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COMMOHWUIHt Of prHHSVI VAHU
DlPAA1HlHI Of NlVINU[
BUREAU Of' IHDIVIDUAl taXIS
U[Pf. :IOU I
HARRI SIUAG, PA 11111-01001
*'
/ (, / I:) ()
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 'If" C..IO
ACN 96122676
DATE 06-13-96
1t,.,..1II t" IIIU
EST. OF PETER PEREGRIN
S,S, NO, 168-09-4921
DATE OF DEATIl 03-11-96
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
[xl CIIECKING
[] TRUST
lJ CERTIF,
ROBERT J PEREGRIN
APT B
1722 JUDIE LN
LANCASTER PA 17603
REHIT PAYHENT AND FDRHS TD.
REGISTER OF WILLS
CUMBERLAND CO COURT 1l0USE
CARLISLE, PA 17013
DAUPHIN DEPOSIT BANK I hu provided 'hI DIPart.."t ..lth thl Infor...' Ion I hted bllo\ll whh~h has bun uud In c:elculatlng the
potlntlal taM due. fhelr r.cords Indlc.te that lit the death of the aboy. decedent. you wer. II joint owner/beneflciarv of thl. account.
If you f..l thls Infor.lltloR Is Incorr.ct, pie... obtain written corr.cUe" fro. the Unandal Instltutlon. attach II COpy to this for.
,,~A..1 r;lltJr. l' t.. '''A ,1,,=,," .o;tt'~.... Thh "'''I"'I'\O.,.t I. ,...."hi.. In IIt'coral"nca ..Ith the: Inheritance I"1Il l".... 01 the CO..M"'8.lth of PennlyhMIII.
Qu..tlon. .ay b. answered by calling (111) 181.8S2/,
COMPLETE PART 1 BELOW M M M SEE REVERSE SIDE FOR FILING AND PAVMENT INSTRUCTIONS
Account No. 0010644032 D.t. 02-10-95
Established
Account ealance
Percent Taxabl.
A~ount Subjact to
Tax R.t.
Potential rax Due
4,216.32
50.000
2,108,16
.06
126,49
TAXPAYER RESPONSE
FAILUR! TO R!SPOND WILL RESULT IN AN OFFICIAL TAX ASSESSNENT BAS!D ON THIS NOTIC!
fo Inlur. prop.r cr.dlt to your account, two
{ZI cop I.. of thl. notic. .u.t acco.pany your
pay.ent to the Reol.ter of Will.. Mak. ch.ck
payable to: "R.OI.t.r of will., Ao.nt".
K
HOTtt If tax pay..nt. are .ad. within thr..
(31 eonth. of the d.ced.nt'. date of death,
you .IIY d.duct a !lie dhcount of the till( du..
Any Inh.r ltnnu till( due w 1I1 b.co.. d.lInqu.nt
nine (9) .onth. aft.r the date of de.th.
K
T..
PART
[!]
[CHECK ]
ONE
BLOCK
ONLY
A. ~ the above Infor.lltlon and tax due I. correct.
~ 1. You aay choo.. to r..lt pay.ent to the Reol.t.r of Will. with two copl.. of th\. notlc. to obtain
. dl.count or avoid int.r..t, or you allY ch.ck bOI( "A" and r.turn thl. notlc. to the R.ol.t.r of
will. and an official ........nt will b. Issued by the PA Depart.ent of R.venue,
B. c=J Th. above a...t ha. b.en or will b. report.d and tal( paid with the Penn.ylvanla Inh.rltance fax return
to b. flied by the decad.nt'. repr..entatlve.
C. c=J Th. above lnfor.atlon I. Incorrect and/or debt. and deduction. were paid by you.
You .u.t co.pl.t. PAAf [!] and/or PART ~ b.low,
OFFICIAL USE ONLY 0 AAF.
PA DEPARTMENT OF REVENUE
If you indicata a diffarant tax rata, pl.asa stata yau~
ralationship to dacadant:
PART
~
TAX RETURN - COMPUTATION
LINE 1. D.t. E_t.bIt_h.d
2. Account Oalanca
3. Parcant Taxabl.
4. AMount Subjact to Tax
S. Dabt. and Daductions
&. Anount Taxabl.'
7. Tax Rat.
8. Tax Du.
OF TAX ON JOINT/TRUST ACCOUNTS
I
2
3 X
4
5
.&
7 K
8
PAD
1
2
3
4
5
6
7
8
DEBTS AND DEDUCTIONS CLAIMED
PART
[!]
DATE
PAID
PAYEE
DESCRIPTION
AMOUNT PAID
, ,
.0
..'
TOTAL (Ent.~ on Lin. 5 of Tax Conputation)
.
Und.~ panaltl.. of
conpleta) to tha bait o~
.r-- I
" l l ./
parjury, I daclare that the
ny kn,Mladga and balief.
, ~ ( U l\ t ' ~"
facti I hava raportad abov. are tru., corract and
1l0ME ( )
WOkK (''71'7) ~~(f r7- ) ~ >.~ X/r::!lC
.,.. untlr:: 'nIlMD.l;'g DA~
/
If-Ilf'- ~
BUNEAU OF INDIVIDUAL TAkES
INtIl..lANC[ UIC DIVIIIOH
DCPJ, :10.01
flARRISlWG, J1A 1/..'1-01001
COHHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
v.
NOTICE Dr INHERITANCE TAk
APPRAISEMENT, ALLOWANCE DR DISALLOWANCE
Dr DEDUCTION., AND ASSESSMENT Dr TAX ON
JOINTLY IIHO DR TRUST ASSETS
tlf.'h'" IIf III.hl
ROBERT J PEREGRIN
APT B
1722 JUDIE LN
LANCASTER PA 17603
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
COUNTY
SSN/DC
ACN
PETER
12-16-96
PEREGRIN
03-11-96
21 96-0610
CUMBERLAND
168-09-4921
96122676
Allou"t R...Ut.d
HAKE CHECK PAYABLE AND REHIT PAYHENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-V:is4-i-EX--AFP--iiz-:96i------------------------------______________________________________________________
NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 12-16-96
ESTATE OF PEREGRIN
PETER
DATE OF DEATH 03-11-96
COUNTY CUHBERLAND
FILE NO. 21 96-0610
TAX RETURN WAS.
S.S/D.C. NO. 168-09-4921
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORHATION
FINANCIAL INSTITUTION. DAUPHIN DEPOSIT BANK & TRST CO ACCOUNT NO.
ACN
96122676
0010644032
TYPE OF ACCOUNT,
DATE ESTABLISHED
( ) SAVINGS (lO CHECKING ( ) TRUST ( ) TIME CERTIFICATE
02-10-95
Account Balance
Percent Taxable X
Amount Subjact to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
4.216.32
0,500
2.108.16
,00
2.108,16
,06
126.49
NOTE. TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CIlECK
OR MONEY ORDER PAYABLE TO,
"REGISTER OF WILLS, AGENT,"
TAX CREDITS:
PAYMENT
DATE
08-07-96
RECEIPT
NUMBER
AAI46607
DISCOUNT (+)
INTEREST (-)
.00
AMOUNT PAID
126.49
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
· IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST, .
I IF TOTAL DUE IS LESS THAN fl, NO PAYNENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" I CRI. YOU NAY BE DUE A REFUND,
SEE REVERSE SIDE OF TillS FORN FOR INSTRUCTIONS, )
126.49
.00
,00
,00
.,
PUR1'OSE OF
NOTlcEI
PAMHTI
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REF1JND(CRh
oaJECTloHS:
ADtnHa
ISTAATlVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST I
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To fulfIll the raqulr...ntl 01 Sactlon Zl~a of thl Inheritance end E,tat. 1__ Act, Act ZZ of 1'91. 112 P.S.
SacUon Z14aJ.
Detach the top portlun of thl, Notlcl ~ ,ubelt with your ply..nt to thl Rlg.,tar 01 Will, printed on the
r."u" .Ida.
aa "~. check or .~y order PIYlbl. tal REGISTER OF WillS, ACENT.
All ply.entl racllved ,hall '.r.t ba .pplled to any lnt.r..t whIch ..y bl due, with any r...lndar appllad to the tlM.
A r.fund of . tax credit, which w.. not r.queltld on thl tax return, ..y ba raqua.tld by co~l.tlng an "application
for Refund of Pennsylvania Inherlt~. end E,tat, Tlx" (REV.I]!S). Applications .r. available at thl OffiCI of
tha Regl.ta~ of will., any of the Z1 Aavenua DI.trlct Off lea. or by calling tha .paclal Z~~hour en.werlng .arvlc.
nu.eer. for 'or.. ordarlngl In P.nn.ylvanla 1~100.S'Z~Z050, out.lde Penn.ylvanla and within local
Harrl.burg araa Cl11) 181.80''', TOOl (111) 11Z~ZZ5Z fHearlng lapalrad Only).
Any party In Intera.t not .atl.fled with the appral...ant, allowBnc, or dl..llowanc. 0' deduction. or .......ant
of t.. (Including dl.count or Intara.t) a. .hown on thl. Notlca .ay obJact within .I.ty (60) d.y. of racalpt of
this Notice by:
..wrlttan prota.t to the PA Depart.ent of Ravenue, Board of Appeal., Dapt. Z810Z1, Har~l.burg, PA 171ZI.IOZ1, OR
. ::.ctlng to h.v. the .",t.r d.t.raIMd at the audit of the ,cco,"",t of the par.onal repr..ent.tlva, OR
nappaal to tha Orphan.' tourt
Factu.l .rror. dl.covar.d on thl. a.....aant .hould b. addr....d In writing tOI PA Oapart.ant of Aavenue,
Bur.au of Indlvldu.1 T...., ATTNI Po.t A....I.ant Aavlew unit, DEPT. Z10601, Harrl.burg, PA 171Z8.0601
Phon. (717) 717.6505, S.. pao. 5 of the booklat "In.tructlon. for Inherltanc. Ta. Aaturn for a Aa.ldant
D~adant" fAEY.I~OI) for an a.planatlon of a~lnl.tratlvaly corr.ctabl. .rror.,
If any t.. dua I. paid within thra. fl) cal.ndar .onth. afta~ the dacadant". daath, . flva parc.nt C5X)
dl.count of tha t.. paid I. .llow.d.
The 15X ta. aana.ty non.partlclp.tlon penalty I. coaputad on the total of the taM and Int.r..t .......d, and not
paid bafor. January II, 199', the flr.t d.y .ft.r the .nd of the ta. aane.ty period, Thl. non~p.rtlclp.tlon
penaltY Is app.ahtb1a In the .... .ennar and In the the .... U.. p.riod .. you would .."..1 the ta. IInd Int.r..t
that ha. b.an .......d al IndlcatLd on thl. notlc..
Int.r..t I. charg.d b.glnnlng with flr.t day of dallnquency, or nlna (9) aonthl and on. fl) day
froe the d.t. of d.ath, to the data of p.y.ant. T.... which bec... dellnqu.nt b.'or. Janu.ry 1, 1'8Z
bear Intar..t .t the r.ta of .1. f6XI p.rcant per annul c.lculatad at a d.lly rat. of .000164.
All ta... which bac... dallnqu.nt on o~ .fter Janu.ry I, 1'8Z will b..r Int.ra.t at a r.ta which will vary fr~
c.l.ndar y.ar to c.l.ndar y.ar with that rat. announced by tha PA D.partaant of Aevenue. Th. app1lcabl.
Intar..t rat.. for 1'8Z through 1997 .r.1
V..r Int.r..t Aat. D.Ily Int.r..t r.ctor Yaar Intar..t Aat. O.lly Int.ra.t Factor
1982 tOX ,0005.8 1987 'X ,oaoz'"
l,n 16X ,0004'" 1988.1991 \IX ,000101
198" \IX .DDOSDl 199Z OX .000Z~7
1985 ISX .000556 19'1.19'~ 7X ,OOOl9Z
1986 lOX ,OOOZ7~ 1'95.1997 'X .DODZ'"
ulntar..t I. calculat.d a. followlI
INTEREST = BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
a.Any Hotlc. I..ued .ftar the ta. b.co.e. delinquent will raflect an Intare.t calculation to flft.en CIS) day.
beyond the date of the .......ant. If pay.ant I. .ada aftar tha Intara.t coaput.tlon d.t. .hown on the
Hotlc., additional Int.r..t .u.t ba calculat.d.