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Home My WebLink About06-04-12COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 7 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX111-96) NO. CD 016059 ECKERT KAREN J 918 EMILY DRIVE MECHANICSBURG, PA 17055 ,o~d ESTATE INFORMATION: s FILE NUMBER: 2112-0622 DECEDENT NAME: VERBOS ELLEN M DATE OF PAYMENT: 06/04/2012 POSTMARK DATE: 06/01 /201 2 couNTY: CUMBERLAND DATE OF DEATH: 03/26/201 2 REMARKS: ACN ASSESSMENT AMOUNT CONTROL NUMBER 12502360 ~ 5901.34 TOTAL AMOUNT PAID: 5901 .34 CHECK# 4171 INITIALS: HMW SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA ,/~ DEPARTMENT OF REVENUE INFORMATION NOTICE .--~//- ~/~~ BUREAU OF INDIVIDUAL TAXES 1~1C~ FILE NU. 21 ~,( PO BOX 280601 HARRISBURG PA 171zs-o6ol ~ " ~ ! AXPAYERNRESPONSE ACN 12502 60 i'sa#,r'n ~~ ~~' ~, ~. DATE 05-28-2012 ~'%! 2 JEIN - 4 ~~~ ! 1~ 5 t ~4 ~~IJmQGf7Ll~lvt.l ~., KAREN J ECKERT 918 EMILY DR MECHANICSBURG PA 17055-5707 TYPE OF ACCOUNT EST. OF ELLEN M VERBOS ~ SECURITY DATE OF DEATH 03-26-2012 ^ STOCK COUNTY CUMBERLAND ^ soNDs REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 T D AMERITRADE has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a beneficiary of this asset. If you feel this information is incorrect, please obtain written correction from the transfer agent, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW ~ * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 928-018250 To insure proper credit to your account, two (2) copies of this notice must accompany your 21 ~ 084.00 payment to the Register of Wills. Make check DOD Valuation payable to: "Register of Wills, Agent". Percent Taxable X 100.00 NOTE: If tax payments are made within three Amount Subject to Tax 21 ~ 084.00 (3) months of the decedent's date of death, Tax Rate X .045 you may deduct a 5% discount of the tax due. Any inheritance x ue wi 1 become delinquent Potential Tax DUe 948.78 nine (9) months after the date of death. PART TAXPAYER RESPONSE 1^ FAILURE TO RESPOND wILL RESULT IN AN OFFICIAL TAX ASSESSMENT BASED ON THIS NOTICE A. The above information and tax due is correct. 1. You may choose to 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 you may check box "A" and return this notice to the Register of 0 N E Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 C K ~ B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ^3 below. PART If you indicate a different tax rate, please state your OFFICIAL USE ONLY ^ AAF relationship to decedent: PA DEPARTMENT OF REVENUE TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSET(S) pAD LINE 1. DOD Valuation 1 1 2. Percent Taxable 2 X 2 3. Amount Subject to Tax 3 3 4. Debts and Deductions 4 - 4 5. Amount Taxable 5 5 6. Tax Rate 6 X 6 7. Tax Due 7 7 8 PART DEBTS AND DEDUCTIONS CLAIMED ^3 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties mplete to ~he best --r, i TAXPAYER ~IGNATURE perjury, I declare that the facts I have reported above are true, correct and m knowledge and belief. HOME C`I!~ ) 7lF'~~ 1~~~~ 2~ woRK c'i~7 ) .~l~-i~ y~~'~,) c~-~'~1 :~-i-j:~ TELEPHONE NUMBER DATE IUINL itnter on Line 5 of lax Computation) 5 M•~• ....' w• `` G} ~"'~ ~) ~: ~' (a} ~ ) (~ t~l ~ ~- tLl _~~ . - hy ,~ ~~ ~ ~ ~l ~ '7 ~~ ~._ ~~~ ~,~: ._~ ~ ~« .,.f- ,~° _ ~ l' ~ ~~ _ .~ ~~ ~ . I~~ s •.a c'.' w.s J ~ .Z.i n Cq "S m `' 5 @. ~' `G R ~ d 5 G y ~ m b ~ ~ n K O v~ J O ~~ C.'~%' G ~~ ~C ~r- ' T'i wxr ,~ ~,,~ ~... c-... r .~ s~ E,j .w 'Y? ~'" ~'~a. i I r i i F I f