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COMMONWEALTH OF PENNSYl VMJIA
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
NO. CD 007604
DUPLICA TE
LEVAN DALE R
380 STATE RTE 442
MUNCY, PA 17756
-------- fold
ESTATE INFORMATION: SSN: 180-01-4445
FILE NUMBER: 2106-1141
DECEDENT NAME: LEV AN KENNETH R
DA TE OF PAYMENT: 12/26/2006
POSTMARK DATE: 12/26/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 08/13/2006
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
06161739 I $36.89
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 263
SEAL
INITIALS: CJ
RECEIVED BY:
REGISTER OF WILLS
$36.89
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEAL TH 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
LEVAN DALE R
380 STATE RTE 442
MUNCY, PA 17756
_n___h fold
ESTATE INFORMATION:
SSN:
180-01-4445
FILE NUMBER:
2.J..O.O--0000 c2 \ - D ~ _ \ I 4- l
LEVAN BALE R ~t-NNtT\-\
12/26/2006
12/26/2006
CUMBERLAND
12/26/2006
DECEDENT NAME:
DA TE OF PAYMENT:
POSTMARK DATE:
COUNTY:
DATE OF DEATH:
NO. CD 007604
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
06161739 I $36.89
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 263
SEAL
INITIALS: CJ
RECEIVED BY:
REGISTER OF WILLS
$36.89
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
PCt'0.,C
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INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 'b&,- (LV I
ACN 06161739
DATE 12-15-2006
za06 Dfe 26 PM 12= S9
DALE R LEVAN
380 STATE RTE 442
MUNCY PA 17756
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EST. OF KENNETH R LEVAN
5.5. NO. 180-01-4445
DATE OF DEATH 108-13-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
OCI CHECKING
o TRUST
o CERTIF.
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MUNCY BANK & TRUST CO has provided the Departunt with the infor.ation 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
..,. .....". " ... ..., ..,. """'""" ,. ........" .,.... ...... """" ......".. .... ... "'""'" ...,.'"",.. .,.... . ...,
.. .... ..~ ... ~..... " .. ... "'" ....~... Th.. ......, .. .....,. ,. ~._. .,.. ... ""'"',"".. .,. ._. "' ... -.........
of PennsYlvania. Questions .ay be answ.~tid by Ctilling (717) 787-8327.
COMPLETE PART 1 BELOW · · . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 1703056806 Date 03-13-2001
EstabUshed
Account Balance
Percant Taxable
A.ount Subject to
Tax Rate
Potential Tax Due
x
1,639.37
50.000
819.69
.045
36.89
TAXPAYER RESPONSE
To insure proper credit to your account, two
[Z) copies of this notice must acco.pany Your
paY.ent to the Register of Wills. Make check
payable to: "Register of Wills, Agant".
Tax
x
NOTE: If tax paY.ents are .ada within threa
(3) .onths of the decedant.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.
PART
m
The above inforeation and tax due is correct.
1. You .ay choose to reeit 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 asses~ent will be issued by the PA Departeent of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
If yoU indicate a different tax rate, please state your
relationship to decedent:
B. c=J 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. c=J The above infor.ation is incorrect and/or debts and deductions were paid by You.
You .ust co.plete PART ~ and/or PART ~ below.
PART
[!j
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established 1
2. ACcount Balance 2
3. Percent Taxable 3 X
4. A.ount Subject to Tax 4
5. Debts and Deductions 5
6. A.ount Taxable 6
7. Tax Rate 7 X
8. Tax Due 8
PART
@]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
of perjury, I declare that the facts I
of .Y knOWledge and beUef.
have reported above are true, correct end
HOHE '570 l .&":s.?;~
~ORK ({It) ~ 54
TElEPH NUMBE
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