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Home My WebLink About12-11-06 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 SAURMAN PATRICIA A 431 HERMAN AVE LEMOYNE, PA 17043 nn__u fold ESTATE INFORMATION: SSN: 163-07-6635 FILE NUMBER: 2106-1095 DECEDENT NAME: DIERICH ERNEST R DA TE OF PAYMENT: 12/11/2006 POSTMARK DATE: 12/11/2006 COUNTY: CUMBERLAND DA TE OF DEATH: 09/18/2006 NO. CD 007544 ACN ASSESSMENT CONTROL NUMBER AMOUNT 06500632 I $14,976.42 I I I I I I I I TOTAL AMOUNT PAID: $14,976.42 REMARKS: CHECK# 846 SEAL INITIALS: MW RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTIENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE ;)' -' O~- ~D1S FILE NO. 21 ACN 06500632 DATE 11-27-2006 REY-lS45l AFP 17-DD) EST. OF ERNEST R DIERICH S.S. NO. 162-07-6635 DATE OF DEATH 09-18-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT D SECURITY lXJ SEC ACCT D STOCK D BONDS PATRICIA A SAURMAN 431 HERMAN AVE LEMOYNE PA 17043 REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 HERRILL LYNCH has provided the DepartHnt with the infonlation listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedant~ you were a beneficiary of this asset. If you feel this infor.ation is incorrllCt~ please obtain writtan correction fro. the transfer agent~ attach a COpy to this for. and raturn it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co..onwealth of Pennsylvania. Questions ..y be answered by calling (717) 787-R~?7, COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 23444761 x 700,651.87 50.000 350,325.94 .045 15,764.67 TAXPAYER RESPONSE To insure proper credit to your account~ two (2) copies of this notice .ust acco.pany your pay_ant to the Register of Wills. Make check payable to: "Register of Wills~ Agent". DOD Valuation Percent Taxable A~t Subject to Tax Rate Potential Tax Due x NOTE: If tax pay.ants are .ade within three (3) .onths of the decedent"s date of death~ yOU .ay deduct a 5% discount of the tax due. Any inheritance tax due will beco.e delinquent nine (9) .onths after the date of death. Tax PART [!] A. ~The above infor.ation and tax due is correct. ~l. You .ay choose to r..it pay.ent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest~ or you .ay check box "A" and return this notice to the Register of Wills and an official assess.ent will be issued by the PA Depart.ent of Revenue. [CHECK ] ONE BLOCK ONLY B. DThe 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. D The above infor.aUon is incorrect and/or debts and deductions were paid by you. You .ust co~lete PART [II and/or PART 0 below. PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PART ~ TAX RETURN - COMPUTATION If you indicate a different tax rate, please state your relationship to decedent: LINE 1. DaD Valuaiion 2. Percent Taxable 3. MOWlt Subject to Tax 1\. Debts ....d Deductions S. Mount Taxable 6. Tax Rate 7. Tax Due OF TAX 1 2 X 3 1\ S 6 X 7 ON ABOVE ASSETCS) PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line S of Tax Co~utatlon) I $ perjury, I declare that the facts I "ledge and belief. have reported above are true, correct and HOME C 117) 7 ~ 3, - Lj 077 WORK C) ) ;;J-1I-0Co DATE TA