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Home My WebLink About08-22-12COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TA%E6 DEPT. 280601 HARRISBURG, PA 1]128-0601 RECEIVED FROM: MARTIN LINDSAY R 1615 PINE ROAD CARLISLE, PA 17015 role ESTATE INFORMATION: ssN: aRR-s2-olae FILE NUMBER: 2112-0921 DECEDENT NAME: MARTIN GLADYS DATE OF PAYMENT: 08/22/2012 POSTMARK DATE: 08/21 /201 2 COUNTY: CUMBERLAND DATE OF DEATH: 05/ 1 1 /201 2 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT 101 ~ 5541.26 REV-1162 EXI11-961 NO. CD 016418 AMOUNT ACN ASSESSMENT CONTROL NUMBER TOTAL AMOUNT PAID: REMARKS: 5541.26 CHECK# 3850 INITIALS: HEA SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BURFAO OF INDIVIDUAL TAXES PO BOX 280601 pen HARRISBURG PA 1712 a-0601 pEPABT PEV-1563 EY YfP (0E -11) n .1~~ MEN -,~ _ PENNSYLVANIA INHERITANCE ,`-`~-,~ ~dFORMATION NOTICE ;'r-',,A~~je AND ,. `.~.~JfAXPAYER RESPONSE +~12 AUG 22 PM 121 ORPFiAN'~ '~OUFiT CUMBERLAND CO., PA LINDSAY MARTIN 1615 PINE RD CARLISLE PA 17015-9324 FILE N0. 21 ACN 12144971 DATE 08-14-2012 EST. OF GLADYS MARTIN SSN 488-62-0135 DATE OF DEATH 05-11-2012 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS TD: REGISTER OF WILLS i COURTHOUSE SpUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. M a T BANK provitletl the department with the information below, which was usetl in calculating the inheritance tax tlue. Records indicate that at the death of the above-named decedent, you were a joint owner/benefi <iary of this account. If you are the Spouse Of the deceased and any amount other than zero 1s reflected below on the Potential Tax Due line, note no taz may be due, but you must notify the deDa rtment 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 address. Please call 717-787-8327 with cuesfi ono. COMPLETE PAR T1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 773298 Date 11-01-1971 To ensure proaer credit to the account, two Establishetl copies of this notice oust acconpanv Account Balance 24,055.84 payment to the Register of Wills. Make check a}` oar able to •'Re9i ster of Wills. Agent". Percent Taxable X 50.000 NOTE: If tax payments are Wade within three AmOUnt $ubd0<t to Tax S 12,D27.92 nonkhs of the decedent's date of tleakh, Tax Rate X . 0 4 5 deduct a 5 percent discount on the tax tlue. Am inheritance kax due will become tlelinauent Potential TaX DUe $ 541.26 nine nonkhs after the tlaka of death. PART TAXPAYER RESPONSE 1^ A. The above information and kax tlue is correct. Remit payment to the Register of Wills with two copies of this notice ko obtain a discount or avoid interest, or return this notice ko the Repisker of Wills and CHECK r an official assessment will be issuetl by khe PA Da pa rtment of Revenue. I ONE L BLOCK B. ~ The above asset has been or will ba reported and tax paid with the Pennsylvania inheritance tax return ONLY filed by the estate representative. C. ~ The above info rna eon is incorrect and/or tlebts and detluc4ions were paid. Complete PART 2~ antl/or PART ~ below. PART If 3ntlicatin9 a different tax rate, please state relationship to decedent: TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 S 3. Perce r.k Taxable 3 X 4. Ampunt Subject to Tax 4 +t 5. Debts and Deductions 5 6. Ampunt Taxable 6 7. Tax Rake 7 X 8. Tax Due 8 $ Untler penalties of perjury, I declare that the facts I reported above are true, ~<qor re ct/~a(~n''1fd)~ com~plet~e to the besEt~/"/"o~/f~ my knowledge antl belief. HOME C `'/I"j_) ~~w ~ ~T'S~3 !2 ~ z "/~ WORK ( "7/7 1 e`l~~ .~OD/ 2[~,fnf. ,t}20~2 1X AYER GNATURE TELEPHONE NUMBER ` DATE f°" PART DEBTS AND DEDUCTIONS CLAIMED ^3 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Iwmr ~~ t.: w~ ~S ~ [ .VPNIPr~IXn [¢ iA~" W~:. }~ 1' ~~ ~ ~p"v K ~ _~ V ~ ~ U \' ' ~~ x'~ C,~ N i~ r v n~ W/ ,] c~ Z r a ,~ O lJ J a 4 ~,, :i~wa Zz ~n~',~az ~,- '~,~13u j~, ,., in ~~ :Y, t M J