HomeMy WebLinkAbout05-07-12COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11-96)
N0. CD 015943
SHORT WILLIAM M
71 SMITH RD
NEWVILLE, PA 17241
fold
ESTATE INFORMATION:
FILE NUMBER: 2112-0532
DECEDENT NAME: MICHELSON MURRAY E
DATE OF PAYMENT: 05/07/2012
POSTMARK DATE: 05/04/201 2
COUNTY: CUMBERLAND
DATE OF DEATH: 03/29/201 2
REMARKS:
CHECK# 617
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
12128705 ~ 533.17
TOTAL AMOUNT PAID: 533.17
INITIALS: HMW
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES (~~ )',"r
PD eox zao6ol penri~rlVanl
HARRISBURG PA 17128-D601 DERARTM EI~F{~DF.i~~LENU e
REV-1543 EX AFP (OS-11)
PENNSYLVANIA INHERITANCE TAX
IrNFORMATION NOTICE FILE N0. 21
~'i ~ ~~{ AND ACN 12128705
`c TAXPAYER RESPONSE DATE 04-30-2012
~:
EST. OF DONNA B WILLIAMS
C~~tS~ r,t SSN
O~F~L~ \~,` ` ~~'~! DATE OF DEATH 0 3 - 12 - 2012
Cl'~p~,C~~ ~,~I;~'„`.~ DA COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
GREGORY R WILLIAMS REGISTER OF WILLS
122 CAMBRIDGE DR 1 COURTHOUSE SQUARE
MECHANICSBURG PA 17055-3560 CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
PNC BANK NA 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 I BELOW * SEE REYEI2SE SIDE FOR FILING AND NAYMENT INSTRUCTIONS
Account No. 21001016280 Date 01-28-1988 To ensure proper credit to the account, two
Establ ished copies of this notice must accompany
Account Balance $` 4
656
00 payment to the Register of Wills. Make check
,
. payable to "Register of Wills, Agent".
Percent Taxable X 16.667
Amount Subject to Tax
$
776 • U2 ~[~~
!V'lDTE: If tax payme4_ts are made within thre
months of e decedent's,,, date of death, ~
~
7
~~
Tax Rate X . 045 deduct a 5 percent disc nt on the tax due.
~
i
Potential Tax Due
$
34.92 Any inhe a will become delinquent
nine months after the date of death.
PART TAXPAYER RESPONSE
FAILURE TO RESPOND WILL RESULT IN AN OFF ICIAL TAX ASSESSMENT
A. M The above information and tax due is correct.
I~ 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
an official assessment will be issued by the PA Department of Revenue.
O N E
~
BLOC K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
0 N L Y filed by the estate representative.
C. ~ The above information is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART 3~ below.
PART
TAX
LINE
If indicating a different tax rate, please state
relationship to decedent:
RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS
1. Date Established
2. Account Balance
i. Percent Taxably
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
1
2 $
3 X
4
5 -
6
7 X
8 $
OFFICIAL USE ONLY ~ AAF
PA DEPARTMENT OF REVENUE
PAD
1
2
4
5
6
7
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation) $
Under penalties of perjury, I declare that the facts I reported above are true, correct and Th~
c mplete to the best of my kn wledge and belief. HOME C~f ~ ) ~(j~~' ,~i 1~, t~V
~, L'J ~., WORK ( -]f' ~ oc3~' -l~t~ 5 -.S "'
TAXPAYE SI NATURE TELEPHONE NUMBER DATE