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Home My WebLink About02-02-12COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: CEKOVIC MICHAEL JAY 3528 BRISBAN STREET HARRISBURG, PA 17111 fold REMARKS: RECEIPT TO ATTY CHECK# 94 SEAL REV-1162 EX111-961 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 015538 INITIALS: HEA RECEIVED BY: REGISTER OF WILLS ACN ASSESSMENT AMOUNT CONTROL NUMBER GLENDA EARNER STRASBAUGH REGISTER OF 'WILLS TOTAL AMOUNT PAID: 555.15 1 __ ~ PENNSYLVANIA INHERITANI;E T~ BUREAU OF INDIVIDUAL TAXES I N F O MAT I O N N O T I C Ec PO BOX 280601 Pennsylvania AND HARRISBURG PA 171P8-0601 DEPARTMENT OF REVENUE TAXPAYER R E S P O N S E REY-1543 EX AFP (R5 -13) is. ~' O G~ "'- ,,-L- • 1 ~ ~L. .l ~ s. - a C ~ ~ . ~ ~ ~~ _.' ~ FR ~ U ~ 1 K W +~ ~ EKOVIC ERT LE RD ENffiA .,-., ~ PA 1 7025-1 159 S`y FILE N0. 1 11-1313 ACN DATE 12-26-2011 EST. OF ELLEN CEKOVIC SSN 190-26-6323 DATE OF DEATH 11-10-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SgUARE CARLISLE PA 1.7013 TYPE OF ACCOUNT ^ SAVINGS ® CHECKING ^ TRUST ^ CERTIF. PNC BANK NA Records indicate that at the death of the aboveVnamedtdecedenttment with the information below, which was used in calculating the inheritance tax due. deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but notify the department of your relationship to the deceased byechecking Box7Cnin1PART lfbelow andnwritin you are the spouse of the 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. 9 spOUSe" in PART 2USt COMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 5112031218 Date 03-27-2009 Established To ensure proper credit to the account, two Account Balance copies of this notice must accompany $ 2, 580 , 00 payment to the Register of Wills. Make check Percent Taxable X payable to "Register of Wills, Agent". Amount Subject to Tax 50.000 $ 1 ~ 290.00 N07E: If 'tax payments are made within three Tax Rate X months of +t he decedent's date of death, Potential Tax Due • 045 deduct a 5 percent discount on the tax due. $ 5 8 . 0 5 Any inheritance tax due will become delinquent PART nine ^onthl: after the date of death. 1^ TAXPAYER RESPONSE Ri:,- -i~ESPoND WZI,~'`. a#3L:~'.-z >~ ~# ~r . ova= IAr, i'~c ,ass ss NT A• ^ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain C CHECK a discount or avoid interest, or return this notice to the Register of Wills and 0 N E 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 0 N L Y filed by the estate representative. Paid with the Pennsylvania inheritance tax return 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, please state relationship to decedent: OFFIC L US NLY, F TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS ~ PA ~JEPARTMENT OF REVENUE® LINE 1. Date Established 1 P D 2. Account Balance 2 $ 1 3. Percept Taxable g X 2 4. Amount Subject to Tax 4 $ 3, ~ 5. Debts and Deductions 5 - 4 6. Amount Taxable G $ 5 ~ i 7. Tax Rate ~ ~( 6 8. Tax Due 8 $ 7 PART a DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter 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. HOME ( ~ TAXPAYER SIGNATURE WORK ( ~ TELEPHONE NUMBER DATE 8 DEBTS AND DEDUCTIONS CLAIMED