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Home My WebLink About02-10-12COMMONWEALTH OF PENNSYLVANIA REV•1162 EX(11-961 DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARR158URG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 015576 DORMAN ROSEMARIE H 1397 LOWTHER ROAD CAMP HILL, PA 17011 Auld ESTATE INFORMATION: SSN: 792-30-2124 FILE NUMBER: 2112-0184 DECEDENT NAME: DORMAN MAX DATE OF PAYMENT: 02/10/2012 POSTMARK DATE: 02/09/2012 COUNTY: CUMBERLAND DATE OF DEATH: 01/22/2012 ACN ASSESSMENT AMOUNT CONTROL NUMBER 12108168 ~ 54.72 TOTAL AMOUNT PAID: 54.72 REMARKS: ROSEMARIE H DORMAN CHECK# 7131 INITIALS: WZ SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~ PENNSYLVANIA INHERITANCE TAX _~~~~, ~ f~;-~( ,~I~ORNATION NOTICE FILE ND. 21 - ~ ~ - ~ BUREAU OF INDIVIDUAL TAXES PO BOX 280601 enn L ~ ~~" ''~rla~~~~(~~ AND ACN 121oalba HARRISBURG PA 17128-0601 p ~ ~~ "' ~`~'~ T~XpAYER RESPONSE DEPARTMENT OF flEVENUE DATE 02-03-2012 REY-1543 EI 4FP (85-11) ~: CLERK Q~ aRP~w(s CouRr cta~r~~P, ~vr~ ro.. ~a ALEXIS WARREN 1397 LOWTHER RD CAMP HILL PA 17011-7535 EST. OF MAX DORMAN SSN 192-30-2124 DATE OF DEATH 01-22-2012 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU provided the department with the information below, which was usetl in calculating the inheritance tax due. Records indicate that at the death of the above named decedent, you were a ~otnt owner/beneficiary bf 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_re7ationship to the deceased by checking Box C to PART 1 below and writing "spouse" 1n PART 2. If you believe the information is incorrect, please obtain written correction from the financial institution, attach a coDY 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. 208765-0 0 Date 08-25-2001 To ensure proper cretlit to the account, Established copies of this notice oust accoapeny oayaent to the Resister of Wills. Nake cheek Account Balance 6 62.4 7 payable to "Register of W~11.. sm...r•~ ~~ Percent Taxabls X 16.b67 NOTE: If tax peyaents are cede within three AIl10Unt Subject to Taz ~ 110.41 aonths of the decedent's date of death, Tax Rate X (~Qr .045 deduct a er a t discount on tM tax due. e '~ Ary inher3 a ce ax dw rill bacoae delinawnt Potential Tax Dua t9c+~ 4 • 97 $ y.~'] nine aonths attar the dat• of death. PART 1 AJCF'ATCK Kt`JF'U175C A. III Tha above inforaation and tax duo is correct. J~ Roait parient to the Resistor of Wills with two copies of this notieo to obtain CHECK a discount or avoid interest. br return this notieo to the Resister of Wflls and an off ieial assessaent will be .issued by the PA Departaent of Revenue. C ONE BLOCK B. ~ The above asset haz bean or will be reported snd tax paid with the Pennsylvania 3nheritanee tax return O N L Y filed by the estate representative. C. ~ Tha above infona Ion is ineorr c and/or dehts and deductions were paid. Coaplete PART ~ and/or PART ~ baler. PART If indicating a different tax rate. ploase state relationship to decedont: TAX RETURN - CALCULATION OF TAX ON JOINTlTRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 ~ 3, Perc~ttt Taac stela 3 X 4. Amount Sub)act to Tax 4 5. Debts and Deductions 5 - 6. Amount Taxable 6 ~ 7. Tax Rate 7 X 8. Tax Due 8 PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under penalties of per'ury, I declare that the facts I reported above are true, correct and /complete to the best of my knowledge and belief. HOME C~ ~'~ ) Q 1'iC..+..a ~ ~~y~s.~ 4......,.`._..,.,._ e~.~.a WORK ( )Z $,~ l'1 T )PAYER~SIGNATURE ~ ~~~ TELEPHONE NUMBER DATE ~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES ~ AND FILE NO. 21 _ ~~~ ~8(.( PO BOX 260601 nn nr HARRISBURG PA 1712E-0601 ~ ~' ~~F~~Q~pAYER RESPONSE ACN 121as169 DEPARTMENT OF ~IR7FNy~E. •--w - r~I~`tS___ DATE D2-03-2012 -aEY-1563 Ex xrr ~ Irii ' ~.~; ~ 1~'t._~J ROSEMARIE DORMAN 1397 LOWTHER RD 1G12 f ~B I 0 ~~ 12~ 04 IXJM~ER1 AN~~pR PA CAMP HILL PA 17011-7535 EST. OF MAX DORMAN SSN 192-30-2124 DATE OF DEATH 01-22-2012 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU provided the department with the information bel ow,~whlch was used in calculating the inheritance tax due. Records indicate that at the death of the above-naaed decedent. you were a ,i Dint owner/beneficiary of this account. If you are the spouse of the deceased and any amount other than zero 1s reflected below on the Potential Tex Due line. note no tax may be due. Dut you must notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" 7n PART 2. If you beiieve the information is Incorrect, please obtain written correction from the financial institutf on, attach a copy to this form and return it to the above address. Please calf 717-787-8327-with ouestions. COMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 208765-00 Date 08-25-2001 To ensure proper credit to the account, two Established copies of this notice must eccomparo Account Balance 4 7 DiWment to the Register of Wills. Make check g 6 6 2 . pmrable to "Register of Wills, Agent". Portent Taxable X 16.667 Amount Subject to 41 NOTE: If tax payments era wade within three Tax S 11D . months of the decedent's data of death, Tax Rate ~( , DD deduct a 5 percent discount on the tax due. Potential Tax Duo ~ 0 0 Aro inheritance tax due will become delinquent nine months after the dat• of death. P T TAXPAYER RESPONSE ~ 1 A. QI The above infonat ion and tmc tlue is correct. IL~J Remit payment to the Reaister of Wills with two copies of this notice to ebtain 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 paid with the Pennsylvania inherit t t 0 N L Y ance ax re urn filed by the estate representative. C. ~ The above infona eon is incorr and/or debts end deductions ware paid. ComDlst• PART ~2 and/or PART ~ below. PART If indicating a different tax rate. please stato relationship to tlaeedent: TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Estebiishetl 1 2. Account Balance 2 ~ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 $ 5. Debts and Deductions 5 - 6. Amount Taxable 6 ~ 7. Tax Rate 7 X 8. Tax Due e $ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax ComputatlorJ e Under penalties of perjury, I declare that the facts I reported above era true, correct and complete to the best of my knowledge and belief. HOME C~1\'2 ) -13"~-~~~ e.+~n...:.. ~ - WORK C ) 'ymty TAXPAYER SIGNATURE w TELEPHONE NUMBER DATE a= ca ~ o. o F n na L(7 ~ a¢uineib ~o aF~ Q fn W ~o ~ ~i u_ ~e w ~: -~~ ~~ o ~~.~ ~~ i '^^ ~ M~j > O O W J O •--~ F a ~g .: r '« i Y~ .,; :~., .~. !'~ ± r ~ 3 _ ~ t ~ ,~ .~, ~~v sand.; s,~+--~aa~ 9 ~ ^ ~o xa3~~ ~ ~ 4 `~' ( ) ~U'~~1~0 O~ 9J~G"lt~i ~~ ~ u J ~ ~•`Yr1 ^ ' ~,~ 1 „li~~ r~ ^~ ~iJS~~Q l.~~. t'IJJ~ _ ~ ,._.._~ k a.,~...a ....c_ .