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Home My WebLink About03-28-13 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 1 7 1 28-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 017373 RIETHEIMER JOHN L III 3710 LEYLAND DRIVE MECHANICSBURG, PA 17050 ACN ASSESSMENT AMOUNT CONTROL NUMBER -----°- fold ---------- -------- � �� 12503384 S287.19 � � � ESTATE INFORMATION: SSN: I FILE NUMBER: 2127-0091 � DECEDENT NAME: RIETHEIMER HELENE T � DATE OF PAYMENT: 03/28/2013 � POSTMARK DATE: 03/27/2013 � COUNTY: CUMBERLAND � DATE OF DEATH: 06/28/201 2 I � TOTAL AMOUNT PAID: $287.19 REMARKS: CHECK# 3390 INITIALS: HMW SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE FILE N0. 21"',��""� � BUREAU OF INDIVIDUAL TAXES A N D Po Box 2so6oi ACN 12503384 HARRISBUR6 PA i�izs-o6oi TAXPAYER RESPONSE DATE 08-02-2012 REV-1543A AFP(7-00) ��;�� '�"��- TYPE OF ACCOUNT R�(��S i�� ;-''�k�:9�-� EST. OF HELENE T RIETHEIMER � SECURITY S.S. NO. XQ sEC ACCT :1�� $ �t� �.: �� DATE OF DEATH 0 6-28-2 012 ❑ sTOCK COUNTY CUMBERLAND � BONDS ��„�t�� ,+�' REMIT PAYMENT AND FORMS T0: JOHN L RIETHEIMERII��5� ��`�' REGISTER OF WILLS 3710 LEYLAND DR 1 COURTHOUSE SQUARE MECHANICSBURG ��{�$�� i�.. D� CARLISLE PA 17013 PRUDENTIAL FINANCIAL has provided the Departeent 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 froo 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 Pennsvlvania. Questions may be answered bv calling C717) 767-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 167I6b258 To insure prover credit to your account, two C2) copies of this notice must accompany Your 382.�� pav�aent to the Register of Wills. Make check DOD ValuatiOn 6� pavable to: "Register of Wills, Agent". Percent Taxable X 100.00 NOTE: If tax payments are made within three Amount SubjeCt to Tax 6 s 382.�0 (3) months of the decedent's date of death, Tax Rate X .045 vou �ay deduct a 5% discount of the tau due. Any inheritance tax due will become delinquent Potential Tax Due 287•19 nine C9) months after the date of death. PARr TAXPAYER RESPONSE � A. The above intornation and tax due is correct. . 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 0 N E Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 C K B. �The above asset has been or aill be reported and tax paid with the Pennsylvania lnheritance 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 bv vou. You must complete PART � and/or PART � below. PART If you indicate a different tax rate, please state your � relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSETCS� LINE 1. DOD Valuation 1 2. Percent Taxable 2 X \ 3. Amount Subject to Tax 3 4. Debts and Deductions 4 � _ \ 5. Amount Taxable 5 6. Tax Rate 6 X 7. Tax Due 7 \ �� PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on �ine 5 of Tax Computation) S Under penalties perjury, I declare that the facts I have reported above are true, correct and complete to t b t f � and belief. H O M E C ) ` WORK C 7/ ) y/L�.S''.53� TAXPAYER S NATURE TELEPHONE NUMBER DATE t h _ h , � • V j+. * � �u� s x•�.J'M�Y ;��. ' �M�Y S +nr E� f ��`w" e�`� - � ;`-��.. w. �. Y er�,� j� w+• : i: �:' w� ,�}� `j.+fY`v � � � � ' . . :'� '... . :�w w.r. �n �w++ ww � � �w � `~�A �:� •� ?.�Ti � •� ?�;: .... `'. .� ++.n� T .::i j` .,wn.. 3•.d:• �� r. . ��. � t.� �... � ,... _ � � �'�� ..,. � :°� ��» _,.,,, _.�:: �� .,: � :.r�: � � ..� :.k.: .: � � � s i'. "` .... :.�. k�t t (� � � {'-:� �� ;�� '�^ , � �� ,�r. � ,.».. � � � � � �' � . � �� 4 U � <__� : 1 �'J � � � ': �.. Lt._ �-�� ..a. �{_� � � �:i:� �;:i � �r� t,. fM;3 � � �: � �':. � A 1,�» �J f�,� �? � � � � � -... \ �.F � �' � � `�, � � � � � � c.�► � w � a H � � � � '"' : ° •� a , �v � � � � � 'r� �.� �� d U , +� M ,� .