HomeMy WebLinkAbout10-25-12COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280801
HARRISBURG, PA 17128-0601
RECEIVED FROM:
FOSTER PATRICIA ANN
2126 BERRY HILL STREET
HARRISBURG, PA 17104
fo1C
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX111-96)
NO. CD 016688
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
ESTATE INFORMATION: ssrv: i 72-2s-s4~ 3
FILE NUMBER: 2112-1142
DECEDENT NAME: MYERS WILLIAM G
DATE OF PAYMENT: 10/25/2012
POSTMARK DATE: 10/24/2012
COUNTY: CUMBERLAND
DATE OF DEATH: 01 /30/2012
REMARKS:
CHECK# 8151
SEAL
12152113 ~ $1,775.78
TOTAL AMOUNT PAID:
INITIALS: CJ
RECEIVED BY:
$1,775.78
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
auREAU of INDIVIDwL TAxes ~ :p-} [C f~[ INFORMATION NOTICE FILE N0. 21--12 )~ Z
PO aDX 280601 ! ~PO G I~ff AND
ACN 12152113
NARRISauRG PA rriza-osol ~,t ~~~* TAXPAYER RE S P O N S E
~,~i ,. ~,,; r~.~ 1 DATE 09-20-2012
REY-ISi3 EX 11F- (RS-11)
~ PENNSYLVANIA INHERITANCE TAX
~~2 OCT 25 PM IZ~ 26
'J~-L.i~if',. ..
ORPNt~Cv'S ~QUR~
CUN~3ERi.AND C4., PA
PATRICIA A FOSTER
2126 BERRYHILL ST
HARRISBURG PA 17104-2005
EST. OF WILLIAM G MYERS
SSN 172-26-9413
DATE OF DEATH ol-3a-2o12
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
® CERTIF.
SOVEREIGN BANK 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 named decedent, you were a joint owner/beneficiary of this account. If you are the Spouse O1 the
deceased and any amount other than zero 1s reflected below on the Potential Tax Due line, note no tax uay 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 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 questions.
COMPLETE PART 1 BELOW ~ .SEE BEYfi~SE SIDE FOR 6ILINS 4l+ID~__P,1C!lENT IlISTRUrCTIONS
Account No. 10554549448 Date 11-13-2003 To ensure proper credit to the account, two
Established copies of this notice wet accompany
payment to the Register of Wills. Make check
Account Balance $ 23, 677.00 payable to ^Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax ~` 11 X838.50 months of the decedent's date of death,
Tax Rate X . 15 deduct a 5 percent discount on the tax due.
Arq: inheritance tax due will become delinquent
Potential Tax Due ~` 1 ~ 775.78 nine months after the date of death.
P~T TAXPAYER RESPONSE
1
A. The above intonation and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
CHECK a discount or avoid interest, or return this notice to the Register of Wills end
C 0 N E ~ an official assessment will be issued by the PA Department of Revenue.
BLOCK a, ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
0 N L Y filed by the estate representative.
C. ~ The above inform ion 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
relationship to decadent:
TAX RETURN - CALCULATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Sub~ect to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
s X
4 ~
5 -
6 ~
7 X
8 ~
PART DEBTS AND DEDUCTIONS CLAIMED
^3
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perfury, I declare that the facts I reported above are truefi corpre~t and
om leto to the~st of kn pdge and belief. HOME C~/ ~ )p~~a ~3 ~ ~~
Cl f 'tom WORK ( -.--~'""_. - •~,
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
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