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HomeMy WebLinkAbout03-12-12REV-1162 EX111-96) COMMOPJWEALTH OF PENNSYLVANIA GEPAFTMENT OF REVENUE BUREAU OF INDIVIpU AL TAXES D"tPT.280601 HARRISBURG, FA 1 71 2 8-0601 RECEIVED FROM: CHURCH WILLIAM L 8 PINE CIRCLE NEWVILLE, PA 17241 fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: SSN: 143-22-521 ~ FILE NUMBER: 211 1-1272 DECEDENT NAME: BOBBINS SHIRLEY G DATE OF PAYMENT: 03/12/2012 POSTMARK DATE: 02/28/201 2 couNTY: CUMBERLAND DATE OF DEATH: 1 0/ 1 6/ 201 1 ACN ASSESSMENT CONTROL NUMBER AMOUNT 12105242 ~ 5398.44 TOTAL AMOUNT PAID: REMARKS: CHECK#108 SEAL INITIALS: CJ RECEIVED BY: 5398.44 GLENDA EARNER STRASBAUGH REGISTER OF WILLS N0. CD 015690 REGISTER OF WILLS ~• PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 21 11-1272 BUREAU OF INDIVIDUAL TAXES AN D Po Box zao6ol t' ~ ~P~ rl~ ` ~ ~ ACN 12105242 HARRISBURG PA 17128-06011 4v -pEP~ME~I~oF'A~~'' TAXPAYER RESPONSE ~ {_ rr;~'~~€ DATE 01-24-2012 - -.,_ REV=1541_Ex AF Pr Cg51 Y> ;~ 3';~;~ ! 2 f'~'~ 12• ~~ CLARK rr= ouP-;ar~'c Coc~~T WILLIAM L CHURCH 8 PINE CIR NEWVILLE PA 17241-9480 EST. OF SHIRLEY G ROBBINS SSN 143-22-5211 DATE OF DEATH 10-16-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS © CHECKING TRUST CERTIF. ACNB 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 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. 2293773 Date 07-30-2007 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance $ 5, 312.53 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 2, 656.27 months of the decedent's date of death, Tax Rate X , lrj deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ 398.44 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO 'RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT 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. C ONE BLOC K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return D N L Y filed by the estate representative. C. ~ The above informs ion is incorrre~ct and/or debts and deductions were paid. Complete PART ~ and/or PART 3LJ below. 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 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS i 1 2 $ 3 X ~._._._-- _. 4 $ _- _. 5 6 $ 7 X 8 $ PAD OFFICIAL USE DNLY U AAF PA DEPARTMENT OF REVENUE 1 2 3 4 5 6 7 8 PART DEBTS AND DEDUCTIONS CLAIMED 0 HATE PAID PAYEE DESCRIPTION AMOUNT PAID IUTAL ltnier Un LlfIC a ,,,r...a. 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 ) WORK C ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE 0 J ." ~,' ` l :r- ~ ~ 'R~ ~ :, ~ c~ ~' ~ ° ~~ G-- 0 d c°. ~ L~ ~,, ~- a ~ ^- i~„ C~ < ~cr)r w~4 ~Q 7 - ~ Ur. `_` -_ C_:- c~ c~+ O P J 2 d Z ~ ~: r' /~ .,.., .,.., !, ~i ~t; °: iii .,.., ;•~.. .,.., l