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Home My WebLink About08-10-12COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 ]128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT MILLER THOMAS O 6209 WHITEHILL DRIVE MECHANICSBURG, PA 17050 mle ESTATE INFORMATION: ssN: z1o-as-7381 FILE NUMBER: 2112-0877 DECEDENT NAME: MILLER GERTUDE M DATE OF PAYMENT: 08/10/2012 POSTMARK DATE: 08/09/2012 COUNTY: CUMBERLAND DATE OF DEATH: 01 / 1 5/201 2 ACN ASSESSMENT CONTROL NUMBER REV-1162 EXI11-961 N0. CD 016372 AMOUNT 12143123 ~ 578.82 TOTAL AMOUNT PAID: REMARKS: CHECK#1288 578.82 INITIALS: HEA SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~ PENNSYLVANIA INHERITANCE TAX ~ ~ ~ 7 INFORMATION NOTICE J BUREAU OF INDIVIDUAL TAXES FILE NO. 21 PD BOX 280601 [~ej~nj~nsYlVania AND ACN 12143123 HARRISBURG PA laze-osol RI ~9F'7'"1'"~.~?of~1`I~.~ TAXPAYER RESPONSE DATE 07-31-2012 1fai2 AUG I 0 PM l2~ ! 5 t.~tPFU~v'S ~UuRr THOMAS o r~M~~RI-~`1D CO., PA 6209 WHITEHILL DR MECHANICSBURG PA 17050-2343 EST. OF GERTRUDE M MILLER DATE OF DEATH e1-15-2812 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17813 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. M & T BANK provi tletl the department with the information below. which was used in calculating the inhert Lance tax tlue. Records intli care that at the death of the above-nametl decedent, you were a Joint owner/beneficiary of this account. If you are the spouse 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 relati onshiD to the deceased by checking Box C in PART 1 below and wri Ling "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 address. Please call Ill-]87-8327 with euesti ons. COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS account No. 9838443308 A<counT Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due Date 11-13-2004 Estahlishetl $ 3,503.29 X 50.000 g 1,751.65 X .045 g 78.82 To ensure proper credit to the account, two copies of khis notice Husk acconpanY Payne nk to the Register of Wills. Make check payable to "Register of Wills. Agenk". NOTE: If kax payments are made within three eon the of the decedent's lake of death. tledu<t a 5 percent discount on the tax tlue. A:ar inh aritance tax due will be cone delinquent nine months after the tlate of tleath. PART TAXPAYER RESPON SE 1^ A. ~ The above inf ornation and Sax due is correct. Resit paYn ant to kha Reai star of Wills with two copies of this notice to obtain a tlisc oust or avoitl interest, or return this notice to the Register of Wills and C HEC K r an official assessment will be issuetl by the PA Oepa rtnent of Revenue. I ONE L BLOCK 6. ~ The above asset has been or will be reported and tax Daid with the Penn svlvania inheritance tax return O NLV filed by the estate representative. C. ~ The above inforna ion is incorrect and/or debts and tleduckions ware paitl. Complete PART ~2 and/or PART ~ below. PART If indicating a different tax rate, please skate 2 relatSOnshio to decedent: TAX RETURN - CALCULATION LINE 1. Date Estahlished 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts antl Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS 1 2 $ a X c $ 5 6 ~ T X U r pe alt ies of perjury I declare thak the facts I a n d re true, c or tact reported above a cam a of nowledge antl belief. to t best ~ / ~ 7 / > - ~ ~ HOME C / / 7 ) ~Yf(, `~ T~ "t / / w ~j / ' ~~ _. WORK ( ) ~~-~~. / om (/ i/ "TAXPAYER SIGNATURE TELEPHONE NUMBER DATE PART DEBTS AND DEDUCTIONS CLAIMED ^3 GATE PAID PAYEE DESCRIPTION AMOUNT PAID ~~I ~~ a~ ~~ „„ _ ;~, ~ js~ 14'.i M k44~ _ M = ~ ~. ~ _ ~, ~ ~ ~ ~ o ~~ ~~ ~}~ \ \ T ,'1~\ V(~ tT1 .y ` (.. `C ` i,`, `v, qM C \ \v' -- ae , r;;rd~ ~,? , ~ ~ a zap d ~ ~ ~ ,Z~ ~~~ ~ ~ ~ ~~ ~1`d~~ YJ~~ ,~ ____ .u~. ~. _ ~ ....