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Home My WebLink About05-07-12 (3)COMMONWEALTH 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(11-961 NO. CD 015945 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: 03/29/2012 REMARKS: CHECK#569 ACN ASSESSMENT AMOUNT CONTROL NUMBER 12127024 ~ 5184.06 TOTAL AMOUNT PAID: 5184.06 INITIALS: HMW SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS F~ PENNSYLVANIA INHERITANCE TAX BUREAU OF INDIVIDUAL TAxES ~ INFORMATION NOTICE Po eox zao6ol ~~'1~]~~/i~V'dCyj"c7,~ ~~ AND HARRISBURG PA l~lzB-ocol oavnRjn+~NroFaEyEraue,, ~, ~ ~, TAXPAYER RESPONSE kE0-1543'EX~APP (0'S =11) ~~J FILE N0. 21 '" /Z '~3Z ACN 12127024 DATE 04-23-2012 CL~~~' ~_ ,,,,,, ~ LORI M SHORT 71 SMITH RD NEWVILLE PA 17241-9506 EST. OF MURRAY E MICHELSDN DATE OF DEATH 03-29-2012 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT ^ savlNGs ^ CHECKING ^ TRUST CERTIF. PN C 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 y0U 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. 1205274763 Date 11-09-2009 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ ~ 611.00 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to TaX NOTE: If tax payments are made within three $ 4,305.50 months of the decedent's date of death, Tax Rate )( .045 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ 193.75 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPDND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT A. ('~(( The above information and tax due is correct. ~~1y1 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. 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 ~ below. PART If indicating a different tax rate, please state OFFICIAL USE ONLY ^ AAF relationship to decedent: PA DEPARTMENT OF REVENUE TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established I 1 2. Account Balance 2 $ 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ 4 5. Debts and Deductions 5 S 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 7 8. Tax Due 8 $ $ PART DEBTS AND DEDUCTIONS CLAIMED ^3 DATE PAID PAYEE DESCRIPTION AMOUNT PAID ider penalties of perjury, I declare that the facts I reported above are true, correct and t ~m 1 to to the best f my knowledge and belief. HOME C7~? ~ 77~p~~0~~ ( 1_^~ WORK C 7~7 ) yi~$_ 7~,p 2 12 ~`~rNNN PA E SIGNATURE TELEPHONE NUMBER DATE TOTAL (Enter on Line 5 of Tax Computation) S ~ ;~ ~ N. ~. o m ~ =• v~~ Dam s N ~ A w.~. ~"'t F•'• csr ~~, ~r cAr ~~r stir ~ l ..... A ~.. . n . ~ M ~~ ~ ~- 7 r J ~ d vA F u W A ~`) Q~~~~ ''~,i i~ i~f10~ ~, ~~ ~ ~!~d0 ~C ; ~~1J ,_ . , ~~.,,~ i~; s ~: .: -. ~~ ~~ c a C,.Cia . _ 1~.