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HomeMy WebLinkAbout02-09-07 COMMONWEALTH OF PEN DEPARTMENT OF REVENU BU~;'u~, ;;;;:nVIDUAL T DEPT. 280601 HARRISBURG, PA 17128-0 RECEIVED FROM: CLARK WILM 638 HIGHLA MT HOLLY S __nnn fold ESTATE INFORMA FILE NUMBER: DECEDENT NAME: DA TE OF PA YMEN POSTMARK DATE: COUNTY: DA TE OF DEATH: REMARKS: CHECK# SEAL NSYLVANIA E AXES 601 REV-1162 EX(11-96) PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT AJ NO AVENUE PRINGS, PA 17065 TION: SSN: 207-07-9946 2107-0134 QUIGLEY MELVIN K T: 02/09/2007 02/09/2007 CUMBERLAND 09/03/2006 4538 NO. CD 007795 ACN ASSESSMENT CONTROL NUMBER AMOUNT 06157521 I $765.95 06157522 I $156.43 06157523 I $236.59 06157525 I $450.56 06154041 I $294.91 06154042 I $605.29 06154043 I $360.56 I I TOTAL AMOUNT PAID: $2,870.29 INITIALS: WZ RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS COHMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 ...a...... ..' ...,..'.... ' 'fIIII" , INFORMATION NOTICE , AND ,,"'TAXPAYER RESPONSE FILE ACN DATE : I I , ' REY-154S EX AFP fOt-DOl' 2007 FES -9 Pl' 3' 28 1 . . EST. OF MELVIN K QUIGLEY S.S. NO. 207-07-9946 DATE OF DEATH 09-03-2006 COUNTY CUMBERLAND NO. 21--01-134 06157521 11-22-2006 TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST 00 CERTIF. ~~ WILMA J CLARK 131 COVENTRY DR CARLISLE PA 17015 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC BANK has provided the DepartGent with the inforGation 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 inforGation is incorrect, please obtain written correction frOG the financial institution, attach a copy to this forG and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the COGGonwealth of PennSYlvania. ~~estions..y be answered by ceIling (717) 787-8327. COMPLETE PART 1 BELOW . . ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 31600300251 Date 09-16-2005 Established To insure proper credit to your account, two (2) copies of this notice GUst acco.pany your pay.ent to the Register of Nills. Make check payable to: "Register of Nills, Agent". Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 17,021.09 100.00 17,021.09 .045 765.95 TAXPAYER RESPONSE NOTE: If tax pay.ents are Gade within three (3) .onths of the decedent's date of death, you .ay deduct a 5X discount of the tax due. Any inheritance tax due will beco.e delinquent nine (9) Gonths after the date of death. Tax x PART ill A. [ CHECK ] ONE BLOCK B. ONLY c. r=J The above infor.ation and tax due is correct. 1. You Gay choose to reGit paYGent to the Register of Nills 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 Nills and an official asseSS8ent will be issued by the PA Department of Revenue. r=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. r=J The above infor.ation is incorrect and/or debts and deductions were paid by YOU. You .ust cOGplete PART ~ and/or PART ~ below. If you indicate a different tax rate, please state your relationship to decedent: PART ~ TAX RETURN - COMPUTATION OF LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 8. Tax Due 8 TAX ON JOINT/TRUST ACCOUNTS x x PART [!J DATE PAID o/O-t//J7 DEBTS AND DEDUCTIONS CLAIMED PAYEE '}.! J-.i' k {; '! (x::Ihf I~ ( DESCRIPTION I JJRtd'h..- TOTAL (Enter on Line 5 of Tax Co.putation) I $ AMOUNT PAID "7 bJ-: rr of perjury, I declare that the facts I my knowledge and belief. ~a;~Erep~~;ed a~o~ve a;dr~:JhoV/t and WORK () /J~/ IV TELEPHO NUM DATE ~- . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Z8-0601 ~,...,C".." .' . J,"", . , ~ " .. :.', :~. ,'" ,- I , ., .,' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21-0l'0~ 06157522 11-22-2006 "tlnLi5<I, EX If1' lD'~DD> ZG07 FEB -9 PI~1 3: 28 TYPE OF ACCOUNT EST. OF MELVIN K QUIGLEY 0 SAVINGS S.S. NO. 207-07-9946 IX] CHECKING DATE OF DEATH 09-03-2006 0 TRUST COUNTY CUMBERLAND 0 CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 r'l r:C'~.< \.../ _~i ,1 \ O~.....,~ I,~ '\ jl{"", f;r...r to"" ri jf'~ /\]<:-:' ~,~" ~~.) ,~_r: I i CU:'Jr-'" ,.. WILMA J CLARK 131 COVENTRY DR CARLISLE PA 17015 PNC BANK has provided the Depart.ent 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/beneficiery of this account. If you feel this infor.ation is incorrect, please obtain written correction fro. 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.aonwealth of PennsYlvania. Questions..y be answered by calling (717) 737-83Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 51440109289 Date 12-02-1999 Established Account Balance Percent Taxable AMount Subject to Tax Rate Potential Tax Due x 6.952.57 50.000 3.476.29 .045 156.43 TAXPAYER RESPONSE To insure proper credit to your account, two (Z) copies of this notice .ust acco.pany your pay.ent to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax pay.ants are .ade within three (3) .onths of the decedent's date of death, you .ay deduct a 5X discount of the tax due. Any inheritance tax due will beco.e delinquent nine (9) .onths after the date of deeth. Tax PART ill A. [ CHECK ] ONE BLOCK B. ONLY c. [J 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 assessaent will be issued by the PA Depart.ent of Revenue. [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. [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. 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. A.ount Taxable 7. Tax Rate 8. Tax Due PART I!J DATE PAID .)./ () ~ /.1 7 DEBTS AND DEDUCTIONS CLAIMED OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 PAYEE "lAh~. f (I/th.-L f DESCRIPTION I V{b"{fJ6= TOTAL (Enter on Line 5 of Tax COMputation) perjury. I declare that the facts I y knowledge and belief. AMOUNT PAID /57P. ~3 I $ have reported above are true. HOHE (~' :~O W~~~EP~O ~M R correct and -,..}..(:; (// If~{(/A7 ~ DA ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Z8-0601 -,..,-~* ,'.-:. :-.:-"~I :1, " - - 'i> - "~. . . .~ +'-'.,- ,', "'" '. . t' '. INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 "o1-r~l/ 06157523 11-22-2006 REY~1543 EX IFP lD9~DII (I ~:Ci/ .......' ~- ~_I ,: \ Orinl't,', 1"1"'1",/>1' ,\ ",' eLl ~\/ r~' i ;~-~,j 'ii i EST. OF MELVIN K QUIGLEY S.S. NO. 207-07-9946 DATE OF DEATH 09-03-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST IX] CERTIF . Z007 FEB -9 Pl'l 3: 28 t"..\ WILMA J CLARK 131 COVENTRY DR CARLISLE PA 17015 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC BANK has provided the oeparbent with the infol"llation 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 ioint owner/beneficiary of this account. If yoU feel this inforBation is incorrect, please obtain written correction froB the financial institution, attach a copy to this forB and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the COBBonwealth of PennsYlvm,ia. Q~Mstions .ay be enswered by calling (717) 787-83Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 31900260992 Date 04-25-2005 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 10,515.25 50.000 5,257.63 .045 236.59 TAXPAYER RESPONSE To insure proper credit to Your account, two [Z) copies of this notice BUst accoBpeny your paYBent to the Register of Wills. Make check payable to: "Register of Wills, Agent". Tax x NOTE: If tax pay.ents are Bade within three (3) Bonths of the decedent.s date of death, yoU eay deduct a SX discount of the tax due. Any inheritance tax due will becoBe delinquent nine (9) .onths after the date of death. PART [!] A. [ CHECK ] ONE BLOCK 8. ONLY c. c=J The above inforBation and tax due is correct. 1. You Bay choose to r88it pay.ent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or yoU Bay check box "A" and return this notice to the Register of Wills and an official asseSSBent will be issued by the PA oeparteent of Revenue. 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=J The above infDr.ation is incorrect and/or debts and deductions were paid by you. You BUSt co.plete PART ~ and/or PART ~ below. 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 PART [!] DATE PAID PAYEE o/~7 ~cf cf~ DEBTS AND DEDUCTIONS CLAIMED OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 DESCRIPTION I 4,!'f.., TOTAL (Enter on Line 5 of Tax Computation) I $ AMOUNT PAID .4- .:'f (p. s~ perjury, I declare that the facts I have reported above are true, nowledge and belief. HOME / WORK T COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *.:::{,~:c._;t~, i=-9R ,~ATJ:ON NOTICE i'.".., 'iJ) '_' ,-/,/: ~ND , '-TAXPA,VJSR RESPONSE FILE ACN DATE NO. 21 '"'07-/3y 06157525 11-22-2006 IEV-ISU EX AFP C09-001 WILMA J CLARK 131 COVENTRY DR CARLISLE PA 17015 zaUl FES - 9 P;1 3: 27 TYPE OF ACCOUNT EST. OF MElVIN K QUIGLEY 0 SAVINGS ClC;J,!( n~.S. NO. 207-07-9946 0 CHECKING '-" -,1\1....1 0 O",q '::Hi'i\i,'( (r~~ OF DEATH 09-03-2006 TRUST ,'"', i" ' ,: "";"C()~TY CUMBERLAND IX] CERTIF. \-'1..,. ., ! ;. ,I:""" .1 REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC BANK has provided the DlIpart.ent with the infor.ation listed billow which has baan used in calculating the potential tax due. Their records indicata that at thll death of the abovll decedent, YOU were a joint owner/beneficiary of this account. If yoU feel this infor.ation is incorrect, please obtain writtan correction fro. the financial institution, attach a copy to this for. and return it to the above address. This account is taxable in accordancll with the Inheritance Tax Laws of thll Co..onwealth of PennsYlvania. Qull2tions ~y bll answllred by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 31000298211 Date 09-16-2005 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 10,012.46 100.00 10,012.46 .045 450.56 TAXPAYER RESPONSE To insure proper credit to Your account, two (2) copies of this notice .ust acco.pany your pay.ant to thll Register of Wills. Make check payablll to: "Registllr of Wills, Agent". Tax x NOTE: If tax paY.lInts are .ade within three (3) .onths of the dllcedent's date of death, YOU .ay dllduct a 5X discount of the tax due. Any inheritance tax due will beco.e delinquent nine (9) .onths after thll date of death. PART [!J A. [ CHECK ] ONE BLOCK B. ONLY c. r=J 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 rllturn this noticll to the RlIgister of Wills and an official asses~ent will be issued by thll PA Departallnt of Revenue. If you indicate a different tax rate, please state your relationship to decedent: r=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. r=J The abovll infor.ation is incorrllct and/or debts and deductions were paid by you. You .ust co.plete PART ~ and/or PART ~ below. 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 DEBTS AND DEDUCTIONS CLAIMED OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) perjury, I declare that the facts I my knowledge and belief. $ have reported above are true, correct and 2- Vo Jeo 1'/ ~ ER ~~n#/ HOME ( 7f~) WORK ( ) TElEPHONE UM 1V ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRIS8URG, PA 17128-0601 ..~,* i~, _. ! . " ! ,r, ~: .: 1,_.; . .... '.. . ,'. INFORMATION NOTICE ... AND . TAXPAYER RESPONSE FILE ACN DATE NO. 21 ""'01-/34 06154041 10-25-2006 , -IEV-1545.EX 'AFUD9-IQI 2nD7 FEB - 9 PI1 3: 27 TYPE OF ACCOUNT EST. OF MElVIN K QUIGLEY IX] SAVINGS S. S. NO. 207-07-9946 0 CHECKING DATE OF DEATH 09-03-2006 0 TRUST COUNTY CUMBERLAND 0 CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 C'I ,-", '. 'Li-;-;j< OQ'-'''-, ".'.'.1'.",' I jl"'" t-.' "~.', ,'. "'-., r!jJ"Il-'~,,:,l_.;II,,"l" " VI ': WILMA J CLARK 638 HIGHLAND AVE MT HOllY SPGS PA 17065 MEMBERS 1ST FCU has provided the Depart.ent with the infor..tion 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 fro. the financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Coa.onwealth of PennsYlvania. Questions aay be answered by calling (717J 787-83Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 240335-00 Date 01-27-2004 Established Account Balance Percent Taxable AlIOUnt Subject to Tax Rate Potential Tax Due x 13,107.32 50.000 6,553.66 .045 294.91 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice BUst accoapany your pay.ent to the Register of Wills. Milke check payable to: "Register of Wills, Agent". Tax x NOTE: If tax payaents are .ade within three (3) .onths of the decedent's date of death, yoU aay deduct a SX discount of the tax due. Any inheritance tax due will beco.e delinquent nine (9) .onths after the data of death. PART ill A. [ CHECK ] ONE BLOCK B. ONLY c. ~ The above inforaation 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 assessaent will be issued by the PA Depart.ent of Revenue. ~ 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. ~ The above infor.ation is incorrect and/or debts and deductions were paid by you. You .ust coaplete PART ~ end/or PART ~ below. If you indicate a different tax rate, please state your relationship to decedent: PART [!] TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established I 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 [!J DATE PAID PAYEE <11 0.01 ~ J ,; #NYi0'1 '4>Jl-L DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION I '- in, ~ (f'~ TOTAL (Enter on Line 5 of Tax Computation) facts I AMOUNT PAID 2...9YP/ and belief. I $ HOME WORK L COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Z8-0601 w; c":;:~t::AET~~O~NES::::CEE :; ,;', I (, FILE ACN DATE NO. 21.D1-/3~ 06154042 10-25-2006 IEV-1S4S EXAFP 10'"00) cu.:=y OF Or'i~" j I. ". I'~' ("{"., !:IT rli-'r,/-', I '-', .> :'_'<,-'\,):11 CU~\/~-''-'-I '~, TYPE OF ACCOUNT PM 3: 2fsT. OF MELVIN K QUIGLEY 0 SAVINGS S.S. NO. 207-07-9946 0 CHECKING DATE OF DEATH 09-03-2006 0 TRUST COUNTY CUMBERLAND IX] CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 2007 FEB - 9 WILMA J CLARK 638 HIGHLAND AVE MT HOLLY SPRGS PA 17065 MEMBERS 1ST FCU hils provided the Depllrbent with the inforBlltlon listed below which hils been used in clllculllting the potentilll 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 inforBation is incorrect, please obtain written correction froB the financial institution, attach a copy to this forB and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the COBBonwealth of PennsYlvania. Questions Bay be answered by calling (717) 787-83Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 240335-41 Date 08-07-2004 Established Account Balance Percent Taxable A.ount Subject to Tax Rate Potential Tax Due x 26,901.65 50.000 13,450.83 .045 605.29 TAXPAYER RESPONSE To insure proper credit to your account, two (Z) copies of this notice BUSt accoBpany your paYBent to the Register of Wills. Make check payable to: "Register of Wills, Agent". Tax x NOTE: If tax paYllents are Bade within three (3) Bonths of the decedent.s date of death, YOU Bay deduct a S~ discount of the tax due. Any inheritance tax due will becoBe delinquent nine (9) Bonths after the dete of death. PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. o The above inforRtion and tax due is correct. 1. You Bay choose to reBit paYBent to the Register of Wills with two copies of this notice to obtain a discount or avoid Interest, or YOU Bay check box "A" and return this notice to the Register of Wills and an official asses588nt will be Issued by the PA Departeent of Revenue. If you indicate a diffarent tax rate, please state your relationship to decedent: o 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. o The above inforRtlon is Incorrect and/or debts and deductions were paid by You. You BUSt cOBplete PART ~ and/or PART ~ below. PART ~ TAX RETURN - COMPUTATION OF LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 4. Allount Subject to TII)( 4 5. Debts and Deductions 5 6. AIIount Taxable 6 7. Tax Rate 7 8. Tax Due 8 PART (!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED TAX ON JOINT/TRUST ACCOUNTS x x PAYEE AMOUNT PAID .2 TOTAL (Enter on Line 5 of Tax Co~utation) facts I $ III \f - --'-- -.....-. ...-.-.".-- ---------'----~,_.._-,--.:,-~,----- --:..---;-.:.~-_-::: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 r,'-".,, ". " . . '" ..'" , ~- ,." , -' ." INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 -o1-/'3~ 06154043 10-25-2006 I .~"15.4S EX, .AFP 11"'10). ~~ WILMA J CLARK 638 HIGHLAND AVE MT HOLLY SPRGS PA 17065 EST. OF MELVIN K QUIGLEY S.S. NO. 207-07-9946 DATE OF DEATH 09-03-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST 00 CERTIF. 2007 FEB - 9 PI'1 3: 27 REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 HEHBERS 1ST FCU has p...ovid.d the D.pa...t..nt with the info...ution list.d b.low which has b.en used in calculating the potantial tax due. Th.i... ....co...ds indicat. that at the d.ath of the above d.cedent, YOU w..... a joint owne"'/benBficiary of this account. If yoU f..l this infor.ation is incorrect, please obtain writt.n cor...ection fro. the financial institution, attach a copy to this fo.... and r.turn it to the above add...ess. This account is taxable in accordance with the Inh.ritance Tax Laws of the Co..onw.alth of PennSYlvanie. Qu.stions BBY be answe...ed by Calling (711) 787-83Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 240335-46 Date 08-22-2006 Established Account Balance Percent TaxBble AIIount Subject to Tax Rate Potential Tax Due x 8,012.48 100.00 8,012.48 .045 360.56 TAXPAYER RESPONSE To insure p...ope... c...edit to your account, two (2) copies of this notice BUst accoapeny Your paY..nt to the Regist.... of Wills. Make check payable to: "Register of Wills, Agent". Tax x NOTE: If tax pay..nts are .ade within th....e (3) aonths of the decedent.s date of death, YOU .ay d.duct a 5~ discount of the tax du.. Any inhe...itance tax due will beco.. delinquent nine (9) .onths after the dete of death. PART ill A. [ CHECK ] ONE BLOCK B. ONLY c. ~ The above infor.ation and tax due is cor...ect. 1. You .ay choos. to r..it pay.ent to the R.gist.... of Wills with two copies of this notic. to obtain a discount 0... avoid interest, or yOU .ay check box "A" and ....turn this notice to the R.giste... of Wills and an official aSS.SSBent will b. issu.d by the PA Depa...taent of R.venu.. If you indicate. different tax rate, please state your relationship to decadent: ~ Th. above ass.t has been or will b. report.d and tax paid with the PennSYlvania Inheritanc. Tax ...eturn to be filed by the d.c.dent.s r.presentative. ~ The above info.....tion is incorr.ct and/or debts and d.ductions w.re paid by you. You .ust coapl.t. PART ~ and/or PART ~ b.low. PART ~ TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balence 2 3. Percent Taxable 3 X 4. AIIount Subject to Tax 4 5. Debts and Deductions 5 6. AlIOunt Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 PART f!] DATE PAID rt(~,f/() 7 DEBTS AND DEDUCTIONS CLAIMED PAYEE /' Ii Hi"",,! C t/",. /: I TOTAL (Enter on Line 5 of Tax Computation) DESCRIPTION jJru~t {b. AMOUNT PAID 13t,.(},,'lr. $ perjury, I declare that the facts I have reported above are true, correct and knOWledge and belief. HOME ( WORK ( TELEPHONE ) ) NUMBE ~{P7 IV A E \l"