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Home My WebLink About02-02-12 (4)COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-961 DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 015537 CEKOVIC MICHAEL JAY 3528 BRISBAN STREET HARRISBURG, PA 17111 ACN ASSESSMEN"f AMOUNT CONTROL NUMBER fold ---------- ESTATE INFORMATION: ssN: iso-2s-x323 FILE NUMBER: 211 1-1313 DECEDENT NAME: CEKOVIC ELLEN MARY MESSI DATE OF PAYMENT: 02/02/201 2 POSTMARK DATE: 02/02/201 2 COUNTY: CUMBERLAND DATE OF DEATH: 1 1 / 10/201 1 REMARKS: RECEIPT TO ATTY SEAL CHECK# 95 1 1 177434 ~ S 196.32 ER ~ TOTAL AMOUNT PAID: INITIALS: HEA RECEIVED BY: REGISTER OF WILLS S 196.32 GLENDA EARNER STRASBAUGH REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-D601 B\ Pennsylvania DEPARTMENT OF REVENUE REV-1543 E% ~FP (05-11) PENNSYLVANIA INHERITANCE TAX / INFORMATION NOTICE FILE N0. 21 ( 3~ AND ACN 11177434 TAXPAYER RESPONSE DATE 11-24-2011 U ~ EST. OF ELLEN CEKOVIC SSN 19iD-26-6323 DATE OF DEATH 11-10-2011 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST u.; ~~ ~ ~d' COUNTY CUMBERLAND ~ CERTIF. W °;-` ~ ~ C REMIT PAYMENT AND FORMS T0: `:'~ .} Fi~kNK O~~~CEKOVIC REGISTER OF WILLS ~,, , ,,- b 4 W[$~~LLE RD 1 COURTHOUSE SI~UARE =.=.-.~~.-~~ EI~A ~' ~ PA 17025-1159 CARLISLE PA 17013 C_'...~:~ oG ::~ r.~ MEMBERS 1ST F CU 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 Lhe 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 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. 342794-1 1 Date 11-07-2008 7o ensure proper credit to the account, two Established copies of this notice oust accompany payment 'to the Register of Wills. Make check Account Balance $` 9, 184.32 payable 'to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax ~` 4,592.16 nonths of the decedent's date of death, Tax Rate X .045 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ 206.65 nine nonths after the date of death. PART TAXPAYER RESPONSE F I t7 R£$PO E ~, rl "$F'FIC L TAX A SMEHT A. ^ The above information and tax due is correct. Remit paynent to the Register of Wills with two copies of this notice to obtain C H E C K a discount or avoid interest, or return this notice to the Register of Wills and C 0 N E ~ an official assessment will be issued by the PA Department of Revenue. 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 inforna 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 ~~ OF ~AL ~~ ['~''I US ~ AAF relationship to decedent: PA DEPARTMENT OF REVENUE TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PqD .\"' LINE 1. Date Established 1 1 2. Account Balance 2 $ 2 ~~ 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ !i 5. Debts and Deductions 5 S 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 7 8. Tax Due 8 +~ ~~ ~~ ~~ _ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID 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 OM E C ) WORK ( ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE TOTAL (Enter on Line 5 of Tax Computation) S