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Home My WebLink About02-14-07 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 BRUNGARD RUSSELL G 7013 DORSEY ROAD LA YTONSVILLE, MD 20882 n______ fold ESTATE INFORMATION: SSN: 177-09-8483 FILE NUMBER: 2106-1147 DECEDENT NAME: BRUNGARD FRANCES T DA TE OF PAYMENT: 02/14/2007 POSTMARK DATE: 02/12/2007 COUNTY: CUMBERLAND DATE OF DEATH: 12/02/2006 NO. CD 007806 ACN ASSESSMENT CONTROL NUMBER AMOUNT 07104401 I $976.58 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 233 SEAL INITIALS: CJ RECEIVED BY: REGISTER OF WILLS $976.58 GLENDA FARNER STRASBAUGH REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRIS8URG, PA 17128-0601 .......,.. . .~. \,,< ~~r~R~A~~~N NOTICE ;TAIPAYER RESPONSE FILE ACN DATE NO.21 06-1147 07104401 02-05-2007 REV-15tt! EX AFP (09-00) ZOG7 FEB I 4 M'lll: 35 EST. OF FRANCES B BRUNGARD '''. rr"'./ ~,- S. S. NO. 177 - 09 -8483 l) ri:\ l ;j' OnDCJ~T:'(' (;'('\1 'R~ATE OF DEATH 12-02-2006 ill i", ,) ~,j,,),,'i i;.nuNTY CUMBERLAND eli':"', "p:"\ IJj.. '\ TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST IX] CERTI F . RUSSELL G BRUNGARD 7013 DORSEY RD LAYTONSVILlE MD 20882-1220 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 FUL TON BANK has provided the Oepartaent with the inforaation 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 inforaation is incorrect, please obtain written correction froa 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 CoaMonwealth of PennsYlvania. Quwstions aay be answered by c~lling (717) 787-8327. COMPLETE PART 1 BELOW · · . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 400-1859844 Date 04-06-1992 Established To insure proper credit to your account, two (2) copies of this notice aust aCCOMPany your PRYaent to the Register of Wills. Make check payable to. "Register of Wills, Agent". Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due 13,706.19 X 50.000 6,853.10 X .15 1,027.97 TAXPAYER RESPONSE NOTE. If tax payaents are Made within three (3) aonths of the decedent's date of death, YOU aay deduct a 5X discount of the tax due. Any inheritance tax due will becoMe delinquent nine (9) aonths after the date of death. PART [j A. fell The above inforaation and tax due is correct. ~ 1. You aay choose to reait paYMent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or YOU aay check box "A" and return this notice to the Register of Wills and an official assessaent will be issued by the PA Oepartaent of Revenue. [CHECK ] ONE BLOCK ONLY 8. 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. If yoU indicate a different tax rate, please state your relationship to decedent: C. c=J The above inforaation is incorrect and/or debts and deductions were paid by You. You aust coaplete PART 0 and/or PART 0 below. PART f!J 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 DEBTS AND DEDUCTIONS CLAIMED OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 4 5 6 7 8 X x PAYEE DESCRIPTION AMOUNT PAID of perjury, I declare that the facts I of my knowledge and belief. ClA4 :J.. -/1-07 have reported above are true, correct and HOME (~O/) q2fo 3399 WORK ( ) TELEPHONE NUMBER DATE r- Ii J ~ i t I " if /./(.: /i.' I t.j (. I ~ 1 "\-t \ \. \ " ~. ~. t Q f.,. l.,.l iY.:1 N U \(.. ~.. 0 u. r"tlj( I:::" j';;. 0 ,.... t~,.1 I- e j r~ 0J I~ '? Q;) WI'" .~ ilJ 1: [L u) .11 N l"l ". ,....~ ~ ~.. 'J U. c) .1l ex: P U..J 1 ..~. 5>G'; QCD C..3 LW,. .. LLJ....,L. cr:. N 00 00 "0 .0 a~N 0.0 >. A C:::(I)~ ~ ~ . .....0(1) -'t:~ = iM.~ ~'o = ~r--O ~ , ~ C/') _J J j ~1 C'C') - Q r- - ~ "'6<::J <:t: ~ ~1 i { <::J ...::t" M - - - -::: - - - - - - - - - - - - - - - - - -:: - - - - - ::c ~ ~,_G cr =~( LLr),:. c)() ~cf./).<- cr:: -,? ' ::1 ~ ~. UIC &0" 0::) c' " o " " , j9 " o r- eA ...::t" co w w... r-- <:::;:) <= C'-.I