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HomeMy WebLinkAbout11-26-12COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: MEMBRINO SANDRA L 457 S OLD MIDDLETOWN RD MEDIA, PA 19063 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) NO. CD 016829 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold ESTATE INFORMATION: FILE NUMBER: 2112-0321 DECEDENT NAME: JONES HARRY D DATE OF PAYMENT: 1 1 / 26/ 2012 POSTMARK DATE: 1 1 /21 /2012 COUNTY: CUMBERLAND DATE OF DEATH : 02/ 24/ 201 2 12503182 ~ $565.34 TOTAL AMOUNT PAID: REMARKS: SEAL CHECK# 1 143 INITIALS: HMW RECEIVED BY: $565.34 ~~ rw ire n r n nnlrn ['`TI") A C`~ /~ I Ir_Ll REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE FILE N0. 21 12-0321 BUREAU OF INDIVIDUAL TAXES ~; •~;, Po eox 2so6o1 ~; , AND ACN 12503182 HARRISBURG PA ln2s-o6o1 ~'T SCPAYER RESPONSE ~'~--_~~~~` _ ` 'I ~ .` DATE 07-23-2012 ~: ..v ~ REV-1543A AFP~(7-00) ti ~(';{ TYPE OF ACCOUNT EST. OF HARRY D JONES ^ SECURITY S.S. N0. X^ sEC AccT DATE OF DEATH 02-24-2012 ^ sTOCK ~~ ~'~' " `='' `' COUNTY CUMBERLAND ^ BONDS Cta~~F,~` ~t;~"~.~Cl ~`~ ' ~~ REMIT PAYMENT AND FORMS T0: SANDRA L MEMBRINO REGISTER OF WILLS 457 S OLD MIDDLETOWN RD 1 COURTHOUSE SQUARE MEDIA PA 19063-4859 CARLISLE PA 17013 BANKERS LIFE has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a beneficiary of this asset. If you feel this information is incorrect, please obtain written correction from the transfer agent, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW * * ~ -C EE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 7936776 To insure proper credit to your account, two (2) copies of this notice must accompany Your payment to the Register of Wills. Make check DOD Valuation 12, 563.13 payable to: "Register of Wills, Agent". Percent Taxable X 100.00 NOTE: If tax payments are made within three Amount Subject to Tax 12, 563.13 (3) months of the decedent's date of death, Tax Rate X . 045 you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent Potential Tax Due 565.34 nine C9) months after the date of death. PART TAXPAYER RESPONSE FAILtiRETfl RESPOND WIL1. RESULT IN AN OFFICIALTAX ASSESSMENT BASEDONTHIS NOTICE A. ^ The above information and tax due is correct. 1. You may choose to 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 you may check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. ONE BLOC K B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ^2 and/or PART ^3 below. PART If you indicate a different tax rate, please state your OFFICIAL USE ONLY ^ AAF relationship to decedent: PA DEPARTMENT OF REVENUE TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSETCS3 PAD LINE 1. DOD Valuation 1 1 2. Percent Taxable 2 X 2 3. Amount Subject to Tax 3 3 4. Debts and Deductions 4 - ~ 5. Amount Taxable 5 5 6. Tax Rate 6 X ~ 7. Tax Due 7 7 PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID IUTAL CtnLer On Llne D or ~d7C t,u mNuta ~l~ui T Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to he best of my knowledge and belief . HOME C ~y) y !-T '~~! ~,/ ~ woRK c ~~ ~ S- TAXPAY SIGN TURE TELEPHONE NUMBER DATE -~ ' N F=- ~ O[_i •CD •~- ~CD •C10^ ~: ~~> i Cn ~ O4- O Z I II 5.-.,y ~, I ~. ~.~ r~ ! ~~ ~ .~~ s~~~ _-~-= ~.~~~~' ~ r. .a 4', ".~ y' u c! u. ',y o i^ ~1 J '~ r' W F I~ "3i 21 ~ m o-- ~- - J `.n ~ a - o ~ ~ _ o ~, ~ ~' ~ ~~ _ C] ` + rf D " v ~ tton ~~~ vi O ~ ~ 0 '~ ti ~ ~ ~ J~ M ~ ~ ~ r ~~ ~ ~ ~ ~ ~ ,~= ~, a ~ ~, ~~ p~ v F .., ~'~l '~'`' ~~ v .~ © ~ ~~, ~~~.~~ r ' i, ~ ~ ~~ - `' X11 ~ ` ~~ ~ .S ` -~ ` J ~~/^/ •/ f~ s ~~ } ~° !:`~ ~~: ~~ _~.: , ~,,;.~