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Home My WebLink About04-09-12COMMONWEALTH OF PENNSYLVANIA REV-1162 EXI11-961 DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 015809 MCKEEHAN TRUDY 4548 MISTY MORN CIRCLE ORLANDO, FL 32812 ACN ASSESSMENT AMOUNT CONTROL NUMBER fold ESTATE INFORMATION: ssN: 173-of-55s7 FILE NUMBER: 2112-0393 DECEDENT NAME: COULSON GEORGETTA J DATE OF PAYMENT: 04/09/2012 POSTMARK DATE: 04/05/201 2 COUNTY: CUMBERLAND DATE OF DEATH: 03/ 1 9/201 2 REMARKS: SEAL CHECK# 1366 12122517 ~ $216.91 TOTAL AMOUNT PAID: INITIALS: HEA RECEIVED BY: $216.91 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES - PO BOX 280601 D ' HARRISBURG PA 17128-0601 • e ~~~~ DEPAR Iq dT-4~~ REVENU~ ~, REY-1 ~ATa ~(RS-111 PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE AND ACN '(,i!'.!., ~ TAXPAYER RESPONSE DATE No. 21 _p a- ~~ 12122517 03-30-2012 CI.ER~C OF ORpHAN~S~~ 0 ~RTPA C111~~,~_~~ ~ , TRUDY MCKEEHAN 4548 MISTY MORN CIR ORLANDO FL 32812-7670 EST. OF GEORGETTA J COULSON SSN DATE OF DEATH 03-19-2012 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILILS 1 COURTHOUSE SQIUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. MEMBERS 1S T 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 deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due h but you must he notify the department of your relationship to the deceased by checking Box C in PART 1 bela~w and writing "spouse" in PART 2. 1f you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it io the above address. Flease call 717-757 8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 157273-41 Date 10-25-2010 To ensure ioroper credit to the account, two Established copies of this notice must accompany Account Balance ~` 10 ~ 148.15 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to TaX $ 5 ~ U74 . 08 NOTE: If +t ax payments are made within three months of 1:he decedent's date of death, Tax Rate X .045 deduct a 5 percent discount on the tax due. Potential Tax Due $ 22$.33 Any inheritance tax due will become delinquent nine month:: after the date of death. P~r TAXPAYER RESPONSE 1 AIL TO SPN~ ~ILL~~ttESULT I'N aAkl ~FF~ICiAL TAX ASSw~SSMENT A. I.J/'fhe LJ above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain C H E C K 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. B L 0 C K ~ D N L Y g, ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax ret urn filed by the estate representative. C. ~ The above infor~ m s ion is incorrect and/or debts and deductions were paid I , l Complete PART ~-~ and/or PART ~ below. . PART 1r indicating a different tax rate, please state ^2 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 a X 4 $ 5 6 $ 7 X 8 +~ OFFICIAL USE ONLY ~ AAF PA DEPARTMENT OF REVENUE 1 2 3 4 5 6 7 8 PART a DEBTS AND DEDUCTIONS CLAIMED Under penalties of perjury, I declare that the facts I complete to the best of my knowledge and belief. reported above are true, correct and ~~H~~nnO ME C f/D~~ o7~J-779 ~r,e~ ie ~ ~~~ TELEPHONE NUMBER DAT-~ E PAD DATE PAID PAYEE DESCRrprrnu ...,,,...r ... _.. sue.. r ~a3naaoi ssv~~-isaii:vzr~ ::~. ice' ~,,' R ~, ~~ I ~\ ~_ \ ~ ~~ ~v ~ 3 ,~~ . ~ '~ ~+ ~. ~~ r n ~ ~ ~- `.i 1 ~.: ~:~ ~~ ~ ~ p. ~ ~' ~,~ ~ ~ 0 K, 1 ~ F' L+v l;.t~ L1 C~ ~ ~ ~ ) to {_ ;_a i J _ ~ l' ~ C. ~- v Y W ~ ~ -~ 6y (E=~ ~ C~ 0 .~ , UN ~~'''' N ~~M ~~ t ~~ 00 ~ ~ F''~~ ...; "w .ti 1 :~ ~-3 ~~ !~} .rt E,t .~..~ r