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HomeMy WebLinkAbout09-05-12COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: KOONS MICHELLE C 121 N SAINT JOHNS DRIVE CAMP HILL, PA 17011 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) NO. CD 016470 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold ESTATE INFORMATION: FILE NUMBER: 2112-0686 DECEDENT NAME: PFLUGER MAGDALEN M DATE OF PAYMENT: 09/05/2012 POSTMARK DATE: 09/05/201 2 COUNTY: CUMBERLAND DATE OF DEATH : 06/ 08/ 201 2 12137428 ~ $283.16 TOTAL AMOUNT PAID: REMARKS: SEAL CHECK# 107 $283.16 INITIALS: HMW RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~~, PENNSYLVANIA INHERITANCE INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES [';r,`' , _ "; ~~ Po Box Zso6ol peC~1~-~~Varj_la ";,_;,_. ~~" w AND n HARRISBURG PA 17128-0601 DEPARTi~4~6h7jQFREVENUE i`~~~ ~AX.Pr/k~~E~ ILE~~,L.NSE REV-1543 EX AFP (05-11) I(C V JCL IV l1 I l.~ iF TAX FILE N0. 21 12-0686 ACN 12137428 x DATE 08-29-2012 ///~~~ +G~"l}^~~ }~~.'~~~+lylr Sppp ~~~l,~.f (~J ~.1 ~ i 7.Re ~J~l..~~i lLl~iJ \3~., t (~ MICHELLE C KOONS 121 N SAINT JOHNS DR CAMP HILL PA 17011-1932 EST. OF MAGDALEN M PFLUGER 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. MEMBER S 1S T F C U provided the department with the information below, which was used in calculating the inheritance tax due. Records indicate that at the death of the above-gamed decedent, you were a joint owner/beneficiary of this account. If y OU 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 relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe he 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 questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 378346-42 Date 09-27-2010 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance $ 18,508.72 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 9,254.36 months of the decedent's date of death, Tax Rate )( , 15 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ 1 , 388.15 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESULT IN AN fl FFICIAL TAX ASSESSMENT A. ^ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain C H E C K a discount or avoid interest, or return this notice to the Register of Wills and 0 N E an official assessment will be issued by the PA Department of Revenue. B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return O N L Y filed by the estate representative. C. The above information is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART ~ below. PART If indicating a different tax rate, please state OFFICIAL USE ONLY.... AAF relationship to decedent: ~ Q " ~~~~ 0 PA DEPARTMENT OF REVENUE TAX RETURN - CALCULATION OF TA~X/~ ON JOINT/TRUST ACCOUNTS pqp LINE 1. Date Established 1 (l/ "//~~~7"'~~~ 1 2. Account Balance 2 $ tfJ, ~/~~ r 7~ 2 3. Percent Taxable 3 X ~if.~rf1L~ 3 4. Amount Subject to Tax 4 $ ~r ~-~~~ 3~ 4 5. Debts and Deductions 5 - q t+->/ 5 6. Amount Taxable 6 $ / / ZJ `r r ~~ ~ 7. Tax Rate 7 X 7 8. Tax Due 8 $ ~~~ ,~~ ~7 ''_' S'~~~~ r r7 ~' ~ ~~.r $ .~ PART DEBTS AND DEDUCTIONS CLAIMED o ,~ s~~ ~~~~~ C~~y DATE PAID PAYEE DESCRIPTION AMOUNT PAID - - - , -- ~ - Z ~';S ~ ~'~l a~ ~- cn `~ ,~c Q ~~ D ~ f r TOTAL (Enter on Line 5 of Tax Computation) $ Under penalties of perjury, I declare that the facts I reported above are true, correct and ~o~p to to the st of my knowledge and belief . HOME c 7! ~ ~ `1.Jf ~ " ZI L$~ ~ WORK C ~)7 ) 5~7~._ /36~ TAXPAYE TELEPHONE NUMBER Sr . ~ ~©i~ ATE