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Home My WebLink About04-04-12COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280801 HARRISBURG, PA 17128-0801 RECEIVED FROM: HURST PHYLLIS L 950 ROUSER RD FAYETTEVILLE, PA 17222 _-_--_._ foW PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) NO. CD 015795 ACN ASSESSMENT AMOUNT CONTROL NUMBER ESTATE INFORMATION: FILE NUMBER: 2112-041 1 DECEDENT NAME: SHOAP MABEL V DATE OF PAYMENT: 04/04/2012 POSTMARK DATE: 04/03/2012 COUNTY: CUMBERLAND DATE OF DEATH: 02/20/2012 REMARKS: 12122656 ~ 52,476.00 TOTAL AMOUNT PAID: 52,476.00 CHECK# 2239 INITIALS: HMW SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~ PENNSYLVANIA INHERITANCE :.T INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES PO BOX 280601 p ~y ~ AN D HARRISBURG PA nlzs-o6o1 )}.»~~~~J~~ ~~ TAXPAYE R RE S P O N S E ~t iRFy'•1343 Ex I1FP~.f/d~1~7! FILE N0. 2YI Q~-011 ACN 12122656 1 DATE 04-02-2012 `~ ; ~aRf~`~ T PHYLLIS L (HUR~~~.~ip ~'~:' PA 950 ROUSER RD FAYETTEVILLE PA 17222-9790 EST. OF MABEL V SHOAP DATE OF DEATH 02-20=20Y2 COUNTY` CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILES 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. M 6 T 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 spOUSg OP the deceased and any amount other than zero 1s reflected below on the Potential Tax Due line, note no tax may be due, but yyou nust notify the department of your relationship to thA 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 fora and .return f ___ it_to..the .above aQdress.. Please call 717-787-6327 with questions. ~~ x_ , ~~,r ~~ . COMPLETE PART 1 BELOW *'$EE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. .9833865851 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due Date 11-10-2003 Established $ 43,438.59 X 50.000 $ 21,719.30 X .12 S 2,606.32 To ensure proper credit to the account, two copies of this notice aunt accoapany payaent to the Register of Wills. Make check payable to "Register of Wills, Agent". NOTEa If tax payaents aro aade withie three aonths of the decedent's date of death, deduct a 5 percent discount oh the tax due. Amr inheritance tax due will bacoaa dalipquent nine ronths after the date of death.' A. The above inforaation and'tax due is correct. Reait payaent to the Repistgr of Wills with two copies of this notice tp obtairc CHECK a discount or avoid interest, or return^tliis notice to the Register of Wills and ONE an official assessaent will De issued by the PA Departaent of Revenue. BLOCK ~ B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return ONL Y filed by the estate representative. C. ~ The above infona ion is incorrect and/or debts and deductions were paid. Coavlete PART ~ and/or PART ~ below. PART If indicating a different tax rate, please state relationship to decedent: TAX RE TURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established - 1 2. Account Balance 2 4. Amount Subject to Tax 4 ~ 5. Debts and Deductions 5 - 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 ~ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID - , ~ .: ~ _ ~ T:OTAt CEnter bn Ling S at Tax CO1MPukation) t Under penalties of perjury, I declare that the facts I reported above era true, cdrr•ect and'. ` coMplete to the best of wy knowledge and belief. o~ ,7 ) 3 ~ 02 3l^~ ~~ HOME C ~i Vic) c~ o~~2.e.t/~..t'- WORK C ) , : ~ ~ a - a"10 / ~ JCXPA R SIGNATURE TELEPHONE NUMBERDATE - '~ 1. y ` ~~" t~ ` ' ~ ~ = f ~' C , t # ~i r i x ~ ~ ~ ~ ~ ` ; i~t ~I t f t ' Sl :7 '.r ~ ~~r iL 4~r ~! _ ~ ~~ i 1 s `~`L ,~ f ~ 1 ,p. F"T ar-y ~ . _` yy ~ ` ~' ~ ~ - C - O u "" ~ ~ ~ l . _ ~ ~ R` ' ~ ~ J, ~ a~. ~F ~ , r :,~ } . "~4 ~ a1y F T i. Y7g1 L ~~ ~ I ) ,, ~ ~ I ` ~ yy .F .. ~ - ~ .~+5 i j r J ~ C~']f .• ,``~„ r "^ ~,'~' .: 1~ I~j :,~ y :~ r .~ .. ,, ~ f l~ ~ n....., _ r_ { r