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Home My WebLink About09-08-06 COHMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 111Z8-0601 '* INFORMATION NOTICE AND EC ""'~~e~ ~SPONSE FILE NO. 21 06-0446 ACN 06135052 DATE 07-18-2006 REV-15~S EX AFP U9-DII TYPE OF ACCOUNT o SAVINGS !Xl CHECKING o TRUST o CERTIF. 2006 -~S'AM Jqr t:0ISY A LENKER S.S. NO. 164-36-2795 ORP~~~~M; DEA~UM~~;~:~~006 CUV"--': .'\j!) CO.. PA REGI;:~~T ~~Y~:~L~ND FORHS TO: CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 EMILY D HOUDSESHELL 12 SHARON RD ENOLA PA 17025 SOVEREIGN 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/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 C~.onweelth of Pennsylvania. Questions .ay be answered by calling (111) 181-83Z1. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0921710917 Date 02-18-2005 Established x 22.935.29 50.000 11.467.65 .15 1.720.15 TAXPAYER RESPONSE To insure proper credit to your account, two (Z) copies of this notice .ust acc~any your pay.ant to the Register of Wills. Make check payable to: "Register of Wills, Agent". Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x NOTE: If tax pay.ants ere .ade within three (3) .onths of the decedent.s date of death, you .ay deduct a 57. discount of the tax due. Any Inheritance tax due will bec~e delinquent nine (9) .onths after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [] The above infor.ation and tax due Is correct. 1. You .ay chaose to r..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 Departaent of Revenue. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ~e filed by the decedent.s representative. 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 [!J TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date EstabUsned 1 2. ....1 € - c s:- 2. Account Balance 2 L"l.- Cf ?S. 'Z CJ 3. Percent Taxable 3 X ,~C 4. AlIOunt Subject to Tax 4 \' I '-/ U I . IJJ S- 5. Dabts and Deductions 5 4 17.1 . 0 0 6. A.ount Taxable 6 ..., a '+ (0 . ~ ~ 7. Tax Rate 7 X .0 4 s- 8. Tax Due 8 Z-aO .(.,0 DEBTS AND DEDUCTIONS CLAIMED PART [!] DATE PAID PAYEE DESCRIPTION I --.. - F..,,,,,-, TOTAL (Enter on Line 5 of Tax Cu.putation) AMOUNT PAID ~J2./, lib IRS I $ J,j-J5 -of.&> facts I have reported above are true. correct HOME (7 n >7 32 - 0'S-1 WORK ( > H NU and DcrTt -o~ DeparImri 01 the Treaswy - InllImaI Rewnue Servlc:e Form 1040 u.s. Individual Income Tax Return For the .Ian 1 . Dee 31, 2005, or ~ tax Your first IBM MI lastIBM . - Do IlIIl wriIIl Of sblpIe In lhls OMS No. 1545-0074 YowliOClll AaIItl,y.-.. Label (See Inslrucllons.) Dais A Lenker If a jOint nllum, spouWs first name Ml Last name ~~ ~ IRS label. Otherwise, Home address (1UNIer' .., slreet). If you '- a P.O. box, see InslruclIons.. ~ no. y, &1St ent Please print "'-"" au m er your social security or type. 130 Tower Road . number(s) above. . CiI;v, lDWn Of post oIIIce. It you Mw a foreign adchss. see inslruclions. Stale ZIP code PNsidentIaI ~ a box bekM will lilt Election Enola PA 11025 changeJOlll'taxorlllfund. Canpalgn ., Check here if JOU. or JOIII' spouse if filing jonJy, want $3 to go to tIis fund1 (see instnldions) ................ ~ D You D Spouse Filing Status 1 Single 4 Head of household (with qualifying person). (See 2 Married filing jointly (even if only one had illalllle) =~r> ~~~ ~i~: child 3 Married fiTmg separaleIy. Enter spouse's SSM above & full name here. ~ IBIIe here . ~ 5 0 Qualifying lJib(er) with dependent c:lIld (see insVudions) ': Yourself:.I~.~ .~~ .~~~~.~. ~.~.~~~~.~.~~ ~~~.:::::::::::: 1- ~~. C "-'''-Onls'. (2)OeDendent's (3) Oependent's (4) If on. Icwho: --- social security relationship . hid number to you ~Itf wIlhyou ..... lax credit ....._ c- ireslr.i) lhNt.you duetD dlvwa 01'___.., <_ rnstrs) . . . =~ ....... -- . 164-36-2195 ~.. soc:W MCUItly........ Check only one box. Exemptions 1 First name last name If more than fouri=, see I I Add___ 11 d Total number of ex claimed on'" ~I . .. . . . . . . . . . . . . . . . . . . . . . .. . . . .. . . . . . . .. . . . . . .. . . . . . . . .. aIIclv8..... 7 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 4.120. Income 8a Taxable interest. Attach Schedule B if required. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8a 1.978. b Tax-exempt interest. Do not include on line Sa .............1 8bl 2. 325. AttaI:h Form(s) 9a OrdInary dividends. Attach Schedule B if required ...................................... 9a 2,122. W-2 here. Also b~.................... .............................1 9bl 1,538. attach Forn 18 T aubIe refunds, credlIs, or offsets of stale and local inalme taxes (see instrudions) 10 .-m 2Ild1..R . ~ . .. .. . .. .. .. .. . .. .. .. .. .. .. .. .. .. .. .. if tax was withheld. 11 Alimony received. . . .. . . . . . .. . .. . . . . . .. . . . . . . .. . . . . . . . . . . . . . . .. . .. . . . . . . .. .. . . . . . . . . . 11 If JOlI del lilt 12 Business income or (loss). Attach Schedule C or C-EZ ................................. 12 get a W-2, 13 CapItal gain or (loss). All Sch D if reqd.. If not I1Iqd, d( here .........................~D 13 1,334. see il1strucIions. 14 oo.er gains or (losses). Attach Form 4797 . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . 14 L 671. 15a IRA distributions. . . . . . . . . . . ~ I b Taxable amount (see instrs) . . 15b ROLLOVER 16a Pensions al'Id annuities.... 16a 105,991. b Taxable amount (see instrs) .. 16b 20,340. 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E .. 17 EncIuse, but do 18 Farm income or (loss). Attach Schedule F ............................................. 18 lilt aIIadJ. any 19 UnernpIoyrnent compensation ........................................................ 19 pIJlIIIIl Also, 21a SocIal securiIJ bnfiIs ...... .... U!!.I 13,808.1 b Taxable amount (see instrs) .. 21b 11,131. =:e1:i-v. 21 0ItJer income 21 22 Add the arnOtmtS ir1 fu8 far-rtdi OOtUmn -~ iiiieS7 -ttY'oiicii 2f ThiS ~ YOUr 1Oi8i ~ ~ 22 49,302. 23 Educator expenses (see instructions) .. ~ .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 23 Adjusted 24 Certain business expenses of reseMsts, perfoming artists, and fee.basis GrOss government officials. AttadI Form 2106 or 21ll6-EZ . . . . .. .. . . . . . . . . . . . . 24 Income 25 Health savings account deduction. Attach Form 8889 ........ 25 26 Moving expenses. Attach Form 3903 ....................... 26 'Z1 One-half of self-employment tax. Attach Schedule SE ........... 'Z1 28 Self-employed SEP, SIMPLE, and qualified plans ........... 28 29 SeIf~ he8IIh insurance deduction (see instnidions) .................. 29 sa Penalty on early withdrawal of savings ..................... sa 31 a AIinny paid b Recipient's SSM . . . . ~ .. 31a 32 IRA deduction (see instructions) - . . 32 .. .. r .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 33 Student loan interest deduction (see instructions) ............... 33 34 Tuition and fees deduction (see instructions) ................ 34 35 Domestic production adiviIies deduction. Attach Form m .1........... 35 36 Add lines 23 - 31a 10132 - 35 36 'S1 Subtraclline36from line'2i: Th~"~'~'~~~~'::::: ::::::::: ::: :::: ~ 'S1 49,302. BAA For Disc:Iolue, Priv&y Act, .... Paperwork Reduction Act Notice. see instructions. FOIA0112 11107105 Form 1048 (2005) Form 1040 (2005) Daisv A Lenker 164-36-2795 p.dgtI 2 Tax and 38 Amount from line 37 (adjusted gross income) . . . . . . . ~ . or. . . . . : . .. . . . . . . . . . . . . . . . . . . . . . . . 38 49,302. Credits 39. ~ {B You were born bef9re January ~ 1941, B Blind. Total boxes .L if: Spouse was born before Janua 2, 1941, Blind. checked -- 39a Standard b:l~r~~~esa:~=~~,.~.~~~.~~I.-~....._. __ 39b 0 Deduction for- . People who 40 Itembed ~ (from Sc:heduIe A) or your standard deduction (see left 1JI8I1jn) .................... 40 9,884. chec:k8d any box -41 Subtract line 4O,from line 38 ......................................................... 41 39.418. on line 39a or 42 If line 38 is lMlI' $109,475, or you m == to a person displaced by Hurricane KatIina, see 39b or who can be claimed as a instrucIions. Olherwise, llllltiply ,200 by the number of aemptions claimed llIIline 6d . . . . . . . . . . . . . . . . 42 3,200. dependent, see 43 TuabIe int:ome. Sublract line 42 from line 41. . inStructions. If line 42 is more thlIn line 41, enIer.g.. . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 36,218. 44 Tu(see inslrs). Check if any tal is from: a DFom(s) 8814b 0 Form 4972 ........................ 44 5.427. . All others: 45 AItI8mative minimum 1ax (see instructions). Attach Form 6251 45 ........................... Single or Married .- Add lines 44 and 45 ......................... .-.. ._..................................-- .- 5,427. fiI~ separately, if! Foreign tax credit. Attach Form 1116 if required..:. - . - -. . ... Il1 $5, 48 Credit for diId 8IId dependent care expenses. Attach Form 2441 .......... 48 Married filing 49 Credit for the elderly or the disabled. Attach Schedule R ..... 49 ~,~ ~ng 50 Education credits. Attach Form 8863 . . . . . . . . . . . . . . . . . . . . . . . 50 $10,000)' 51 Retirement savings contributions credit. Attach Form 8880 ... 51 52 CliId tal credit (see instrucIions). Attach Form &901 if required .......... 52 Head of 53 Adoption credit. Attach Form 8839 ......................... 53 household, $7,300 54 Credits from: a 0 Form 8396 b 0 Form 8859 ................ 54 55 Other credits. Check applicable box(es): a 0 Form 38lXl "'" b 0= c DForm 55 , 5& Add lines 47 through 55. These are your totai credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 !i1 Subtract line 56 from line 46. If line 56 is more than line 46, enter -0- ................. -- !i1 5,427. 58 SeIf-employnBttal. Attach ScheduIeSE ............ .......... . ....... -................. .. .... 58 Other 59 Social security 8IId Medicare talllII tip income not reported to llII1lIoJer. Attach Form 4137 ....--........... 59 Taxes 60 Additional talllIIlRAs, oItu quaIific:d retirement plans. clC. Attach Form 5329 if required ...... .. . . . . .. . .. . . 60 61 Advance earned income credit payments from Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 62 Household employment taxes. Attach Schedule H . - . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . - . . . . 62 63 MIl lines 57.Q. TIis is YOlII' total tax ............................................................... -- 63 5.427. Payments 64 Federal income tax withheld from Forms W-2 and 1099 . . . . . . 64 306. 65 2m5 estimated .taI peymenls and amount applied from 2004 return . . . . . . . . 65 L 000. lf you have a ~Id~ 66a EarnedincornecnJdit(ElC) ............................... 66a I b NontaIabIe combat pay eIedion . . . . . --I 66bl Schedule Be. ff1 ff1 Excess soc:iaI ~ and tier 1 RRTA tax wiIhhekI (see imtructions) ...... 68 Additional child tax credit. Attach Form 8812................ 68 69 AnmJt paid .. request for 8llensillII to file (see instructionsb' . . . . . . . . 69 70 payments from: a 0 Form 2439 b 0 Form 4136 c Form 8885 70 71 Add I/nes 64, 65, 668, and filll1RM.9170. __ 71 1. 306. -n-_VliIa-taIII ............................................................ Refund 72 If line 71 is more than line 63, subtraclline 63 from line 71. TIis is the lIIIIlUIlt you lMIfJIIid .................. 72 Direct deposit? 73aAmount of line 72 you want refundecl1oyou ..................................... .., -- 73. See instructions ~ b Routing number. . . . . . . . r I.. c Type: n Checking 0 Savings and fill in 73b, .. d Account number .......1 I I 73c, and 73d. 74 Amount of line 72 _ want IIIIIIled to VIlIIr _ estimated tax ....... -- 74 Amount 75 Amount you owe. Sublract line 71 from line 63. For details llIIlIllI to pay, , " . . . . . . . . . . . . . . -- 75 4,121. You Owe 76 Estimated tax . ~ 'see instructions) .................... 76 Do you want to allow another psson to disaIss tIis return .. the IRS (see instructions)? . . . . . . . . " U Yes. Complete the following. \!JNo Third party Desianee Sign Here Jointretum? See instructions. Keep a copy for your records. Designee's Phone _ PersonaIldenlIIic:alIon name .. no. ~ IU1lber {PIN) .. IhIer JIlII1BIties of perjury, I decfare lh8t I '- exemIned lhIs relI.m and llCClJIIlP8f1YI scI1ecl.des and staliemenlS. and to the best of my Icr-'edge and belief, 1hey _ lrUe, CXIIT8d, and compIetIII. 0ecIarIltl0n of preparer (alMr lhlIn lalcpIlyIIf) is besed on all i>.....talion of which preparer ... 'IJIflJ knOwledge. Ycu si!JlaIIn oiIle Ycu occuplllion Daytlme phone runber ~ clerk 5pcxEe's ~. If 8 joint rel1m. baIh nust sl(pl. 0aIB 5pcxEe's occuplIlIon ~ 0aIB Prep;nr's SSN or PTIN Paid ~rer's Use Only Prep;nr's ~ FJrm'sname Self-Pre ared ~\f )- 8dctess~ ZIP code EIN Phone no. Form 1040 (2005) FCMAOl12 11107~ . ,.... ....1 o ..... (..1 ..... (..i (.) 1.(\ I',) - - - - - - - . - ? - - - - - - .. - .. - - ::"" ::"" ::"" - p....-.f':nPDE.r'lu. (]tr-F\CF OC _" ,.' I V - J' (jr:: WI; \ (, (....1 't t lL 0_'..... 706& SEP -8 AM \\: ,2. CLERK OF QRPrJ.AN'S COURT CUMBEF\I>'D CO, PI\ ~ [.2 f0 ~ l ~ ~[D i?lc; - ~ ...1(:>-::::- o ti \f\ wf 'f 1 r ._:.:~ "",;--, "," t..;:) - b c;;- I L -L ~ 1'h ~ :t, ...... \"D o ^' :'4-l. ~~~ ?1 ~ ~ ~ ~ :: v ., :: :: )1;1 !'>~~ ~ ~ r ~ ~ 0 '-,.. -...j )..... !J VI /....: rn .-. " f.l"i ~ Fl- ;... , ~ ..~..: :~; : ! ""l.,.-::' \i) "..- ~