HomeMy WebLinkAbout07-30-12COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
REV-1162 EX(11-96)
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 016322
MILLER EMILY
236 S WEST STREET
CARLISLE, PA 17013
fold
ESTATE INFORMATION:
FILE NUMBER:
DECEDENT NAME:
DATE OF PAYMENT:
POSTMARK DATE:
COUNTY:
DATE OF DEATH:
REMARKS:
171-12-6166
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
TOTAL AMOUNT PAID:
CHECK# 3595
INITIALS: CJ
SEAL RECEIVED BY:
SSN:
2112-0655
MCCOY KENYON
07/30/2012
07/27/2012
CUMBERLAND
04/09/2012
58.23
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
~ PENNSYLVANIA INHERITANCE T
~~~,~~~F~I~IFORMATION NOTICE
pennsy(vania - FJ(,~ ~D
DEPARTMENT OF REVENUE ~~~~~~ ~ r ,
REV-1543 Ex AFP :05_,,, ~ _ ~:~/41~CR~1~l~'R RESPONSE
FILE N0. 2I 12_0655
ACN 12140583
DATE 07-19-2012
t~ ~~~-
EMILY M MILLER
236 S WEST ST
CA RI rc~ r
` 3Q Pfd l2: ~~
E OF KENYON MCCOY
~~"' SSN 171-12-6166
(~~1Pt~j~{~ t~~,j(Jj~~ DATE OF DEATH o4-09-2012
~MBER(.gNp COUNTY CUMBERLAND
tro,
EMIT PAYMENT AND FORMS Tn•
PA 17013-3878
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
® SAVINGS
^ CHECKING
^ TRUST
^ CERTIF.
PSECU
Records indicate that at the death of the above-named decedent,
provided the department with the information below,
deceased and any amount other than zero is reflected
notify the department Of you were a joint owner/beneficiawh~ch was used in calculatin
if you believe the information UUrineoraect n ph ease obtain wribteno~or0 action from the financial institution c aunt. 9 the inheritance tax due.
it to the above address. Please call 717-787-g3P7 w0ithhqu decceased b the Potential Tax Due line, If You are the spouse of the
Y checking Box C in PART 1 belowtandowritinay be due,
COMPLETE PART 1 9 "spouse" intPART lust
BELOW * SEE REVERSE SIDE FpR F ttach a copy to this form and return
Account No. 8005456051-57 Date ILIN6 AND PAYMENT IN
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
PART
u
FAIL(1~E~ TO
To ensure proper credit to the account, two
copies of this notice must accompany
payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
NOTE: If tax payments are made within three
months of the decedent's date of death,
deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
nine months after the date of death.
E
WILL RESULT IN AN OFFICIAL TAX
A• ~ The above information and tax due is correct. AS S E S ~ T
CHECK Remit payment to the Register of Wills with two co
C a discount or avoid interest, pies of this notice to obtain
0 NE ~ an official assessment will beoissuedrb this notice
BLOCK v the PA Department ofgister of Wills and
0 N L Y B' ^ The above asset has been or will be reported and tax Revenue.
filed by the estate representative, paid with
the Pennsylvania inheritance tax return
C• ^ The above informs ion is incorrec,t and/or debts and deductions were
Complete PART 2~ and/or PART 3LJ below.
PART If indicatin„ ~ paid.
L=.1 relationshi " 1O1eni tax rate, please s-
u P to decedent: -
TAX RETURN - CALCULATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4• Amount Subject to Tax
5. Debts and Deductions
6• Amount Taxable
7. Tax Rate
B. Tax Due
penr
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4
5
6
7 X
8 ~`
CIAt~, USE mflNLY
PA DEPARTMENT OF ^ AAF
PAD REVENUE
1
2
3
4
5
6
7
~~ g .~
30 DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of
Under penalties of Tax Computation)
complete to the perjury, I declare that the facts 8
best of my knowledge and belief. I reported above
are true, correct and
HOME ( ~
AXPA ER S AT RE WORK
/I~..,_ ~
Established
04-11-1989 STRUCTIONS
$ 365.92
X 50.000
$ 182.96
X
$ .045
T 8.23
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