11-961 NO. CD 015464 ACN ASSESSMENT AMOUNT CONTROL NUMBER fold ESTATE INFORMATION: ssN: I2o9-22-0308 FILE NUMBER: 211 1-0944 DECEDENT NAME: O'ROURKE ROBEF~T DATE OF PAYMENT: 01 / 1 7/ 201 2 POSTMARK DATE: 01 /1 3/201 2 couNTY: CUMBERLAND DATE OF DEATH: 08/21 /201 1 REMARKS: SEAL CHECK# 6608701550 1 1 184779 ~ 51,1 18.74 TOTAL AMOUNT PAID: INITIALS: DMB RE EIVED BY: R GISTER OF WILLS 51,118.74 GLENDA EARNER STRASBAUGH REGISTER OF WILLS t ~ 1 ~ PENNSYLVANIA INHERITANCE TAX r•,,,,, ~ INFORMATION NOTICE FILE N0. 21 11-0944 BUREAU OF INDIVIDUAL TAXES rh ~~ , ~~ r Po BDx zaocol p,~nn~y~V~ r AND ACN 11184779 HARRISBURG PA 17126-0601 ,q~PnFrMeNTOFaevel6ue(~ TAX P AY E R R E S P O N S E ~„ DATE 12-29-2011 REV-1543 EX AFP (05 -11) ~ @,i j j i-~il 1 ry Ca ORPf=HER,, ~l, ~ ~ '~ r JACK R OROURKE 3710 CONWICK DR SOUTHPORT FL 32409-1669 EST. OF ROBERT OROURKE SSN 209-22-0308 DATE OF DEATH 08-21-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. WELLS FARGO 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 y0U 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 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, please obtain ritten correction from the financial institution, attach a copy to this form and return it to the above address. Please call 717-787-8327 with que~tions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 1010264503772 Date I .04-09-2010 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance 14,916.51 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 7,458.26 months of the decedent's date of death, Tax Rate ~( 15 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due ~` 1 ~ 118.74 nine months after the date of death. PART T XPAYER RESPONSE FA~ ~„T~~~~ WILL ~ AN OFFICTAL TAX AS ~ NT A. ~ The above information a¢d tax due is correct. Remit payment to thq Register of Wills with two copies of this notice to obtain C H E C K a discount or avoidl'Iinterest, or return this notice to the Register of Wills and 0 N E an official assessm$nt will be issued by the PA Department of Revenue. [ B L 0 C K ~ g. ~ The above asset has bee or will be reported and tax paid with the Pennsylvania inheritance tax return 0 N L Y filed by the estate representative. C. ~ The above informs ion i incorrect and/or debts and deductions were paid. Complete PART ~2 and/~r PART 3^ below. PART If indicating a different tax rate, please state relationship to decedent: TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 3. Pence..^.t Taxable ; X i 4. Amount Subject to Tax 4 OFF~~IAL USE a~IL ~] AAA PA DEPART3IENT OF REVENUE PAD \ 1 2 '~ '-R- 6. AmountYTaxablev 7. Tax Rate 8. Tax Due "- 6 '~ 7 X 8 $ 6 7 $ PART 3^ DATE PAID PAYEE DE BTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID IOIP~L canter on Line 5 of Tax computation) S Under penalties of perjury, I declare thit the facts I reported above are true,~lc~orrect and complete the best of my knowledge and belief. HOME C ~~ ) „L,p~ -d 3~-(,U WORK C ) 3 - S~7 ~. T PAYER SIGNATURE TELEPHONE NUMBER DATE o o N 0 O O O W ..~ ..0 ..0 E-' D ~ ~ o C/ 3 C ~ I U ''~ ~- ~ II ~ ~ I ~ ~ -._-~°.~ ~ 0 ~ U~ X ~ ~~ I R ~ ~,a 0 0 it f ~ ~ Qa o ~ d O O W ..~ ...D ~' t-' d I ~ II ., '~ (~ ~ -' s ~ , ; c ~~ ~ ~ U i ~ ~ `, ~J ~ ~ ~ 5 n G 7 b_ ~ ~ z r ~~ ~ ~\ v W Y 1 "d ~_; i~ ~~ ~ ~~~~ i~ '_ _ ~.,~ ~ I' « ~ ,f ''~~ ~~ Cp ig ~ ~ t„ of i~ ~C. n. ~~ ~. ~ ~;; :.