HomeMy WebLinkAbout07-17-12COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1]128-0601
RECEIVED FROM:
ENGLEMAN SALLY A
PO BOX 167
WEST MILTON, PA 17886
foie
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ESTATE INFORMATION: sSN: 178-36-0103
FILE NUMBER: 211 2-0778
DECEDENT NAME: SHIRK CHERYL J
DATE OF PAYMENT: 07/17/2012
POSTMARK DATE: 07/16/2012
CouNTY: CUMBERLAND
DATE OF DEATH: 06/07/2012
ftEV-1162 EX111-961
NO. CD 016266
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
12137189 ~ 5769.95
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 8697
SEAL
INITIALS: HEA
5769.95
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
~ PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE FILE No. 21
BUREAU OF INDIVIDUAL TAXES ~ ~1 )~ ~ ~,--
PO BOX 280601 PE11115~/LV f^X"= .^~"~rE ~ AND ACN 12137189
HARRISBURG PA lnze-BeBI OswABrnswt ofH ~9 tr ~ ~ 4,~tycPAYER RESPONSE
`~ DATE 06-21-2012
RE Y -1543 E% /.FY <Y5 -]I)
Ql2 JUG. f 7 PM 1?.. 26
~'y p~ ~ 'LI"~i
WRHB~-~~ Mn
MICHAEL F ENGLEMAN
PO BOX 67
WEST MILTON PA 17886-0867
EST. OF CHERYL y SHIRK
SSN 178-36-0103
DATE OF DEATH 06-07-2012
COUNTY CUMBERLAND
REMIT PAYMENT AND FURMS TU:
REGISTER OF WILLS
1 COURTHOUSE SgUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
WEST MILTON STATE BK provided the de Oa rtment with the information below. which was usetl in calculating the inheritance tax due.
Recortls indicate that at the death of the above-named tlecedent, you were a Jot nt owner/beneficiary of this account. If y0U are the sDOUSe 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 atltlress. Please call 717-787-8327 with 0uesti ons.
COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 33198 Date 06-18-2009 To ensure orooer cretlit to the account, two
EstablSShad cooias of this notice oust accompany
Account Balance 13%507.77 Pavnenk to the Register of Wills. Make check
~` Day able to '•Regi ster of Wills, Agent".
Percent Taxable X 50.000
Amount Subjeet to Tax SY 6,753.89 NDT E, If 'r ax Payments are Wade within three
months of the tlecetlent's tlate of tleat h,
Tex Rate ~ ~( 1 2 tletluck a 5 Percent di seount on the tax due.
Potential Tax Due ~Gg•q ~` 810.47 Any inheritance tax due will become tlelinouent
nine months attar the data of death.
PART TAXPAYER RESPONSE
Untler penaltSes of erjury, I tleclare that the facts I reported above fare true, correcpt~and y
complete t th b y knpwbelief. HOME (1~7d) ~~a ~0~0
WORK C )
.NAT RE TELEPHONE NUMBER DATE
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
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