HomeMy WebLinkAbout03-26-07
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
NO. CD 007943
.------
E
FI
D
D
P
C
D
R
!
PAYNE CAROL K
220 W MAIN STREET
MECHANICSBURG, PA 17055
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
- fold
STATE INFORMATION:
SSN:
348-36-1386
101 I $68.74
I
I
I
I
I
I
I
I
LE NUMBER:
2107-0286
PAYNE CHARLES T
03/26/2007
03/24/2007
CUMBERLAND
12/27/2006 .
ECEDENT NAME:
ATE OF PAYMENT:
OSTMARK DATE:
OUNTY:
ATE OF DEATH:'
T'oT AL AMOUNT PAID:
$68.74
EMARKS:
CHECK# 1767
SEAL
INITIALS: CJ
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
, REGISTER OF WILLS
CGIIIONoIEALTH OF PE"'SVLVAH%A
Dl!I'AItTIlENT OF REVENUE
8lJREAU OF INDIVIDUAL TAXES
IIEPT. 21ICal
~RRISIURC. ~ 17121-0'01
.'-""
,"""..':"" '\", !
';'1 ',":,
'i'.
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21-o1}-~Kb
07111297
03-U-2007
CLERI\ Ot
ORPti~NS,~9~R\"
CUMP "", , ',i ,,,\
EST. OF CHARLES T PAYNE
S.S. NO. 348-3'-1386
DATE OF DEATH 12-21'2006
COUNTY CUM.ERLAND
TYPE OF ACCOUNT
IiJ SAVIN;S
o CHECICINQ
o TRUST
o CERTIF.
ERIN PAVNE~
62' EVERGREEN RD
NEW BLOOMFIELD PA 17D'8
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
HEHIIRS 1ST Feu hes .,.o..id" the o.nrtllnt "ith tho info....th. Ibt... IIdow "lIidl II.. ...n used in
colcu1oUno tho _tonti.l t_ duo. Their records i....ic.t. th.t at tho d..th .f th. ........ decodont. Ifau ...... . jOint _no,./lNn.U.h,." of
this o..aunt. If If au f..l thi. in'o....tion is in..,.....t. .1.... ollt.in "ritten co,....cti... traM tho finonai.l instituti.n. ottach a c~
to 1hi. fo... ..... ...tum it to the ob.... .dd...... Thh .ccoUnt 1. t......l. in .ce....r.neo ..ith the In...,.it_ T... Lov. .f the C_..lth
. -of Ponn~ Qnlft1't>,Ill..... II. ..'l.....d1ly-CiI111nr'tT1?)'11I7>>'8Sff;-,., ".'P-' _. _ .""'.'.'. "._"_"'_'__ .,._..
COMPLETE PART 1 BELOW
Acoount No. 198262-05
· SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Date 11-26-2001
Established
. .
Account lalllnee
p.,.eent Tlxabl.
A.ount SYDjeot to Tax
Tax Itato
Potentiel Tax Duo
x
20,205.88
1&.667
S,3'7.71
.045
151.55
TAXPAYER RESPONSE
x
PART
[J
To 1n...... ........,. c...dit to YOU" .ccount, tlfO
(2) copies 0' thb not!" aust lICCOIIlleJW your
pay..nt t. tho R..l.t.,. .f Will.. "~. ch.ck
payoll1. to. .....bt.,. of Wills. AlJOnt".
NOTE. If tllX 1I.lIOn'- .... ..... vithin th....
eS) ..nths of tho d.c.dont'. d.t. of d.oth.
you ... d.duct a S1l discount of tho to du..
AI'tII inht!rUanc. t_ ..... will boc... ...U.......nt
nino (9) IIOfttho aft.,. the ...to of dooth.
:;i.~.~'5 ',;~j :-r;:~: ,:~';o ~ ~ '-', .'~ ~..~: "'~ ,'J':.-~:; ~:~.- '-.:.~' -:-, '. _ c- _".~:~~..~_' .'~'- -:-.;'~_--, ; ~_' I ,:. ' - _; -. :;~, _~_'~ ,:.T~~":;r:r; ~r:f'
[CHECK ]
ONE
BLOCK
ONLY
A. 0 The alia... i"fo.....tion and t_ due is c.,.roct.
1. Vou aiill' chao.. to ,...it .~ht to the Re.i.t.r of Wills with twa copi.. of this notieo to Obt.in
· discount 0,. avoid 1nto,..st. 0,. you II. ch.ck b.. ~An ond ...turn this "oti.. to tho R..istor of
Will. and on .fflal.1 ........nt vill II. i.su.d IIv tho ~ Oell.rt.ont of Rovonuo.
.. 0 Tllo 8110... a..ot II.. lI..n ar ..ill IN ,....lH't.d Mil tox ...id "Uh tIl. f'IIftA."l...nill 1II1l...itllne. TOlIl r.turn
ta be fil.d IIv tile d.c.d.nt'. r...,....nt.ti....
C. ''fit( Tho 8IIon inforllilUon 1~nc.rroct "CV~'lIts and deducti_ ...,.. ..id bIr Yeu.
P VDtI ..t coa.l.t. PART I!J .nIVo,. PART l!J bolo".
PART
l!l
TAX
LINE
If you lndloate a different tax rate. please state your
,.,lationship to docedont:
RI;:TUR1L_~.CD~UT~OILOF TAX. OILJODlT/.1llIlS,T-AC
1. Oat. EstabIl.had 1
2. Account Balllnce 2
S. Percent Taxable 3
4. A.aunt Subjeot to Tax 4
S. D.bts and Deductions 5
~. A.aunt raxabl. ,
7. Tax Rete 7
e. Tax Due .
PART
l!1
DATE
DEBTS AND DEDUCTIONS
PAYEE
PESCRIPTION
AHOUfIIT PAID
perjury. I doclare that the facts t
-V knowledge and bellef,
TOTAL CEnter on Llno 5 of Tax Computation)
.
AT4.A:;:;rAC/TI
have ,.eported abov. are tru.. co,.r.at and
HOME (7:'7 )....:~ -kc..f J ~ ~
WORK ( _ >___ ~ () 7
TElEPHON NUH - 6A (V
auc::...I UT.J-::J ......~ !on , n " .JDIl'1)
COtllONWEAL 1H OF PENN8VLVAIlIA
IlEPARTIlENT OF ItEVEIlUE
lIUREAU OF INDIVIDUAL TAXES
IlEPT. 210U 1
~RRISIU"'G, PA 17121-0'01
..~....'.'.;",,-':;cr,i..:"
. -. . .-~.
, " ,
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO.21-o1-UIo
07111312
03- 16-2007
Cl' I=fJI/ r:iL
_...... If \ \~, I
ORPHl.N'S COURT
ClJ~ ,lr: ,"', " i", D,~
Iv:,.' : " " i I,
EST. OF CHARLES T PAYNE
S.S. NO. 348-3'-1386
DATE OF DEATH 12-27-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
[i] SAY I HGS
o CHEeUN;
o TRUST
o CERn F .
ERIN PAYNE~
52' EVERGREEN RD
NEW BLOOMFIELD PA 17D68
RE"IT PAY"EHT AND FORKS TO:
REGISTER OF WILLS
CUMJERLAND CO COURT WOUSE
CARLISLE. PA 17013
HEPlBERS 1 ST Feu twos '>I'ovided tho Ouortllo"t with tho Inf.....U.n U.ted bol_ whiCll II.. Iloon u..C1 ill
colcu10tino tho p.t."tio1 tea due. Th.ir recorda indleoto tllot ot tll. doath of tho ab.ye d.eodont, ~ou w.~. a joint own.r/bonefici.ry of
thls .ccount. If you f.o1 thi. inf.~oti.n i. inco~oct, 01.... obtoln wrltt.n co~~otioll fr.. tho finanoi.l institution. attoeh . cOPW
to thl. foro and roturn it to tho .bovo addros.. This account i. taxobla in accordanco with ttwo Xllhoritollco T~ LONs of the'C...olIWo.lth
IIIf PonlYSYlvoni... Qautions.ay be- ..n.....l'I1t 1IV cunlnl--c71T> -717-1$2:7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Accollnt No. 1982'2-00 Date 10-30-2000
Established
Account lalance
Percent Taxabl.
Aaount Subject to
Tax Rat.
Potential rax Due
lC
424.04
16."7
70.67
.045
3.18
TAXPAYER RESPONSE
To insure ,rOPor c~odit to vour accDUnt. two
(2) co.ios of this ..otic. au.t acoco.any ~our
p~.ont to tho ROlistor of Will'. Hako chock
~ob1. to. "R.list.r of Wills, Alant-.
x
NOTE. If t.. pay..,.ts ora lIodo with!1I three
(3) aonths of tho doc.deAt's dat. of ~.ath,
yO" a. deduct a 5X disc.ullt etf tho hx c1u..
A~ inheritonco t~ cIuo will boc... da11nouont
nino (9) Months .ftor tho dato of doath.
Tax
PART
[!]
The .bovo inforMation and toa duo is corroct~
You ..y chaos. to r~it p.wftant to tho Rooister of Wills with two cOPios of this lIotlca t. obtain
a discount or ovoid intorest. or yOU May chock b~ "AU and r.turn this notico to tha "'ooistor Of
Wills and an offieiel ass.....nt will b. issuod ~ tho PA Dep.rt..nt of Rovenue.
[CHECK ]
ONE
BLOCK
ONLY
.. 0 The allovo ....t has bo.n o~ will b. r.portod ",d tax 'aid with the /'annwl..ni. Inhoritance TM I"etllrn
to be filed ~ the decadant's r.p~..nt.tivo.
C. 0 Tho aIHIv. infer.aUon i~ncorr.c:t enellor d.bts ..nd d.ductions w.,.o pdd by YOII.
You IlUSt c_.lota PART L!..J 'neVor PART [!J b.l_.
If yOu Ind1c.te .. d1fferent tax rate. ploese state your
re1atlonshlp to dooadant:
PART
~
TAX
L.INE
RETUR~__C~F JAlLDN JOINUDUSL..ACCJJmu:s
1. Date E.tabl1ahed I
2. Account lalance 2
S. Percent Taxable S x
4. A.aunt SUbjoct to Tax 4
5. Debt. and >>oduct1ons 5
6. A.aunt Taxable ,
7. Tax Rate 7 X
e. To ~. .
PART
I!J
DATE PAID
PAYEE
DESCRIPTION
AMOUNT PAID
I
T01AL (Enter on Lln. S of rax Computation)
.
perjury, 1 d.clore that the facts
my owled.. end belief.
have ,.epoo,oll
HOM If
WORK (
TELEPHONE NUMB
au~ed u~,J3
cltoS:BO
~.~
BU'BZ8Si. Ii.
COllltClIllEALTH OF PENNSYLVANIA
DEPAlIITIlEHT OF IlEYENUE
llIIEAU OF INDIVIDUAL TAXES'
DEPT. nOel1
HARRIS.URG. PA 17121.1'01
."~, :-. r+\ ~""!'-_" ;~. !-:., ""': ',__ ,....' l"' r
fM'" .....:,.p,..:' iI.~.ORMATION NOTICE
.' ,.'.. _ AND
TAXPAYER RESPONSE
FILE
ACH
DATE
ND.21'"'D1-t2lro
07111295
03-16-2007
CLER!< cr EST. OF CHARLES T PAYNE
ORPH,n,!rs COURT S. S. NO. $48 - '6 - 13"
CUM~T:i ",,;,\ p,~DATE OF DEATH 12-27-2006
- t1:0UNTY CUMBERLAND
TYPE OF ACCOUNT
o SAYINGS
fi] CHECICING
o TRUST
o CEATIF.
ERIN PAYNEWIMC&
52' EVERGREEN RD
NEW BLOOMFIELD PA 17068
REHIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT WOUSE
CARLISLE. PA 17013
ME"IERS IS1' Feu h., pr."id.d tho DaDort..nt with tho inf.,...Uon list.d bs1... which has bun u.od in
calculotinD tho .ot.ntiol tax duo. T~i~ ~o.o~s iftdico~a ~hot at the d.oth Df tho ab..- d.~d.nt. YOU ...~. a j.int ~no~'ben.ficiory of
this occount. If VOY f..l tni. In'o~otl.n I. Inc.~r.ot. .1.... obtain w~itton co~~oction f~oM tho financial inatitutian. attach a C.PV
to thi. fol'll MId rot""" it t. tho .b."o oddros.. Thi. .._unt is t.._l. in oacordonc. with tho Inh.rit."co Tax L.... of tho C_.nvos1th
..,r P...,",..~l..nl.. ..mull. ~IU' b. CI,,~_....4' h ...111.... (11,., .7t~: - - ~
COMPLETE PART 1 BELOW
Account No. 198262-11
. .
. SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
D.te lO-30-20tlO
Est.bUstl.d
Acoount I.lanc.
P.rc.nt Taxabla
Aaount Subject to Tax
Tax Rate
Pot.nt~ol Tax Du.
x
2,185.20
16."7
364.21
.OG5
16.39
TAXPAYER RESPONSE
To insu~. ,r.,.~ c~dit to ~ou~ .ccount. two
(2) co..i.. of this notic. ~t accoap.nt your
~Ment to tho Ragistar of Will.. Mako chock
p8lI'o..1. to. -R.dste" of \IIills. Alant".
x
NOTE. If tllll ._nb a,.. MlId. within t~..
U) ..nths of tho d.c.d.nt'. dah of dadl!.
YOU MaY doduct a ~ di.count .f tho to. du..
Ant inherit.nc. t.. duo will bOCDn. d.linQuent
nino (,) aonth. .ft.r the "at. .f d.ath.
PART
[!J
Tho ....". inf.Nati.n and tax dUD i. corr.ct.
Vau a.w ch..so to ~..it ..,..nt to tho ~..I.t.~ .f Will. ..Ith two co,ia. of this n.tic. to obtain
o di.eovnt o~ a"oid intor..t. or I/OU aw ch.ck bn: -A" ..nd ~oturn this n.tica to tho R..hler of
Will. and on .ffici.l O.....SoAt will "0 issuo" by tho PA D..a~ta.nt of Rovonue.
[CHECK ]
ONE
BLOCK
ONLY
.. (:] Tho abov. o...t has b..n .r will Il. r....rt.d and tax .aid with the PennlY1"ania Inh.ritanca T_ return
to be filed by tho dec.d.nt.s r.p~...ntotl"a.
C. r:J The ab.vo lnfo,..atlDn l~corr.ct and/or dabts and d.duction. w.r. paid bv ~au.
You ou.t c..,lota PART l!J endlor PART [!] balow.
If you indicat. a diff.r.nt tax r.t.. 01.... stat a your
r.lotion'hlp to deced.nt:
P.RT
[!)
DAn: PAID
DEaTS AND DEDUCTIONS
PART
[!l
TAlC
LINE
R~TURN - r:.OMPIITATtnN
1. Date Est.blished
2. Account Bal.nco
3. Po,.c.nt To~abl.
4. AMount Subject to Tax
5. D.bts and Deductions
,. Amount Taxable
7. Tax lot.
e. Tax Du.
OF TAlC nN Jnt~r/J.RUST.ACQ
1
2
3 x
4
5
,
7 x
e
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Entar on Lin. 5 Of Tax Co.putat~on)
parjury, I decl.re that the facts I
m~ knowl...o and bol1ef.
I
.
B t toB28Sl. tl.
or.
:'ll.Jioe;rt
and
c1€S:80
COIlMONWEAlTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
w--
INFORMATION NOTICE
-\-- --- . ... -AND
'~AXPAYtR RESPONSE
FILE
ACN
DATE
NO. 21-07-2'110
07111311
03-16-2007
IIEV-I_ EX on (I'"...
2DD7 H/\R 26 P11St:.3Bt CHARLES T PAYNE
5.5. NO. 348-36-1386
CLEfiK OFDATE OF DEATH 12-27-2006
ORPHAN'S COgJjl1NTY CUMBERLAND
ClJlM). .:1:' c' ("., ,..,~
Pll~. .,.J .; ,. :...." l, :/..1,
TYPE OF ACCOUNT
[iJ SAVINGS
D CHECKING
D TRUST
D CERTIF.
CAROL PAYNE
220 W MAIN ST
MECHANICSBURG PA 17055
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MEMBERS 1ST FCU has provided the &part..nt with the info...aUon listed below which has been used in
calCUlating the potential tax due. Their records indicate that at the death of the abova decedent, you were a joint owner/beneficiary of
this account. If YOU feel this info...ation is incorrect, please obtain written correction froa the financiel institution. attach a copy
to this for. and return it to the. above address. This account is taxable in aCCordance with the InheritanCe T.x Laws of tha C...onwaalth
of P-"""wll<lUlu. --,-Qu~ona'.DY be._ered~iQ/:'cal.1in& (717) 787....327-.-.. . .. ._______
COMPLETE PARTl BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 198262-00
Date
EstabUshed
10-30-2000
To insura Proper credit to YOUr account. two
(2) copies of this notiCe .ust accoapanv your
payaent to the Register of Wills. Make check
payable to. "Register of Wills. Agent".
Account Balance
Percent Taxable
A.ount Subject to Tax
Tax Rate
Potential Tax Due
x
424.04
16.667
70.67
.00
.00
TAXPAYER RESPONSE
NOTE. If tax pay.ents are .ade within three
(3)..onths of the decedent's date of death,
you .ay deduct a 5X discount of the tax due.
Anv inheritance tax due will becoae delinquent
nine (9) .onths after the dete of death.
x
PART
[!]
The abOve info...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
· discount or .void inter..t, or you _.v check box "AM .nd return this notice to the Resister of
Wills and an official assessaent will be iSSued by the PA Depart.ent of Revenue.
[ C~~~K ]
BLOCK
ONLY
B. c=l 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. c=l The abOVe infoMlation is incorrect andlor debts and deductions Were paid by you.
You .ust coaplete PART ~ andlor PART [!] below.
DEBTS AND DEDUCTIONS CLAIMED
PART
~
T~ ~ETURN - CO~P~JATION
If you indicate a different tax rate. please state YOUr
relationship to decedent:
QL_TAX_ON JOINT/TRUST AfCOUNT~.
LINE 1. Date Established 1
2. Account Balance 2
3. Percent Taxable 3
4. Amount Subject to Tax 4
s. Debts and Deductions S
6. Amount Taxable 6
7. Tax Rate 7
8. Tax Due 8
PART
[!]
DATE PAID PAYEE
x
x
DESCRIPTION
AMOUNT PAID
T
(Enter on Line S of Tax Computation)
.
perjurY, I de.~e that the facts I have repOrted above
MY knowhdlle .nd ~el1ef. HOME (
WORK (
TELEPHONE
end
COMIIONIIEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280'01
HARRISBURG, PA 17128-0'01
.*"....
. ~. , ',i-
'-- _" .' ".'f
"':~EX N'l> (1'"0.'
INFORMATION NOTICE
-. AND
'TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21-07-:2K(o
0711129&
03-16-2007
CAROL PAYNE
220 W MAIN ST
MECHANICSBURG
CI ERt" er-
~ 1,\ U:-
ORPI-li\!\j'S COURT
ell'. ~r:'C' '! '-\r\ '"'
J/Vi" " 'i' . I i'<i;
EST. OF CHARLES T PAYNE
5.5. NO. 348-3&-138&
DATE OF DEATH 12-27-200&
COUNTY CUMBERLAND
TYPE OF ACCOUNT
Ii] SAVINGS
o CHECKING
o TRUST
o CERTIF.
2007 rojAR 26 Ptl/2: 33
PA 17055
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MEMBERS 1ST FCU h.. p..ovid..d th.. D..p...t...nt with th.. info....tion list..d below which has b..an used in
c.lcul.ting th.. pot..nti.l tax du.. Th..i.. ....co..ds indic.t.. th.t at th.. death of the .bov.. d.c.d.nt, you w.... . joint own..../b.nefici.ry of
this account. If you f..l this info....tionis inco.....ct, pl..as.. obtain w..itten co......ction f..... the financi.l institution, .tt.ch a cOPY
to this fo... .nd r..turn 'it to the above addr.ss. This account is taxable in accordanc. with the Inh.rit.nc. Tax Laws of the C....onw..lth
...fP~v~ Il....tion_~. an_.red byc.U,inlr<H7)--7lS1-,.83iN-.---- _ _'___ ___."__ ..._________.
COMPLETE PART I BELOW
Account No. 1982&2- 05
. .
· SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Date 11-2&-2001
Account Balance
Percent Taxable
A.ount Subject to Tax
Tax Rate
Potential Tax Due
x
20,205.88
16.&&7
3,3&7.71
.00
.00
TAXPAYER RESPONSE
To insure p..op.r credit to your .ccount, two
(2) copi.sof this notic. aust .ccoapany your
p~.nt to the R.gistar of Wills. Mak. ch.ck
pay.bl. to. uR.gist.r of Wills, Ag.nt".
Established
x
NOTE. If tax paya.nts .r. a.d. within thr..
(3) .onths of the d.c.d.nt's d.t. of d..th,
you .ay deduct . 5X discount of the tax du..
Any inh.rit.nc. tax due will b.c.... d.linqu.nt
nine (9).onths .ft.r the d.t. of d.ath.
PART
[!]
Th. .bov. info....tion and tax due is corr.ct.
1. You.ay choos. to r..it paya.nt to the R.gist.r of Wills with two copi.s of this notic. to obt.in
· discount 0" .void int....st, 0.. you .ay check box "Au end r.turn this notice to the R.gist.r of
Wills and .n offici.l .ss.ss..nt will b. issu.d by the PA D.pa..t..nt of R.v.nu..
[CHECK ]
ONE
BLOCK
ONLY
8. c=l Th. above .ssat h.s b.en or will be r.ported and tax paid with the P.nnsYlvani. Inheritance Tax return
to b. fil.d by the d.ced.nt's rep...sent.tiv..
C. c=l Th. .bov. info....tion is incorr.ct andlor d.bts .nd d.ductions w.... p.id by you.
You .ust coapl.te PART ~ andlor PART ~ b.low.
If YOU indicate a different tax rate, please state your
relatiOhShip to decedent:
PART
I!l
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PART
I!l
TAX RETUitN.-.:..SgMpUTATJ"gN. OF .I..A~
LINE 1. Date Established 1
2. Account Balance 2
3. Percent Taxable 3 X
4. Amount Subject to Tax 4
5. Debts and Deductions 5
6. A.ount Taxable 6
7. Tax Rate 7 X
8. Tax Due 8
ON. JOINT/TRUST AC~9UNTS
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
I
.
of perjury, I declare that the facts I
of my knowledge and belief.
have reported
HOME ( 7
WORK (
TELEPHONE
COMllOl<<ri/EAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
'*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21-D7-U~
07111294
03-16-2007
1IEV-lS4J EX AFP n,- on
EST. OF CHARLES l' PAYNE
S.S. NO. 348-36-1386
DATE OF DEATH 12-27-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
Ii] CHECKING
o TRUST
o CERTIF.
CAROL PAYNE
220 W MAIN ST
MECHANICSBURG PA 17055
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MEMBERS 1ST FCU h.s provid.d the Dep.rt..nt with the info~.t1on listed b.low which h.s baan used in
calculating the pot.nti.l tax du.. Their records indic.t. th.t at the d..th of the .bove dec.d.nt, you were. joint owner/benafici.ry of
this account. If yoU feel this infor..tion is incorr.ct, pl..s. obt.in writt.n correctian fr.. the financial institution, .tt.ch a COPY
ta this fara .nd return it ta the .bov. .ddr.ss. This .ccount is tax.bl. in .ccard.nc. with the Inheritanc. Tax Laws of the C....nw..lth
of--bMsvlvania....- ...$I:1as-t.ion~-be""""'.P.r: I;v BJl1-1...(71-.."").~7~"~~,._____,_ __ __. _____.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 198262-11 Date 10-30-2000
EstabUshed
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
2,185.20
16.667
364.21
.00
.00
TAXPAYER RESPONSE
Ta insure proper credit ta your account, twa
(2) capies of this notice .ust .cc..pany your
p~.nt ta the R.gist.r af Wills. Make ch.ck
pay.bl. ta. "Register of Wills. Agent".
x
NOTE. If tax pay..nts are ..de within thr..
(3) .onths of the d.ced.nt's d.t. af d..th,
YOU .ay d.duct . 5X discount of the tax due.
Any inherit.nc. tax due will b.c... d.linq~.nt
nine (,) .onths .fter the d.te af death. .
Tax
PART
[!]
The .bav. info~.tian .nd tax due is carr.ct.
1. Yau.ay chaas. ta re.tt pay..nt ta the Regist.r of Wills with twa capies af this notic. ta obtain
a discaunt or avoid inter.st. or you .ay check box "A" and return this natice ta the Regist.r af
Wills and an afficial .ss.ss.ent will b. issu.d by the PA D.part..nt of R.v.nu..
[CHECK ]
ONE
BLOCK
ONLY
B. [:] The above ass.t has been or viII be report.d and tax paid vith the Pennsylvania Inheritanc. Tax r.turn
to be filed by the d.ced.nt's representativ..
C. [:] Th. abav. inforaatian is incarrect and/or d.bts and deductians v.re paid by yau.
Yau .ust coapl.t. PART ~ and/or PART ~ belovo
PART
[!J
_1'JJC. RETURN .,. Cgt!PUTATIJULOF
LINE 1. Date Established 1
2. Account Balance 2
3. Percent Taxable 3
4. Amount Subject to Tax 4
S. Debts and Deductions 5
6. A.ount Taxable 6
7. Tax Rate 7
8. Tax Due 8
If you indicate a different tax rate, please state your
relationship to decedent:
PART
I!l
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
1'A1C ON__JQJN1ZTRU_$J ACCOUNTS
x
x
PAYEE
DESCRIPTION
AMOUNT PAID
.
facts I
have reported above are
7) 7t(()
)
HOME
WORK
(
(
true, correct and
9/3
,..__ _I"ll.._...._ .......___
~".
1"1
11
I ,
I '-
l
, .
, ~ I
\\\\\\\
, ~ I I
, f -<
, 'J ~~
:
~ I "
~~.,~
"
~......
~,
(.' : r-
..... ,....
It'j
It'j
c
,'-
. ...
<Il~~
~.t eo.
....\:S .
<::S~\::'
tl:'o:!
o:>\.l;l
l-- f"" '"
(3c~
....'::$
....-=::
u
<>l
Ii
.'
'-
- :--.~~ ---
[001 ~\i)R 26 pn \2: 3 \
~Lr:~'" nc
L, uw\ \)i
ORD\-ll\ 'I\!' ,"' ,"'(';l \ D,T
,I' . " ' . .) \....../ ...1 , ,
ru' .... ",,~. r-...f>..
i\t!. ' .' 1 J
....., i ~ \' I
.~J~
~ \~
~~'-.....
~ ~
~