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Home My WebLink About02-06-07 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 DARCY BARBARA 2138 YALE AVENUE CAMP HILL, PA 17011 u_nn_ fold ESTATE INFORMATION: SSN: 054-18-8876 FILE NUMBER: 2107-0117 DECEDENT NAME: ROMBERGER IRENE DA TE OF PAYMENT: 02/06/2007 POSTMARK DATE: 01/30/2007 COUNTY: CUMBERLAND DA TE OF DEATH: 11/12/2006 NO. CD 007779 ACN ASSESSMENT CONTROL NUMBER AMOUNT 06161736 I $30.59 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK#1230 SEAL INITIALS: CJ RECEIVED BY: REGISTER OF WILLS $30.59 GLENDA FARNER STRASBAUGH REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Z8-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21-07- 0117 06161736 12-15-2006 REV-1545 EX AFP 109-00) on I r LU ... U I, C: -,.- ...., CLERK ( "":'PHAN'C. '.1 " I~r-PI ^ .... ., L...( ~ _ I,.. i'i1L "., EST. OF IRENE ROMBERGER 5.5. NO. 054-18-8876 DATE OF DEATH 11-12-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS IX] CHECKING o TRUST o CERTIF. BARBARA DARCY 2138 YALE AVE CAMP HILL PA 17011 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 COHHUNITY STATE BANK has provided the Deparblent with the infornation listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, YOU were a joint owner/beneficiary of this account. If yOU feel this infor.ation is incorrect, please obtain written correction fr~ the financial institution, attach a copy to this for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co..onwealth of PennsYlvania. Ou~$tions say be answered by calling (717) 7&7~83Z7. COMPLETE PART 1 BELOW · . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 4307518 Date 07-14-2005 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 4,293.60 16.667 715.61 .045 32.20 TAXPAYER RESPONSE To insure proper credit to YOur account, two (Z) copies of this notice ~st acc~pany Your pa~ent to the Register of Wills. Make check payable to: "Register of Wills, Agent". Tax x NOTE: If tax pa~ents 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. PART [!] The above infor.ation and tax due is correct. 1. You .ay choose to re.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 asses~ent will be issued by the PA Deparblent 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~tion is incorrect and/or debts and deductions were paid by you. You .ust co~lete PART ~ and/or PART ~ below. PART @ 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 Taxabla 6 7. Tax Rate 7 X 8. T~Due 8 PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I complete to the best of my knowledge and belief. ~ have reported above are true, correct and ) 76:>/-1.:l..~'J ) ~9/- 3 J35 HOME WORK (7/7 (7/l l-;)..~~ DA E ~ . ,.",:,qc'H~ ,~,,;j,>~~l_:- ~,'j..~, ~"'*'m..'~-<~!,,"k~'S11"'!kt "i~~,.t. ~ J.0j. ;'';~p !1.~1J"""';:- .'~. . i.11Cil- '.:iJr~'~r8'~.ia",Ji 'll.-"w', .'~",& ". '/1'1:'" .~. ".. -.'"''''......_-~--~..~."..-.., 60.127 ./h 12 3 0 J /;.7 . I ' -~:~(?-b:__~v../. .Lf2to. ..... . ..r..~ -' (.. . '. it ,,' '., ~ _____.. .... .......en. ,""" .._~ " ....'",. ,.,"' V ~ ~ ,- -., . ."..-.. -. -< B:\Rf;\'< 21 -";-~ \ \~p ,_ ' L:- ,Ii :~~. '"1 -~U -.'--C,' ./ 1/ )O~ $ 30 ~ 6'7400 DOLlARS ffi -- - "-~- PNC StINK H.,!\ sourHC~I'r"'r '~;U~:~J~L~::,.{( rt__2/_ ;k~'~ZJ~ '_~~ /' ,....,-/ V r"7 -;.).c:.;..c ':0:1 Lj J c ? 18 ': 500459? 5.3/1- .230 o oe!BE MUMM "!it ~ \ I'