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Home My WebLink About09-12-06 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DISIL VERIO ALBERT T 8916 HANNIGAN CT TAMPA, FL 33626 ___un_ fold ESTATE INFORMATION: SSN: 187-14-1425 FILE NUMBER: 2106-0599 DECEDENT NAME: HOMER IRMA M DATE OF PAYMENT: 09/12/2006 POSTMARK DATE: 09/06/2006 COUNTY: CUMBERLAND DATE OF DEATH: 03/29/2006 NO. CD 007192 ACN ASSESSMENT CONTROL NUMBER AMOUNT 06143805 I $1 30.74 I I I I I I I I TOTAL AMOUNT PAID: $130.74 REMARKS: HOMER IRMA M DISIL VERIO ALBERT T CHECK# 3217 SEAL INITIALS: AJW RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 INFORMATION NOTICE --i"'-'':" AND 'TAXPAYER RESPONSE FILE NO. 21 06-0599 ACN 06143805 DATE 08-30-2006 ALBERT T DISILVERIO 8916 HANNIGAN CT TAMPA FL 33626 ~S~80F IRMA M HOMER S.S. NO. 187-14-1425 DATE OF DEATH 03-29-2006 CdUNTY CUMBERLAND TYPE OF ACCOUNT [i] SAVINGS o CHECKING o TRUST o CERTIF . '-'.:..\ 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 answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 5000015264 Date 08-08-1995 Established x 5,810.72 50.000 2,905.36 .045 130.74 TAXPAYER RESPONSE To insure proper credit to your accountl two (2) copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of WillS, Agent". Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x NOTE: If tax payments are made within three (3) months of the decedent.s date of death, you may deduct a 5Z discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Tax PART [!] A. Ql The L.p'l. above information and tax due is correct. 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 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 JOINT/TRUST ACCOUNTS LINE 1- Date Established 1 2. Account Balance 2 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 PART DEBTS AND DEDUCTIONS CLAIMED ~ DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) perjury, I declare that the facts my knowledge and belief. ,.......... I $ "\ "' ."1, \ " .. '" '\ '\ .'\.. \). ). ). J i II ((.t~, \ \\ \ \. \ ~ ~- In ('I) ~"t it) \~ ~ l "" (!:) 'ai N .go~ Glc<g ~ ~(") lIl"C ...J '0 ~ u-. I-~a -c(!:)E Gl ..- III a$r- Oct \..U v1:2 j-'- "::J -::t:. r-> c::::> = c;r. (/) rr" --r---', -, 2 \ ':__.J . :'0 . \~=s ~1=:1 ..- ~-"- .--- . f1.~ rl ;~"" ~ C") ./) ~ a =l c.J ~ - ~ --> LL \2) \~ U <:L ~ T- "J) \J ~ cr ~ CL. ~ i~ ..-l C::t- ul c-;J.;t: "t:c) .~ o V) .J Q}.