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Home My WebLink About08-24-12 (2)COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TA%ES DEPT. 260601 HARRISBURG, PA 1 ]126-0601 RECEIVED FROM: KOONS MICHELLE C 121 N SAINT JOHNS DRIVE CAMP HILL, PA 17011 /nIJ PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: ssnt: t9t-i2-528t FILE NUMBER: 2112-0686 DECEDENT NAME: PFLUGER MAGDALEN M DATE OF PAYMENT: 08/24/2012 POSTMARK DATE: 08/24/2012 COUNTY: CUMBERLAND DATE OF DEATH: 06/08/2012 REV-1162 EX111-961 NO. CD 016424 ACN ASSESSMENT AMOUNT CONTROL NUMBER 12138357 ~ 54,888.43 TOTAL AMOUNT PAID: REMARKS: CHECK#102 SEAL INITIALS: HEA RECEIVED BY 54,888.43 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES PD BOX 280601 HARRISBURG PA 17128-0601 pennsylvania OE PAPTMENT DF flEVENUE PEV -1563 EY YrP (05 -I1] PENNSYLVANIA INHERITANCE INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ND. 21 ACN 12138357 DATE 07-02-2012 MICHELLE C KOONS 121 N SAINT JOHNS DR CAMP HILL PA 17011-1932 EST. OF MAGDALEN M PFLUGER SSN 191-12-5281 DATE OF DEATH 06-08-2012 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. SUSQUEHANNA HANK provi tled the department with the information below, which was usetl in calculating the inheritance tax tlue. Recortls indicate that at the death of the above-nametl tlecetlent, you were a joint owner/beneficiary of this account. If yoU ere the spouse of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax nay 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" 1n PART 2. If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form antl return it to the above address. Please call 717-787-8327 with pugs ti tins. COMQLETE PART 1. BELOW.* SEE REVERSE SIDE FOR FILING AND PAYMEN T. INSTRUCTIONS Account No. 3000062182 Date 11-01-2887 To ensure proper cretlit to the account, two Establishetl copies of this notice oust accompany paywent to the Rapist er of Wills. Make check Account Balance ~` 68 609.60 3 payable to "Rami star of Wills. Agent". Percent Taxable X 50.000 NOTES If tax paywenks are matle within three Amount Subdect to Tax S` 34 i 304.80 months of the decedent's date of death, Te% Rate X , 1 5 deduct a 5 percent discount qn the Tax due. A'ry inheritance tax due will become delinquent Potential Tax Oue $ 5, 145.72 nine months of Ser khe dake of death. PART TAXPAYER RESPONSE ~ ^ -z7 N ; n A. ~ The above inforwation and tax due is correct. 9 ~ r,7 Resit pave ant to the Re sister of Wills with two copies of this notice to 3471 ~ ,a [~ a da scount or avoid anteres4, o(`, return this motice to the RaBister of Wfl gyyy~f ' [h'I (T1 CHECK an official assessment wIIl be issued by the PA Depa rtwenY of Revenue. L 1 ~ ;v C~3 ONE " [ BLOCK B. ~ The above assek has been or will be ratio rted and tax paid with the Pennsvlvana ` (/I h¢rita [ nce t~ retura- ONLY filed by the estate raoresentati ve. G _ ~ -}+ ._. `°. 0. ~ The above infor~na ion is incorrect and/or debts and detluctions were paitl. OC_ - xi '- ..- '~ ."_ {T{t `n Complete PART lJ antl/or PART 3^ below. .9 w - ppg7 If indicatinH a cram ax ra e, p ease s a e r""",~'°~ i ~E~it ~ ~4 ~! ~ ^ relationship to decedent: ~~ ' 4'~ y' j `11I~ 1 ~ ~~ TAX RETURN - CALCULATION OF p ' TAX ON JDINT/TRUST ACCOUNTS ~/ ^ ~ ~ ~ LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 S 7. Tax Rata 7 X 8. Tax Due 8 S nder penalties of a ury, I declare that the facts I reported above are true-,7corrlect and qg pl to the b pf my knowledge and belief. HOME C f ) / ~ { - l L ~~-- WORK ( ) / TAXPAYER SIGNA}URE TELEPHONE NUMBER ATE PART UtC1J AMU Ub'.V UI:I3U1'iJ f:LA 117GL DATE PAID PAYEE DESCRIPTION AMOUNT PAID