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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128-0601
REV-l'162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
QUIGLEY VIRGINIA M
34 RIDGEWAY DR
MECHANICSBURG, PA 17050
____un fold
ESTATE INFORMATION: SSN: 168-26-3963
FILE NUMBER: 2106-0361
DECEDENT NAME: GOODLING GLADYS E
DATE OF PAYMENT: 07/17/2006
POSTMARK DATE: 06/10/2006
COUNTY: CUMBERLAND
DA TE OF DEATH: 04/07/2006
NO. CD 006978
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $551.70
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: EUGENE & VIRGINIA QUIGLEY
CHECK# 6377
SEAL
INITIALS: WZ
RECEIVED BY:
REGISTER OF WILLS
$551.70
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
E-143 EX (6-05)
1,@"'Ms.VirginiaM.QUigleY*
34 Ridgeway Dr. *
r * * * Mechanicsburg, P A 17050 *
_____ _~__._m_'.__~__.~._~'~~_..
Attention: TIC 340
Zip Code
:2/
HARRISBURG PA 17~
iO .JUL 2.006 F'r.1 S'{'
PA DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
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INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 06- 0361
06129145
06-28-2006
IEY-15~3 EX AFP ID9-DOl
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EST. OF GLADYS E GOODLING
S.S. NO. 168-26-3963
DATE OF DEATH 04-07-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
[X] CHECKING
o TRUST
o CERTIF.
VIRGINIA M QUIGLEY
34 RIDGEWAY DR
MECHANICSBURG PA 17050
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PNC BANK 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 joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, 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 answer~d by c~IJing (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 514014301 Date 09-01-1974
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
7,355.99
50.000
3,678.00
.15
551.70
TAXPAYER RESPONSE
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
x
NOTE: If tax payments are made within three
(3) Ronths of the decedent.s date of death,
you Ray deduct a 57. discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Tax
PART
[!]
A. ~ The above information and tax due is correct.
~l. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
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.
[CHECK ]
ONE
BLOCK
ONLY
B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent.s representative.
C. [] The above information is incorrect and/or debts and deductions were paid by you.
You Rust cORplete PART ~ and/or PART ~ below.
PART
[!J
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
If you indicate a different tax rate, please state your
relationship to decedent:
PART
@]
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF
1
2
3
4
5
6
7
8
x
TAX ON JOINT/TRUST ACCOUNTS
x
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
TOTAL (Enter on Line 5 of Tax Computation)
facts I have reported above are true, correct
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