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Home My WebLink About04-03-12COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: COULSON DELORES J 616 HIGHLAND AVE CARLISLE, PA 17013 told PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX111-961 NO. CD 015788 ACN ASSESSMENT AMOUNT CONTROL NUMBER ESTATE INFORMATION: sSN: 173-o1-55s7 FILE NUMBER: 2112-0393 DECEDENT NAME: COULSON GEORGETTA J DATE OF PAYMENT: 04/03/2012 POSTMARK DATE: 03/03/201 2 COUNTY: CUMBERLAND DATE OF DEATH: 03/ 1 9/201 2 REMARKS: CHECK# 7713 SEAL 12122518 ~ 5228.33 TOTAL AMOUNT PAID: INITIALS: HEA RECEIVED BY 5228.33 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES PD BOX 280601 Pe~_ HARRISBURG PA 17126-0601 DEPARTMt{tE,p7~96~R REV-I54~~E~11~P PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 21 ~~ ~~ ~`"'~ ~F TAXPAYERNRESPONSE ACN 12122518 uE'`y - ,,,i,i, ~ J DATE 03-30-2012 ~~~~i? ~rR -3 P~ i ~ I t1 CLERK {~~ oRP~v's couRT Cl)M#~MF~I ~lrvir,:;~ PA JACK COULSON 616 HIGHLAND AVE CARLISLE PA 17013-4107 EST. OF GEORGET'fA J COUiSON SSN DATE OF DEATH 03-19-2012 COUNTY CUMBERLAND REMIT PAYMENT AND F~DRMS T0: REGISTER OF WILLS 1 COURTHOUSE SQIJARE CARLISLE PA 1'7013 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 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 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. 157273-48 Date 10-25-2010 To ensure proper credit to the account, two Established copies of this notice :oust accompany Account Balance l U 148.15 payment to the Register of Wills. Make check ~ payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are Wade within three Amount Subject to Tax $ 5, U74. U8 months of the decedent's date of death, Tax Rate ~( , ~C+rj deduct a 5. percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due ~` 228.33 nine monthis after the date of death. PART TAXPAYER RESPONSE ^ ~ r conun. I Tr i Gur CHECK C ONE BLOCK ONLY 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 an official assessment will be issued by the PA Department of Revenue. B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART ~ and/or PART 3~ below. PART If indicating a different tax rate, please state relationship to decedent: TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD 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 1 i 2 $ ~~ 2 3 X 3 4 $ fj 5 S 6 $ 6 7 X 7 8 +~ $ OFFI ~U$E ;" PA DEPARTMENT OF R£YENUE PART DEBTS AND DEDUCTIONS CLAIMED TOTAL CEnter on Line 5 of Tax Computatilon) $ Under penalties of perjury, I declare that the facts I reported above are true, correct and complete to the best of y knowledge and belief. HOME C y~~%J ~ ~~- ~ ~~~ WORK C )'~~~ ~y-~ ~Ol`~ AX AYE SIGNATURE TELEPHONE NUMBER ATE `~ DATE PAID PAYEE DESCRIPTION AMOUNT PAID