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Home My WebLink About07-12-12REV-1162 EX(11-961 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: WEAVER DORIS J 3514 RITNER HIGHWAY NEWVILLE, PA 17241 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ACN ASSESSMENT CONTROL NUMBER -------- fold ESTATE INFORMATION: FILE NUMBER: DECEDENT NAME: DATE OF PAYMENT: POSTMARK DATE: COUNTY: DATE OF DEATH: SSN: 162-22-2988 2112-0765 MOUNTZ M I 07/ 12/ 2012 07/11 /2012 CUMBERLAND 05/16/2012 TOTAL AMOUNT PAID: REMARKS: CHECK#1589 SEAL INITIALS: CJ RECEIVED BY: NO. CD 016249 AMOUNT $41.69 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ..... - -. BUREAU OF INDIVIDUAL TAXES ~~~` PO BOX 280601 HARRISBURG PA 17128-0601 (~'.~j ~~4F'~v~ I ,~~~~154b'EX ~p <O~i ~l I~~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE No. 21 ~~~ AND ACN 12136538 TAXPAYER RESPONSE DATE 06-18-2012 ~p12 JUL 12 PM 12~ 16 QRPi-~A+v ~ Cvt~ ~ ~UMBER~ND C~'. PA DORIS WEAVER 3514 RITNER HWY PA 17241-9120 NEWVILLE EST. OF M I MOUNTZ SSN 162-22-2988 DATE OF DEATH 05-16-2012 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST ^ CERTIF. PNC BANK N A 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 ouse'h in PART 2 f 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 "sp it touthelabove addressrmaPleasesca11o717~787p8327ew~thaquestionsn correction from the financial institution, attach a copy to this form and return COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS _ ___ Account No. 5004698859 Date 01-12-2005 To ensure proper credit to the account, two copies of this notice must accompany Established payment to the Register of Wills. Make check Account Balance $ 1 ~ 853 • 00 payable to "Register of Wills, Agent". X 5 0 ' 0 0 0 NOTE: If tax payments are made within three Percent Taxable Amount Subject to Tax $ 926.50 months of the decedent's date of death, . 0 4 5 deduct a 5 percent discount on the tax due. Tax Rate X Any inheritance tax due will become delinquent $ 4 1 , 6 9 nine months after the date of death. Potential Tax Due TAXPAYER RESPONSE PART _ ~ F14ItURE' TO RESPOND. WILi.~RESULT IN AN ~OF,FICIAL TAX'ASSESSMENT CHECK ONE C BLOCK ONLY A,~The above information and tax due is correct. Remit vavment to the Register of Wills with two copies of this notice to obtain 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. g, ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return filed by the estate representative. C The above informs ion 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 relationship to decedent: TAX RETURN - CALCULATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Sub]ect to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due PART DATE PAID PAYEE DEBTS AND DEDUCTIONS CLAIMEu DESCRIPTION AMOUNT PAID s TOTAL CEnter on Line 5 of Tax Computation) Under penalties of perjury, I declare that the facts I reported above are t, e,2cor~ ~ndO ~ ~ ~ /~ HOME C~ I7 ~d" (0000 ` co~mJ _te tooth b~ s(t~of my knowledge and belief. , ~_/~ / ~~ l~~?Y/!~'~ "-"-~ /1/ ~ WORK C TELEPHONE NUMBER DATE ~` DFP3~IAL IJSE Ot~IL~`r=_:~ AAF ~'iq~P,.A~:bEP~RT,~'lEhl7,;fl{R,F_rVENUE .. ~- ~ ~, 1 tSY~k ;!~ x ~,~s x ~ ° s ~, r .: ~ y .,~vr> .~..~9t' ~' arm r ~ "+" `" 4 '~ xUr ~yii 1. .fsz ~ ~~ ~ Scs ,4 x -. 4~~„ . 8 7 OF TAX ON JOINT/TRUST ACCOUNTS P 1 ; 2 $ 3 X 4 $ 5 6 '~ r 7 X B $ ~,~; ~i~ ~ .~ ` + E ~,: iS ~ ! z O ~~ ~. 'r k ~> `~ ~i;~~C ?~El~ JJ~ 12 FM 12~ a a L c~~~~~t~ ~ ~,1 ~..~-~j c~~~~ ~ co.. ~ l ~ v^ v V 1 ~~ ^~ \ +'' ~ y tq~ (~{~ lF t3 :'3 :'} t'x "t ~".. .~~