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HomeMy WebLinkAbout96-01055 COfQON(ALltl or PENNSYLVANIA O[PAlllHlNt or R[V[HU( IUREAU Of IHDIVIDUAl TAXES DEPT. 110601 HARAISIURG, PA 11lZ'-0601 /~-Jl/9-./(1 *' a I~ 9 to. IDI5 l~ INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 ACN 9615B950 DATE 12-17'96 II'.IUIII ,,, "."1 TYPE OF ACCDUNT !Xl SAVINGS o CNECKING o TRUST o CERTIF , EST. OF DAVID W BURGER S,S. ND, 172-01-1912 DATE OF DEATH 10-12'96 CDUNTY CUMBERLAND FILf::f\ L3 p[r (ILr REKIT PAYHENT AND FORKS TO. REGISTER OF WILLS CUMBERLAND CO COURT HDUSE CARLISLE. PA 17013 ROBERT E BURGER 126 S HANOVER ST CARLISLE PA l70l3 FINANCIAL TRUST CO"PAN hIlS pravld.d the n.part..nt wUh the Inforaatlan I ht.d balaw which ha. b..n u..d In calcul.tlnv the potential ta. due. Th.lr r.card. Indlcat. that .t the d..th of the above dac.dant, you wara . joint ownar/ban.flclary of thl. account. If you f..1 thl. Infor..tlon I. Incarr.ct, pl.... abt.ln wrltt.n carr.ctlan froa th. financial In.tltutlon, .tt.ch . copy to thll for. and return It to the .bov. addr.... Thl. account I. t..able in .ccordanc. with the Inharlt.nc. 'a. law. of th. Co..onw..lth of penn.ylv.nla. Oue.tlon. .ey be an.war.d by c.lllnv (117. 161-6)21. COMPLETE PART 1 BELOW . . . SEE Account No. 1-392209 o.t. E s tab Ushod REVERSE SIDE FOR OB- 05-93 FILING AND PAYMENT INSTRUCTIONS To In.ur. prop.r credit to your .ccount, two eZ) cap I.. of thl. notlc. .u.t acco.pany your p.y.ant to the R.gl.t.r of will.. Hak. ch.ck payabl. to: "Ragl.t.r of Will., Agant-. PART [!] lB,477,73 16,667 3.079,68 .06 184.78 TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT BASED ON THIS NOTICE Account aalance Percent Texable Anount Subject to Tax R.te Potential Tax Due x HOTEl If tax pay..nt. are ..d. within thr.e e)) .anth. of the dac.dent.. date of da.th, you .ay daduct a ~Z dl.count of the t.. due. Any Inh.rltanc. ta. due will b.Co.. d.llnquent nlna (9) .onth. aft.r th. data of d.ath. T.. x [CHECK ] ONE BLOCK DNLY A. 0 The above Infor.atlon and t.. due is corract. 1. You .ay chao'. to raalt pay.ent to the Regl.t.r of will. with two cop I.. of thl. notlc. to obtain a dl.count or .vold Int.r..t, or you ..y check box -A- and r.turn thl. notlc. to the Ragl.t.r of Will. .nd an offlcl.l ........nt will b. I..u.d by the PA C.part..nt of R.v.nu.. a. c=J The above ....t h.. b..n or will b. r.ported and tax paid wlth the P.nnsylvanla Inh.rltanc. t.. r.turn to be fllad by the d.c.d.nt.. r.pre..ntetlv.. C. c=J the above Infor.atian i. Incorr.ct and/or d.bt. and deductions w.re paid by you. You lIU.t co.pl.te PART (II and/or PARt ~ b.low. PART ~ If ~ou indicate. different tax rat., pl.ase ,tate ~our rel.tionship to dec.dent: OFFICIAL USE ONLY 0 AAF PA DEPARTMENT OF REVENUE T,,^ Oi.. JOINT/TRUST ;'C:OUi~TS PAIi 1 2 3 4 5 6 1 8 CLAIMED OF 1 2 3 X 4 5 6 7 8 TAX ~~iUi\it .. COiiPUiAi:i:ON LINE I. D.t. Establlshod 2. Account aalance 3. Percent Texable 4. Anount Subject to Tax 5. Debt, and Deduction. 6. Anount Taxable 7. Tax Rete 8. Tex Due X PART I!l DATE PAID DEBTS AND DEDUCTIONS PAYEE DESCRIPTIDN AMOUNT PAID I TOTAL (Enter on Line 5 of Tax COMPutation) . Under penaltie. of perjury, I declare thet the feet. I cQIIPleto to te.be.t of ~y knowledg, and beli.f. "," . I J' c) !I...-...., '-l 1..U..{"'~ , ---' 'V t 1 TAXPAYER SIGNATURE haye reported .boye ere true, HOME (/".-'i(l) L;" '1 I) W~~~EP~:N:'N~MBF.R correct and GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT "ath applicAble Inter..t ba.ad on Infor..tlon ,utMlUMi by the flnllftC:lll In.tltutlon. t. Inherlt.ncl tax ~c~.. delinquent nl~ aonth. .ft" the dlc.dant', dltl 01 d..th. S. . Joint I<count a. t..abl. Iv.n though thl dlcld.nt" n... WI' ndded A' . ..tt., 01 convtnl~c', ~. Account. (Including tho" held blt....n hu.band and wlf,1 which thl dlCldlnt put In Joint n.'.' within onl y..r prior to d..th .r. fully '1.1Ib._ II tnn.'ars. S. Account. ..tabll'had JointlY bltwlen hu.b~ ~ wlf. lor. then one y..r prior to d..th ar. not ,..abl.. .. Account. held by . daudent "In tru.t fo'oo anoth.r or athu' ar. ,..able fullY, REPDRTING INSTRUCTIONS - PART 1 - TAXPAVER RESPONSE 1. BLOCK A . If thl Infur..tlon nnd co~t.tlon In thl notlcl ar. corr.ct and deduction, Ar. not baing clal..d, pilei an ~X~ In block ~A~ of P.rt 1 of the ~T..p.yer R.spon..~ ..ctlon. SI~n 'wo cap I.. and sub.lt 'h.. with your check for the a.ount of ta. to the R.gl.t.r of will. of the county Indlc.t.d. The PA n.part..nt of R.v.nu. will l..u. en official ........nt (far. REV-IS~I EX) upon r.c.lpt of the r.turn froa the R.gIst.r of Will.. z, aLOCK a _ If the ....t .p.clfl.d on this notlc. h.. b..n or will b. reported and taM paid with the p.nn.ylvanla Inh.rltanc. T.. Return '11.d by the dec.dent.. r.pr.sentatlv., plac. an ~K~ In black "a~ of Part I of the "T..p.y.r Ra.pon.a~ .actlon. Sign one coPY Bnd raturn to tha PA napart.ant of Ravenua, Buraau of Individual T...., Oapt ZI0601, HarrhbUrg, PA I1UI-OIIOl In tha anv.lop. provided. 5. aLOCK C _ If tha not Ie. Infor..tlon I. Incorr.ct andlor d.ductlons ara baing cl.la.d, ch.ck block ~C" .nd caaplet. Parts Z and 5 accordlnq to tha In.tructlon. b.low. Slon two cap I.. and .ub.lt tha. with your ch.ck for the ..~unt of t.. p.y.bl. to tha RaoS.tar of will. of the county Indlcat.d. Tha PA Dap.rt..nt of Ravanua will I..u. an official ........nt (for. REV-IS~I EX) upon r.calpt of the return fro. th. R.gl.ter of Will.. TAX RETURN - PART 2 - TAX CDMPUTATIDN 1IHf I. Ent.r the date the account originallY w.. ..tabll,had or tltlad in the ..nn.r a.l.tlno at data of d..th. NOTE~ for a decad.nt dying aftar IZ/IZ/aZ: Accounts which the d.c.d.nt put In joint n.... within on. (1) y..r of d..th ara t..abla fully.' tr.n.f.r.. How.var, th.r. I. an a.clu.lon not to a.c..d 15,000 p.r tran.far.. ragardla.. of the value of the .ccount or the nuab.r of accounts held. If . double ..t.rlsk (..) app..r. b.fora your first n... in th. addr..s portion of this not Ie., the IS, 000 ..clu.lon .Ir.ady h.. b..n d.duct.d fro. the account balanca a. raport.d by the flnancl.1 In.tltutlon. Z. Ent.r the total b.lance of the account Including Int.r.st accru.d to the data of daath. 5. Th. p.rc.nt of the account that I~ ta.abla for .ach .urvlvor I. d.t.ralnad as fallow': A. The p.rc.nt t...bl. for joint ....ts ..tabllsh.d .ora than on. y.ar prior '0 tha dac.d.nt'. daath: I DIVIDED BV TOTAL NUMBER Of JOINT OWNERS E.a.ple: A joint ....t r.gl.terad DIVIDED BV TOTAL HOHBER Of K 100 . PERCENT TAXABLE SURVIVING JOINT OWNERS In the na.. of tha d.c.d.nt and two oth.r p.r.on.. I DIVIDED BV S (JOINT OWNERS) DIVIDED BV Z (SURVIVORS) . .161 K 100 . 16.1~ (TAKABLE fOR EACH SURVIVOR) B. The p.rc.nt ta.abla for ....t. cr.atad within on. y..r of tha d.c.d.nt.. d..th or account. own.d by the d.c.d.nt but h.ld In tru.t for anoth.r IndlvldU.l(') (trust b.n.flclarl..)l I DIVIDED BV TOTAL HUHBER Of SURVIVING JOINT OWNERS OR TRUST BENEfICIARIES 1C loa . PERCENT TAKAllE E..aplu: Joint .ccount regl.tar.d In tha naa. of the d.c.d.nt and two oth.r p.r.on. and ..tabllsh.d within on. y..r of d..th by the dacadent. I DIvIDED BV Z (SURVIVORS) . .50 X 100 . SO" (TAXABLE fOR EACIt SURVIVOR) ~. Th. aaaunt .ubjact to t.. (1In.~) I. d.t.r.ln.d by aultlplylng the account balance (1In. Z) by the p.rcant ta..bl. (lln. SI. S. Ent.r tha tot.1 of the d.bt. and d.ductlon. II.tad In Part 5. ... ii.. _.~ ..."wi. i.ii...~; 1.. u.t.......,'" ..~ .w~liIlI",if1Y ,,,. "'.u~.. csrn.i u.~\iOIl& ,lol". ~J ,.-u. ~na aaoun\ ,uoJ.(;'; \U tax ,.In_ ..,. 1. Ent.r the appropriate t.. r.ta (1In. lJ .. d.t.r.ln.d balow. A. for dat.s of d..th occurring .ftar 6/S0/'4, the ta. rat.. for tran.far. to .pou,., ar. a. follow.: 1. Oat.. of daath on or aft.r 1/1/94 and b.fore 1/1/9S tha rat. I. S". Z. Oat.. of daath on or aft.r 1111'S tran,'.r' to .pou..' will b. ,...d .t OX t.. rat.. Not.: For dat.. of d.ath prior to 111/9~ tran.f.r. to .pou,., .r. t..abl. at 6~. II. Transf.rs to IIn..l ducendant. Including fath.r, .oth.r, .on, dlught.r, orandchlldr.n, .0n-In-IMl, daught.r-In-law, .t.pchlld and thelr hsu. ar. t...bl. at .Ix p.rcant (6~J. C. Transfars to .11 oth.r. Including broth.r. .I.t.r, unci., aunt. n.phaw and nlac. ar. ta..ble .t flft..n p.rc.nt elS"). D. If you chang. tha t.. rat., pl.... .p.clfY your r.latlon.hlp to the d.c.d.nt In the ar.a provld.d. 8. Th. ..ount of t.. due elln. IJ I. d.t.r.ln.d by aultlplylng th. ..ount t..abl. (lln. II) by the t.. r.t. (lln. 1). CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIDNS CLAIMED AlIowMil. dabt. and dadUCtlon. are d.tar.lned a. follows: A. You l.g.lly .ra re.pon.lble for p.y..nt, or the a.tat. 'ubj.ct tD ad.lnl.tratlon by . p.r.onal r.pra,.ntatlv. I. In.ufflcl.nt to pay the d.ductlbl. It.... a. Vou actually p.ld the d.bt. aft.r d..th of the d.c.d.nt and can furnl.h proof of payaant. C. Dabts baing clalaed au.t be It..lzed fully In Part S. If addltlonal .pac. I. n.ad.d, u.. plain papar I I/Z" . 11". Proof of Ply.ant .ay b. r.qu.stad by the PA o.part..nt of R.v.nu.. TAXPAVER ASSISTANCE IF YOU NEED FURTHER INFORMATION OR ASSISTANCE, CONTACT ANV REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE OR CALL THE BUREAU OF INDIVIDUAL TAXES, TAXPAVER INQUIRV UNIT IN HARRISBURG AT (717) 787-8327. TDD. (717' 772-2252 (HEARING IMPAIRED ONLY) , -. .--.- -- -..-.. -- _..~ - D . 184984 COMMONWEALTH OF PENNSYLVANIA NO. AA DEPARTMENT O' REVENUE OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX ............... . . -. .~, >! ....'I6lIl....~ ACN ASSESSMENT I'l' CONTROL ... NUMBER AMOUNT RECEIVED FROM: 6 ROBERT E BURGER "'o.l~tI..,30 ""J~"'. Ie 126 B HANOVER CARll SLE, PA STREET 17013 fOtOHflf ESTATE INFORMATION: ~ FILE NUMBER li1 21-1996-1055 1:1 NAME OF DECEDENT (LAST) ~ BURGER DAVID W II DATE OF PAYMENT EJ POSTMARK DATE COUNTY SSN 172-01-1912 (FIRST) (Mil CUMBERLAND DATE OF DEATH m TOTAL AMOUNT PAID _184.78 SK '\ ." . {)"I . j/ . RECEIVED BY :,It/i.I~1 (' ltu~'.-Y/;.'t_ .; , /, ~GN.'U'!. . t J. MARV C. LEWIS .}/;{./JI//-'Y (~ REGISTER OF WILLS ~ REMARKS MRS HELEN BURGER C/O OF ROBERT E BURGER CHECK II 3448 SEAL REGISTER OF WILLS ._ _. .__. _ ..._ ._. ....... ___u ._ _ . _~_ .___ ..#_ ~- -.- - ___ - __ - __ ..0-_- .____. ..-. .~- - ....... ---- - ...- " . ..--- , -- - -- .-----. .- ~-----:""~ _ _ .. .T ..,:~ I!/ ~/{lq - 1(1 IUREAU Of INDIVIOUAL TAXES INHEAITAHCE TAX DIVISION DOT. 210601 HARAlSIURQ, PA 111%1.0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE -~- "OTICE or III1IEIIITAlCCE TAlC APPII.UBEIlDCT, AI.LOMAltCE OR OIB&l.LOMAlCCE or DEDUCTION <-.AIID AlIllEB81lEKT or TAlC ON JOIIfTI.Y WoLO OR TRUBT WETS tn.,.... (I '" IU.'U ROBERT E BURGER l26 5 HANOVER ST CARLISLE PA 17013 DATE ESTATE OF DATE OF DEATH FILE NUNDER COUNTY SSN/DC ACN 01'28-97 BURGER 10-12-96 21 96-l055 CUMBERLAND l7Z-0l-1912 96158950 ...,..,t R..1t ted DAVID W HAKE CHECK PAYABLE AND REMIT PAYMENT TOI REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .... Rifv:isiis-Eif-AFii-liif:96i------------------------------.----------------------------------------------------- NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS. AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE Ol-2B-97 ESTATE DF BURGER DAVID W DATE OF DEATH lO-l2-96 CDUNTY CUMBERLAND FILE NO. 2l 96-l055 TAX RETURN WAS: S.S/D.C. ND. l72-0l-19l2 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION ACN 96158950 FINANCIAL INSTITUTION, FINANCIAL TRUST COMPANY ACCOUNT ND. l-392209 TYPE OF ACCOUNT: (lO SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 08-05-93 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due l8.471.73 0.166 3.079.68 .00 3.079.6B .06 l84.7B NOTE: TD INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION DF THIS NOTICE WITH YDUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE AUDVE ADDRESS. MAKE CHECK DR MONEY DRDER PAYABLE TO, "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT DATE l2-23-96 RECEIPT NUMBER AAl84984 DISCOUNT (+) INTEREST (-) 9.24 AMOUNT PAID l84.78 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE . IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIDHAL INTEREST. · I IF TOTAL OUE IS LESS THAN .1, HO PAY"ENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" I CR). YOU HAY BE OUE A REFUND. SEE REVERSE SIDE OF THIS FORK FOR IHSTRUCTIDNS. ) 194.02 9.24CR .00 9.24CR 00 c- ::: c.!! -0 .... :D :nm , ~. :"1 ,; , c.... ~ VJ Cl '.. '. d ~ (;;+~. PURPOSE Of NOTICE, -~ . ,'. . .1..- ,.~ e11 w en P.S. To fulfill the requlr-..nt. of Section 21'0 of ~ I~rltenc. and E.tata 'ax Act, Act 22 of 1991. Section 2140). PAYJlEKTI o.tach the top portion of thl. Notice ... ......It with your Plv-'lt to the A.ghta,. of NUh ,rlntlld on the rav.,... .... .. "-kl check or ~v o~r p.~l. tal REGISTER OF WILLS, A;ENT. AU plYMnt. received iMll flrU be eppUed to en, lnt.,...t which ..y be dIA, with en, ,...lnde,. IIPPlhd to the tax. REF1.Im (CA)I .. ,..flRl of . tax crlldlt, which If" not reetu..ted on the tax ,.Iwrn, _, be reque.ted by cCMPI,Una en -Appllc.t1on fOl" Aef,", of Penn.'lv8nl. Inhlrlhnu end Est.t, TIlJl"' (REV-UU), AppUc.tlon. Ir. IYIIIlIlbI. at the OffIce of the Regl.t.,. of Will., en, of the 23 A.venue DI.trlct OfficI' or by cIlllng the specla. Z4-hour ....werlna ..rvlc. nu.ber. for for.. orderlngl In Penn.rlvente 1-800-36Z-Z0SD, out.lde penn.rlvants and within 1000I Hlirrlaburg er.. (111) 717-8094, fDOI (717) nZ-Zz.liz (HAring IIIP.lred only). OIJECTlONSI Any p.rh In Int.r.1t not ..tidIed with the ...r.lI......t, .llowenc. or dl..llowenc. of cMductlon. or ........"t of tu (Jncludlng dllcount or Inbr..tJ a. shown on thll Notlu ..y obJact wIthIn .lxty (60) M)IS of racalpt of this Notle. bYI .-wrlttan prot..t to the PI a.part-.nt of A.venue, Board of App..l., Dept. 261021, Herrlaburg, PI 11121-1021, OR ".lactlng to have the ..ttar dIItaralned at the audit of the ItCcount of the per.on.1 reprasentatlv., OR --appeal to the Orphan.' Court ADttIN. ISTllATlYE CORRECTlONSI factual .rror. dlscaverad on thh ......~t ahould be addr...ecf In writing tal PA o.p.rDwit of A.v........, lur..u of IndIvIdual T...., ATTNI Pa.t I....~t R.vlew unit, DEPT. 280601, Harrllburg, PA 11128-0601 Phon. (117) 717-6505. S.. page 5 of the bookl.t -In.tructlon. far Inherltanc. Tax A.turn for 8 A..ldent Decedent- (REV-1501) for an .xplanatlon of edalnl.tratlv.ly corractabl. error.. Olsccurr s If any talC due Is p.ld wIthin thr.. (3) calenda,. ~th. aft.r the decadent'. death, . fiVe ptIrcent C5%) dllcount of U. tax paId II allowed. PENAL TYs ThII 15% tax --...ty non-participation penalty Is cOllPUtecf on the total of the tax end Inhr..t .....INd, and not p.ld befo,.. Janua,.y 11, 1996, the Urlt day .fta,. the and of the tax ..,..ty ptIrlod. Thh non-pa,.tlc1patlon penal ty h appealabl. In the .... .....,. and In the the .... tI.. ptIrlod .. you would 8PPMI U. tax and Int"..t that has been .....Iad a. IndIcated on this notlc.. INTEREST I Intar..t Is cha,.gad beQlmlng with Urat day of delinquency, or nine (9) ~th. end OM (1) day fratl the data of death, to the data of p.)'Mftt. '.x.. .....Ich bee-. dIIl1nquent bIIfore Jenuary 1, I9Il beIIr Int.,...t at the rat. of .tx C6:.:) ptIrcent pe,. 8lY'IU8 calculated .t a dally nte of .00Gl64. III tax.. whIch *- delinquent on or aft.r January I, 1'8l w1l1 bell,. Inbr..t .t a rat. whIch will WI"Y fro. cal"r y..r to calendar y..,. wi th that rat. ~ by the PA Dep.,.t..\t of A.venue. ThII appllcebl. Int.,...t rat.. fa,. 1'6l th,.ough 1997 ar.1 Ya.r Intar..t Aata Oally Int.ra.t Factor Ya.r Inbr..t Rata Dally Intar..t Factor .'12 20X .DD0541 1'87 9X .DDDl47 196] 16% . DD04S8 1966-1991 I1X .0DnGl 1914 I1X .DDnD! .992 9X .DDOZ47 1915 11% .00Dl56 199]-1994 7X .oool" 1986 lOX .oDD17" 1995-1991 9X .0DDl47 --Inbr..t I. calculated a. follo..'l IIlTEIIEST ~ BALANCE OF TAX UNPAID X KUftBER OF DAYS DELINQUENT X DAILY IIlTEIIEST FACTOR --Any Hottc. I.~ .ft.r the ta. bac~. delInquent will raflect en Intar..t c.lculatlon to fifteen CIS) My. beyond the data of the ........"t. If papant 11 aada aft.r the Int.r.1t cOllPUtatlon data shown on the Hotlctl, adcl1t1onal Int.r.at ...t bII C11lculated. ,S.NlJ/cJ BUREAU OF JNDIVIDUAL TAXES 11I01TAHC( TAll DIVISION PEP'. U06G 1 HARRISIURG, PA .,IZI-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT * C/ .n.ltll(l '" tU-M' ROBERT E BURGER l26 S HANOVER ST CARLISLE PA 17013 DATE ESTATE OF DATE OF DEATH FILE NUI1BER COUNTY ACN 03-03-97 BURGER 10-12-96 2l 96-1055 CUMBERLAND 96l5B950 DAVID W A.aunt R..Ut.d MAKE CHECK PAYABLE AND REMIT PAYMENT Tal REGISTER DF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 HOTEl To 1"l\Ir. proper credit to your eccount, aub.1t the upper portion of thla for. with your tex p.yeent. CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~ ifE'v: i60j-EX-"FP-liZ:m-------.iii-iHH€iiiYliiicE-i;.X-STATEi1Etii-OF-;.ccciuNf""ii..--------------------- ESTATE OF BURGER DAVID W FILE NO. 21 96-1055 ACN 96158950 DATE 03-03-97 THIS STATEHENT JS PROVIDED TO ADVISE OF THE CURRENT STATUS DF THE STATED ACH IH THE HAIlED ESTATE. SHOWN BELllII JS A SUHKARY OF THE PRINCIPAL TAX DUE, APPLJCATION DF ALL PAYMENTS, THE CURRENT BALAHCE, AND, IF APPLICABLE, A PROJECTED JNTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT I Dl-21-97 PRINCIPAL TAX DUE.. l84.78 PAYMENTS (TAX CREDITS). PAYMENT DATE 12-23-96 02-l8-97 RECEIPT NUMBER AA184984 REFUND DISCDUNT (+) INTEREST (-) 9.24 .00 AMOUNT PAID 184.78 9.24- -.:t :1 t 1"', ,-,- -- .....~ i- l84.78 .00 .00 .00 .~ :J UU TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE . IF PAJD AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIDNAL JNTEREST. ( JF TOTAL DUE JS LESS THAN '1, HO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YDU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORl1 FOR INSTRUCTIONS. I PAvt€NT l Dot.... thO t... po.tlon of thl. Notlc. and .....It .Ith y...' r..-t .- ..yobl. to thO ... and ........ printed on U. revar.. .tde. __ If RESIDENT DECEDDfT .... chICk or ~, orde,. p.,.tIlI tal REGISTER OF WILLS, AGENT. __ 11 ",,"-RESIDEIfT IlEWlOII .... ...... o. .....y 0'''''' ..y..l. to. cOf1ltClN\lEAL TH OF PEHHSYLVAHIA. .U ...-tl ._hod _11 .. _Uod f1..t to any Int....t ""I.. .., bo duO .Ith anY ._1..... _llod to thO t... _ lCOll . ..hrd of . tOll c.odlt. ""Ich ... not ,",".tod on _ T.. R.\\Im. .., .. ,......tad by c_l.tI... .. ....1I..tlon for Rahrd of PomIYI.....I. I.....rltonc. and E.tot. T... lREV-nUl. ...ll..tlon.... ...11..1. .t thO affl.. of _ R..lat.. of Mm., any of thO U R....... alatrlc' affl..' o. f.DO thO .....~,.. Z.-_. .._.1... ....I.. ...... for fora' o.""rI.... In .......1_1. l.aaO.S6Z.Z050. ...tal"" .......1_1. end within local Hlr,.hburg .,... (717) 7111.11I94, TDD' (711) nZ~Zl5Z (He.dng I....lr.cl anl'). REPLY Tal _.tlonl ......1I... ...0.. ....tolnod on thla notl.. ahould .. ........od '0. .. ....._t of R........ Iu._ of Ir.II.......t T..... .mll .0.' ....._t Rwl.. Unl', ....t. Za0601. Ho.rI_.a..' l7IZa.a601........ 17171 7a7-6505. DISCDlIfTI 11 any lOll ..... Ia .ald .Ithln thr.. ISl ..1_' _tho .ft.. thO doc.....'.. _tho . fl.. po.c..t 1511 dl.....,' af the tax peld 18 eUDWId. PEKlLnl ThO 151 lOll .....ty _....tlcl..tlon ....Ity Ia _tad on thO 'ot.1 of thO ,.. and Int....t ......ad. and no' ,.ld before ..,...rY 11, 1996, the flr.t day .fter the end af the tu: __.t)' period. IN'fERESTI Int....' Ia _.ood ....Iml... .Ith f1.., "'y of ...11_" o. nino 191 _thl and .... III day f.DO thO dot. of _tho to _ dot. of ...-t. T.... ""I" _ doll_t bofo.. Januory 1. "az ..... Int....' .t thO ..t. of II. IUI po..'" po. ...... ..1..I.tad ., . "'lly ..,. 0' .000161. .11 t.... ""I" -- ""11_' on and .ft.. JonuO., I. 1,aZ .111 ..... Int.,.., .t . ..t. ""I" .111 YO.Y f.DO ..Iondo' y... to ..1_' y... .Ith thOt ..t. ennouneed by the PA DeP.rt.ent af R.v~. The ~llcable Int.re.t rata' fa" 191Z thrOUGh 1997 are I y... Intar..t RIta Dllh Inter..t Fector v..r Int.r..t Rate 0011' Inur..t Factor 19IZ Z01 .0DDSltI 1917 9X .aOOl47 1965 IU .000411 19aa.1991 IU .000501 19" 111 .000501 199Z 9X .000l47 1965 I$X .000556- I99S'I... 7X .0OOl9Z 1916 lOX .GOaln 1995'1997 9X .000l47 --Int.r.. t 1. calcul,t.d .. fol1~'1 IKTERElIT . BAWeE OF TAll UNPAID X HUKBER OF DAYS DELIHQUEKT X DAILY INTEREST FACTOR --Arty Notl.. laouod .tt.. thO '0lI _. ""U_, .111 ,,"oc' .. Int....t oolcul.tlon to flft_ 1151 doy. boyond _ dot. of thO ....._t. 11 ...-t Ia .- .tt.. thO In""" _t.tlon ..... .-. on tho Notice, addltlonlll lntar..t lIlJ.t be ealcul.t.d.