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Home My WebLink About02-02-12 (3)REV-1162EX111-961 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NQ, CD 015539 CEKOVIC MICHAEL JAY 3528 BRISBAN STREET HARRISBURG, PA 17111 fold ESTATE INFORMATION: ssN: 190-2s-6323 FILE NUMBER: 211 1-1313 DECEDENT NAME: CEKOVIC ELLEN MARY_MESSI DATE OF PAYMENT: 02/02/2012 POSTMARK DATE: 02/02/201 2 couNTY: CUMBERLAND DATE OF DEATH: 1 1 / 10/201 1 REMARKS: RECEIPT TO ATTY SEAL CHECK# 93 ACN ASSESSMENT AMOUNT CONTROL NUMBER 11177435 ~ 53,420.26 ER ~ TOTAL AMOUNT PAID: INITIALS: HEA RECEIVED BY: REGISTER OF WILLS 53,420.26 GLENDA EARNER STRASBAUGH REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 .~~ ~~ Pennsylvania DEPARTMENT OF REVENUE REV-1543 EX RFP (05-11) PENNSYLVANIA INHERITANCE TAX `~ INFORMATION NOTICE FILE N0. 21 /~ ~ ~~~" AND ACN 11177435 TAXPAYER RESPONSE DATE 11-24-2011 V,~ _-'; _.. nJ ~--•~ EST. OF ELLEN CEY.OVIC ;~ "+ ~C SSN 190-26-6323 :_.~.~ :, u- C~cJG DATE OF DEATH la-lo-2011 L:-~ ; ,;- ty ~~~ COUNTY CUMBERLAND '~~- ~ ~ REMIT PAYMENT AND FORMS T0: ~ F'~ ' ~ AN V OVIC REGISTER OF WILLS E U ~ 40cM~ER TZV RD 1 COURTHOUSE SQUAR CARLISLE PA 17013 ENOL(~; ~j PA 17025-1159 cv 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 Sp0U5e 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 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. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 342794-05 Date 03-04-2009 To ensure proper credit to the account, two Established copies of 1;his notice must accompany payment to the Register of Wills. Make check Account Balance $ 160 ~ 012 • 07 payable to "Register of Wills, Agent". NOTE: If 'tax payments are made within three Percent Taxable X 50.000 Amount Subject to Tax ~ $0 ~ 006 • 04 months of 'the decedent's date of death, deduct a 5 percent discount on the tax due. Tax Rate X .045 Any inheritance tax due will become delinquent Potential Tax Due $ 3,600.27 nine months after the date of death. PART TAXPAYER RESPONSE 0 Tt'! R ' f1I t. Si1tT:. N, A ~O~FZ, IA1: TAX .J1SS~SSMEN7~ 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. C ONE B L 0 C K B. ~ The above asset has been 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 is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART O below. PART If indicating a different tax rate, please state OFFICIAL USA ONL~ ^ AAF relationship to decedent: PA DEPARTMENT OF REVENUE TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD $ 2 ~ ~~ LINE 1. Date Established 1 1 • 2. Account Balance 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ 4 s 5. Debts and Deductions 5 S 6. Amount Taxable 6 '~ 6 7. Tax Rate 7 X 7 8. lax Due $ '~ 8 - PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computal:ion) 8 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 C ~ WORK ( ~ TAXPAYER SIGNATURE TELEPHONE NUMBER DATE