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Home My WebLink About01-30-12COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: THOMAS BRIGETT 1242 BLACK GAP RD FAYETTEVILLE, PA 17222 fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-961 NO. CD 015522 ACN ASSESSMENT AMOUNT CONTROL NUMBER ESTATE INFORMATION: SSN: 194-28-9359 FILE NUMBER: 2112-0128 DECEDENT NAME: SINGER PAULINE M DATE OF PAYMENT: 01 / 30/ 201 2 POSTMARK DATE: 01 /24/201 2 couNTY: CUMBERLAND DATE OF DEATH: 01 /04/201 2 REMARKS: CHECK# 2012 SEAL 12104588 ~ 535.59 TOTAL AMOUNT PAID: INITIALS: DMB 535.59 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 ~~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 21 - ~~ - ~ ~`as ~e~~C~~~~~ ~~~,~ ~~ AND ACN 12104588 DE PAR ~lx o,€ru_v~uE'_ TAXPAYER RESPONSE DATE 01-19-2012 **~~ ~~ ~ REV- 5~'ExI CtI~.LCS 111] ,1ti del+~ ,~~~ 30 F~~ !2~ ! 7 CLERK OF ORPHAN'S COURT CUN!R~'~~ ~~~~ Ct? . PA BRIDGETTE R THOMAS 1242 BLACK GAP RD FAYETTEVILLE PA 17222-9785 EST. OF PAULINE M SINGER SSN 194-28-9359 DATE OF DEATH 01-04-2012 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. ORRST OWN BANK 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 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 relatlonship 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. 103000047 Date 01-05-1998 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance 1 664.76 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 ~` 832.38 months 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 $ 37.46 nine months after the date of death. PART TAXPAYER RESPONSE SPOHD i!~ AN ~FFIC AL TAX .ASS A. ~7he above information and tax due is correct. Remit payment 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 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 relationship to decedent: TAX RETURN - CALCULATION LINE 1. Date Established 2. Account Balance _ __ - _ - 3. P>rcent Taxahl e 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. lax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS 1 2 $ X 4 $ `_.~.__ __. 5 6 7 X 8 $ PART ^3 DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID FFIC~~k. tiSE WONL'~s [~~ DEPART?IENI OF REYENU~ 1 2 __ 4 6 7 ~_.. TOTAL (Enter on Line 5 of Tax Computation) S Under penalties of perjury, I declare that the facts I reported above are true,(~,c)o/rrect and (~co~mpl,~e~t-e-}-~t'o the b~esQt.~of my knowl/edge and belief . HOME C ~ ( ~ ) jC / (p ~ ~ ~J3~ 1`.L~ L.l1L~--t.~ i-~i l~lQ.~./ WO R K ( ) TAXPA R SIGNATURE TELEPHONE NUMBER DATE ~,s .~; ", '~ ~, I -_ ~.a t~1 `~ ^.~ ':.3 i ;' t.,,,; ~' r ^;~ ~; _ n *r:- ~ ~~ ;~ _ v ti~~ U ;; ~ (' §R ti 'i ~ \ _ -~ \! ,~1 v 1 r f~ ~ ~ . ~J C' ~,, 'f.~~8V1'f~ ~~o ~~ ~o x~ Q ~ ~ ~~ =~i ~:~ o~ ~~r ~~o R~ ^ t 11 rl ~ ~ - ~ y '~ ~- J ~ .~~1 s ~ ~, .. t~ `- " :~;~ 4 ~ '•.. ~ -r'! v ~„~ ,. str '-'. r ~. ter ri C'y Ate a/! si r. ~ . _ u. ~ <'s~ '° ~t~~~t~3 r a~;Se's $~$il'1~ 1#t~3d ~. ~ L ~ ~ ~ ~ O L W ~ 7 N O ~ U~ ~ ~ Q~ 0 ~ ~o c~oc~Q ~~~Ld ~~a~~~ ~~~~ C7 'v~ E ~ u~~~Uc`o ~~U~U W z z -. WD o ~~ o N w Q -~ O~ ~ d W H a" W o r,~ ~U~oa, HZo~