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Home My WebLink About02-16-12REV-1162 EX(11-96) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT MCSHERRY MICHAEL D 1605 AIRPORT ROAD MECHANICSBURG, PA 17050 -------- fold ESTATE INFORMATION: FILE NUMBER: DECEDENT NAME: DATE OF PAYMENT: POSTMARK DATE: COUNTY: DATE OF DEATH: SSN: 166-20-4027 2111-1185 MCSHERRY WILLIAM R 02/ 16/ 2012 02/16/2012 CUMBERLAND 09/23/2011 TOTAL AMOUNT PAID: REMARKS: CHECK#5376 SEAL INITIALS: CJ RECEIVED BY: NO. CD 015597 589.94 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ACN ASSESSMENT AMOUNT CONTROL NUMBER ~~ PENNSYLVANIA INHERITANCE TAX ~ ~ ~ INFORMATION NOTICE FILE r,, -;, ., ~-~~ ~ AND ACN BUREAU OF INDIVIDUAL TAXES PD Box 2BO6ol pen~5 ~~ DATE HARRISBURG PA Iri2a-o6o1 DEPARTME~,,TOFR~ ~R!'i ° ~ TAXPAYER RESPONSE REV-1543 E1( AFP (05-11) CLERK CF oR~)s ca~~j ~jME~~-~1_A~VD ~;a . PA MICHAEL D MCSHERRY 1605 AIRPORT DR MECHANICSBURG PA 17050-2102 N0. 21-(~~Il~~~ 11166430 10-07-2011 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. EST. OF WILLIAM R MCSHERRY SSN 166-20-4027 DATE OF DEATH 09-23-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 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. sedwbre a joint owner/beneficiary of this account. If you are the spouse o e other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must checking Box C in PART 1 below and writing "spouse" in PART 2. deceased and any amount to this form and return notify the department of your relationship to the decea Y If you believe the information is incorrect, please obtain written correction from the financial institution, attac a cop it to the above address. Please call 717-787-8327 with questions. ar~nw ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS .._ CUMYLtI~ r^^' -- Account No. 7388-42 Date 12-28-2004 Established 39,972.69 Account Balance `~ 5,000 Percent Taxable X 1 ~ 998.63 Amount Subject to Tax $ , 045 Tax Rate X $ 89.94 Potential Tax Due PAYER RESPON To ensure proper creak w •~~~ °°---~~-• copies of this notice must accompany payment to the Register of Wills. Make check payable to "Register of Wills, Agent". NOTE: If tax payments are made within three months of the decedent's date of death, deduct a 5 percent discount on the tax due. Anv inheritance tax due will become delinquent nine months after the date of death. TAX E PART FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMEN 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. BLOC K B. ~ The above asset has been or will be reported and tax Paid with the Pennsylvania inheritance tax re urn ONE 0 N L Y filed by the estate representative. C, ~ The above informs land/or1PARTre~ belowr debts and deductions were paid. Complete PART 2~ IAL USE ONLY ~ AAF PART If indicating a different tax rate, Please state 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 OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 '~ 7 X 8 $ PART DATE DESCRIPTION AMOUNT PAID s TOTAL (Enter on Line 5 of Tax Computation) Un er pe alt-es of perjurY,_I declare that the facts I reported above are true,,P.prrect a~ HOME (~1 ~ ) ~ ~ co~ipl to to he be i ledge and belief . ~ry ~p ~''~'~ 1 .~\ ~ ~. ~Il.~m~~_,_/' WORK (~ ~, ~ l' ~ ll~~ DA_ TE PAD 1 2 3 4 5 6 7 8 OFFIC PA DEPARTMENT OF REVENUE DEBTS AND DEDUCTIONS CLAIMED ~~ ~' p~ ~~. rr ~~~ ,,, ~~~~~ds~ ~ 1 C' ~ ~,, /~ 1 U ^.>t, ~4~' v yV ~ ` ^ ~~ t! ~~~ ~ ti •~ r' `~ u_ ~:. .-" U Z U. c c Q L C d W Q U O Q 2 .L .. ~ t~ ,.~ ~ ~ - j ~~ °, ~ ~ ,h-`, ~ ~ +J 4.{~~,p~ ~J V •J 0 0 Q a .. rn s~ n ~n O N ~ ~' c Q a v t ~ U V ~ ~ t: }~ ~fs ia:•. i~2 ,i.t. ~~~{ 'Y'.