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Home My WebLink About04-10-13 (2) COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 017430 MULHOLLAND LORI D 607 N HANOVER ST CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold ---------- -------- 12138227 � $53.03 ESTATE INFORMATION: SSN: � FILE NUMBER: 2112-0678 I DECEDENT NAME: THORPE CHRISTOPHER D � DATE OF PAYMENT: 04/10/2013 � POSTMARK DATE: 03/28/2013 � COUNTY: CUMBERLAND � DATE OF DEATH: 06/08/201 2 � � TOTAL AMOUNT PAID: 553.03 REMARKS: CHECK# 5465 INITIALS: HMW SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS • � � ' PENNSYLVANIA INHERITANCE TAX . INFORMATION NOTICE �-- -C�� BUREAU OF INDIVIDUAL TAXES F I L E NO. 21 � Po BoX Z$o6o1 pennsylvania AND acN �2�3s22� HARRISBURG PA 17128-0601` DEFARTMENTOFREVENUE TAXPAYER RESPONSE DATE OG�ZH-ZO12 REV-1543 EX AFP.(05-11) � ��- TYPE OF ACCUUNT ��''�� C�� Q� EST. OF CHRISTOPH D THORPE � SAVINGS �i��'��""� �` �� S$N � CHECKING � �� t� DATE OF DEATH 06-08-2012 � TRUST (�j� ftP� �.� "� COUNTY CUMBERLAND � CERTIF. REMIT PAYMENT AND FORMS T0: LORI D MULHOLLAND CiL�� `�� REGISTER OF WILLS 607 N HANOVER ST p ��' (;��j�T 1 COURTHOUSE SQUARE CARLISLE PA 1701��i� CARLISLE PA 17013 �UMBE'�l.Atd� �0•, FA i M E M B E R 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-named decedent, you were a joint owner/beneficiary of this account. If yoU are the Sp0U52 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 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 REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 68630-11 Date 07-27-1987 To ensure prover credit to the account, two Established copies of this notice must accompany ACCOUnt Balance 707.10 Payment to the Register of Wills. Make check �` payable to Register of Wills, Agent . Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount SubjeCt to Tax $ 353.55 months of the decedent's date of death, Tax Rate �( . 1�'j deduct a 5 uercent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ 53.�3 nine months after the date of death. P�T TAXPAYER RESPONSE 1 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 0 N L Y filed by the estate representative. C. � The above informa ion is incorrect and/or debts and deductions were paid. Complete PART 2� and/or PART 3� below. PART If indicating 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 $ \ r 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 $ ' � 5. Debts and Deductions 5 ' 6. Amount Taxable 6 $ 7. Tax Rate 7 X 8. Tax Due 8 $ �3 • PART DEBTS AND DEDUCTIONS CLAIMED a DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) S Under_pena perjury, I declare that the facts I reported above are true, correct and comp ete h ,, t of my knowledge and belief. HOME C��1 ) �a (o��'�vd WORK ( ) T AYER SIGNATURE TELEPHUNE NUMBER DATE fii � � � s • . 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