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Home My WebLink About06-08-12COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 016086 ECKERT KAREN J 918 EMILY DRIVE MECHANICSBURG, PA 17055 -------- fold ACN ASSESSMENT AMOUNT CONTROL NUMBER 12502237 ~ 55,130.00 ESTATE INFORMATION: DECEDENT NAME: VERBOS ELLEN M DATE OF PAYMENT: 06/ 1 1 /201 2 POSTMARK DATE: 06/07/201 2 COUNTY: CUMBERLAND DATE OF DEATH: 03/26/201 2 REMARKS: CHECK# 101 SEAL TOTAL AMOUNT PAID: INITIALS: HMW REV-1162 EX(11-961 55,130.00 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMDNW EA LTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '~~ ~ J1 1" BUREAU DF INDIVIDUAL raxES ~[/~ , -,~~ ~INFORMA AND NOTICE FILE N0. 21 °~~ ~ PD Box zso6ol TAXPAYER RESPONSE ACN 12502237 HARRISBURG PA 17126-0601 [1~~ ~ r_ !?,J(! It ti,u''[`` 1; ,~', ~,~' DATE 05-29-2012 REV-1543A AFP (]-00) ~Gi2 ~~~ _8 ~~ 3~ ~~ TYPE OF ACCOUNT EST. OF ELLEN M VERSOS ~ SECURITY S.S. N0. ^ SEC ACCT "ti'~`.' ~' " DATE OF DEATH 03-26-2012 ^ STOCK 0~~~~`~ '''~"~~ COUNTY CUMBERLAND ^ BONDS Cl1M~Rl.~;D ~., PA REMIT PAYMENT AND FORMS T0: KAREN J ECKERT REGISTER OF WILLS 918 EMILY DR 1 COURTHOUSE SQUARE MECHANICSBURG PA 17055-5707 CARLISLE PA 17013 AMERICAN FUNDS 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. 81810481 To insure proper credit to your account, two (2) copies of this notice must accompany your DOD Valuation 120 ~ 000.00 payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". Percent Taxable X 100.00 NOTE: If tax payments are made within three Amount Subject to Tax 120 ~ 000.00 (3) months of the decedent's date of death, TaX Rate X .045 you may deduct a 5!_ducqunt of the tax due. Any inheritance tax due will become delinquent Potential Tax Due 5400.00 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 ~ 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 ASSETCS) 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 r~ 6. Tax Rate 6 X 6 7. Tax Due 7 7 8 PART DEBTS AND DEDUCTIONS CLAIMED ^3 DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) S Under penalt}.€~s of perjury, I declare that the facts I have reported above attre true, cor/re,ct and complete ~:dl, the e t f my knowledge and belief. HOME C 7~~ ) 7`QlQ - i +~~ / " WORK C '-7 ~ ) ` ?jdU3 ~ "~(} , TAXPAYER GNATURE TELEPHONE NUMBER ~ tiT ~~~ ~ DATE ~_ 1 r O0 y ~- m a ~ x ~. ~ a o: ° F: U ~ n a r. A J M O v~ in J O J (..~. ~~~~ \j / (al ~- ~ 1 ~ ~h, , ry Li tai ~~ ~ i L%~ n * a ~~,~ _ C -. l i} .~' + ~ ~ ,-- ~ ~ - ~} - ~ ',J y/~ CJ ~ { \J l~ j ~ L. ._._:;~ l __ ~. C~~ ;~ ~' :N: j', •~f ~.:i. r' ~ 4L x ( .' ti :{1 K t : 1~ ~ # i! i f 1 i `~ #~ i - . ~