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Home My WebLink About02-10-12 (2)COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: DORMAN ROSEMARIE H 1397 LOWTHER RD CAMP HILL, PA 17011 -- foltl PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: ssN: is2-3o-2124 FILE NUMBER: 2112-0184 DECEDENT NAME: DORMAN MAX DATE OF PAYMENT: 02/10/2012 POSTMARK DATE: 02/09/201 2 CouNTY: CUMBERLAND DATE OF DEATH: 01 /22/201 2 REV-1162 EX111-96) NO. CD 015577 ACN ASSESSMENT AMOUNT CONTROL NUMBER 12108170 ~ S 3.44 TOTAL AMOUNT PAID: REMARKS: $3.44 CHECK# 7132 INITIALS: DMB SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS PENNSYLVANIA INHERITANCE TAX i4 INFORMATION NOTICE FILE N0. 21 - 1 ~-' U I e~ BUREAU OF INDIVIDUAL TAXE r, ; ~ -~ 't PO BOX 280601 ~F(`~~ns: AN ACN 12108170 HARRISBURG PA 17128-0601 {{'~ gaPASrrmep'rbF~JE' TAXPAYER RESPONSE DATE 02-03-2012 ' ,L ~'.a}~'7t~~`54i ti`% AFP ~(BS-1 7fi~i? ~~~ ~ 0 F~~~ ~' CLERK rOURT ORPHAN'S C COMP:=~'1 a~'',1~ C;0 , PA LANDEN Z SMITH 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 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 yoU 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 relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe the information :s 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. 215084-0 0 Date 03-09-2002 7o ensure proper credit to the account, two Established copies of this notice gust accompany payment to the Register of Wills. Make check Account Balance $ 482 • 99 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are Wade within three Amount Subject to Tax $ $0 • 50 months of the decedent's date of death, Tax Rate X $°1e ~;,,s~w~n.~~ . 045 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential TaX Due $ ~,l~y 3 • 62 nine months after the date of death. PART TAXPAYER RESPONSE LU ~'' T~ ~t~SAOHD; W #.Lf"`RE~t1LT ~>°•A},t -~~~ AL7~L3I''ASS M NT A. {~ The above information and tax due is correct. 1/ T 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 ~ below. PART If indicating a different tax rate, please state Q relationship to decedent: TAX RETURN - CALCULATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS 1 2 ~ 3 X 4 5 - 6 '~ 7 X 8 ~~ ~..~}FFIC,IAi- ~SE O~L,. .~ CAF PA`' D~PA'RT?4ENT OF REYEi~UE ~ PAI14; i 2 ~ 3 r . _. "4 5 6 _ ,~ 7 ,~~~. a m~ ~ may. -.. a 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. HOME C )Z3~- 15 0.5 ~a ea.e~iaev .-.~ A ems. nsr•~1+~'~ -~~ TAXPAYER SIGNATURE TELEPHONE NUMBER DATE TOTAL CEnter on Line 5 of Tax Computation) s ' ~, PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 21 ' `3 -U ~~y BUREAU OF INDIYIDUAL rT~AX~~E~S Po sox zao6ol L~ b~i'71D~' "p I, J~('111a AND ACN 12108171 HARRISBURG PA 17128 6 ~/'+ + r'pE}~ApTM ~ F~iEVENUE TAXPAYER RESPONSE ~, + DATE 02-03-2012 li.,. ~„Ai~,_'~;_ '" j{gy-ISR~'EZ~ [95-01) '~ € 2 F`H'B 10 Fed ! ~ i 2 CLERK QF ORPF~N'S CQ~1R?' Cl}M~~-R1 %~~Jr? CQ PA ROSEMARIE DORMAN 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 1 ST 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 you 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 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. 215084-0 0 Date 03-09-2002 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance 482.99 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax $` 80.50 months of the decedent's date of death, Tax Rate ~( , 00 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ 00 nine months after the date of death. PART TAXPAYER RESPONSE '~~ E?.~`ti R P{iH[J W LL:rit£~i3L~'r AN I~CiY1L ;ASSESS E `- A. ~/ The above information and tax due is correct. I.iO~ Remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or return this notice to the Register of Wills and 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 3~ below. PART If indicating a different tax rate, please state i~FICIAL U$E ~ LY ~ A~ relationship to decedent: ' a pA 17~E 4RT1iENl, OF REVENUE TAX RE TURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS pAD LINE 1. Date Established 1 1 2. Account Balance 2 $ 2 3. Percent Taxable 3 X ~ ~--- 4. Amount Subject to Tax 4 $ 4 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 0 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. HOME C ~ ) 737-1 ~S - c.-s.~ ~.,j>,rcc~.~Y~ WORK C ) ~L~ TAXP YER SIGNATURE TELEPHONE NUMBER DATE G. fD W 0_ o ¢ C] CJ ' ~.i /00 cn a-o• V I~ oo_ir~ •z ¢uir-coo ~o ai~" Q ~o (lJ a] _] W ~ ~~ u_ ui ~~.~ ~ ~~~ ~ M ~~~ ~ ~~~~~ ~~ ~~~~ ~ r N U 1 ti k O N N O W C .... H 2 ~ ~ 0. M 0 ~a~ p ~ .s= s~~ a ~u ~~ 3 P 0 6 fix! f .~ yy L'~ R~ .,•a ~ ~ • ;,~.