HomeMy WebLinkAbout04-10-07
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COMJiloNWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES' r',' ,'-"
DEPT. 280601 . -
HARRISBURG. PA 17128-0601
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FILE
ACN
DATE
NO. 21~1-o3q~
07113363
03-28-2007
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
REV-154S EX AFP (It-Ol>
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ORPH/\i\J'S /FiT
CIII,,...H',, ,"1
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EST. OF ROSALIA M PAEZ
S.S. NO. 545-12-2034
DATE OF DEATH 12-16-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
[i] CHECKING
D TRUST
D CERTIF.
7001 ~,PR 10 Pi'! 4: 22
CONSUELO ALLPORT
715 WILSON ST
CARLISLE PA 17013
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MEMBERS 1ST FCU has provided th~ Depart.ent with the info~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 info~ation 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 Co..onwealth
I>f Pennwlyania. Questions IIaY be answored by cell:!.nll (717) 781.-&127.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 120898-11
Date
Established
07-08-1991
To insure proper credit to your account. two
(2) copies of this notice aust accoapanv your
pay.ent to the Register of Wills. Meke check
payable to. "Register of Wills. Agent".
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
PART
[!]
x
3,938.99
16.667
656.51
.045
29.54
TAXPAYER RESPONSE
NOTE. If tax pay.ents are .ade within three
(S) aonths of the decedent's date of death.
you aay deduct a SX discount of the tax due.
Any inheritance tax due will beco.e delinquent
nine (9) .onths after the date of death.
x
I
illlit*:!tw_,,,.'li..g;..~......__~. .------ ....___=.~__w.~.!il'.j,.~~~lIL~i!'.~._~"~.__'ll'".__.q,,:J1_~__'li..P_'ii'__.cilL.",..g;i!'..""'i:!IL:ii;!!::il;~:h:<"''f.j.i.:~1!L.__=.ijj!"~",,,'__'liC~.,,..~~z'llilL.~_.iF:AAii
[CHECK ]
ONE
BLOCK
ONLY
A. D The above inforaation and tax due is correct.
1. You aay choose to re.it payaent 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 Depart.ent of Reyenue.
B. D 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. ~ The above inforaation is incorrect andlor debts and deductions were paid by you.
You .ust co.plete PART ~ andlor PART ~ below.
OF TAX ON JOINT/TRUST ACCOUNTS
If you indicate a different tax rate, please state your
relationship to decedent:
PART
[!]
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
I!I
1
2
3--1..
4_
5-=- tJ 5, 0 5 D . 1\ &
6
7 X
8
o
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
i'L350..#i8'
Under penalties of perjury, I declare that the facts I
complete to the best of my knowledge and belief.
CfJlUu/i:lo f2. 0 ()f2,l (I) A Uvl' f6K 0 f f) e tt I~ to)
TAXPAYER SIG ATURE
have reported above are .t,rue, correct
HOME ('7 /1 ) 35 g - LI () 1.5
WORK ( ) IJ !r
TELEPHONE NUMBER
DATE
and
~
... ~....
Page 1
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~ ROSAlJAM.PAEZ -.::."
Th I. I. I LEGAL copy 0 f...... CONSUELO ALLPOIlI JOAQUIN PAEZ , .. I ~ ~, 11.1_
your oheok. You cln u.e It oa 7IImLSON5l'J.1ill 717.w.t01S 1M,. Iv iii' ",11 ...
the ..me WIY you wou I d ... .... CAe! Kill'", VDU. .
uutheorlolflllcheck. .......JI AJ
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:~ i ,ifiotb TtI'IJU~/) tJIGJ/T IIIJ,uf>1\6J> AN' flrre~IJA~%'t~:.
fTI N I 1\ lit
...:r · . MEMBERS 1"
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270
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Tracer: 1219022703 - Amt: $3,815.28 - 12/19/2006
Ewing Brothers Funeral Horne, Inc.
630 South Hanover Street
Carlisle, PA 17013-
(717)243-2421
December 21,2006
Connie R. AUp0l1
715 Wilson St.
Carlisle, PA 17013
The Funeral Service for Rosalia M. Paez
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
1. PROFESSIONAL SERVICES
Services of Funeral Director/Staff. . . .
3. AUTOMOTIVE EQUIPMENT
Vehicle to transfer remains to Funeral Home.
C. SPECIAL CHARGES
Direct Cremation. . . . . . . . . . . . . . . . . . . . . .
FUNERAL HOME SERVICE CHARGES . . . . . . . . . .
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THAT YOU HAVE SELECTED . . . . . . . . . . . . .
Cash Advances
Certitied Copies of the Death Certificate. . . . . . . . . .
Coroners Authorization fee. . . . . . . . . . . . . .
TOTAL CASH ADV ANCES AND SPECIAL CHARGES.
Total
Total Cost .
. . . .. . . . .. .. . . . .. .. .. .. . .. .. .
SUB-TOTAL
IN ITIAL PAYMENT / DISCOUNT / CREDITS
TOTAL AMOUNT DUE
The unpl\id balance owr 30 days is subjected to a 1.50 % service charge per Illonth. 18.0000 % per annulll.
$900.00
$225.00
$245.00
$1370.00
$1370.00
$36.00
$25.00
$61.00
$1431.00
$1431.00
0.00
$1431.00
fA /0 JA-rJ {AD 01
1
t H t el< 'It 5 p '1 J,
Member of National Funeral Directors Association
, Y OUf first name and inItial Last name , , OMS No. 1545-0074
label \
,
(See instructions.) L Rosalia M Paez I Your social security number
I
A I 545-12-2034
B If a joint relurn, spouse's first name and initial Last name I
I Spouse's social security number
Use the E I
L !
IRS label. H Home address (number and streel). If you have a PO. box, see instructions. I Apt. no.
A You must enter
Otherwise, E 715 Wilson St. your SSN(s) above. A
please print R City, town or post office, state, and ZIP code. If you have a foreign address, see instructions.
or type. E Checking a box below will not
'- Carlisle PA 17013 ~ change your tax or refund.
~ ..
~F~'
1040A
DECEASED R Paez 12/16/2006
Department of the Treasury-Internal Revenue Service
U.S. Individual Income Tax Return (99) 2006
IRS Use Only-Do not write or staple in this space
Presidential
Election Campaign ~ Check here if you, or your spouse if filing jointly, want $3 to go to this fund (see instr.)
~ D You
D Spouse
Filing
status
15 Add lines 7 through 14b (far right column). This is your total income.
16 Penalty on early withdrawal of savings (see
instructions). 16
17 IRA deduction (see instructions). 17
18 Student loan interest deduction (see instructions). 18
19 Jury duty pay you gave your employer (see
instructions). 19
20 Add lines 16 through 19. These are your total adjustments.
21 Subtract line 20 from line 15. This is your adjusted gross income,
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions.
Check only
one box.
Exemptions
If more than six
dependents,
see instructions.
Income
Attach
Form(s) W-2
here. Also
attach
Form(s)
1 099-R if tax
was withheld.
If you did flot
get a W-2, see
instructions:
Enclose, but do
not attach, any
payment.
Adjusted
gross
income
KIA
1 ~ Single 40 Head of household (with qualifying person). (See instL)
If the qualifying person is a child but not your dependent,
2 0 Married filing jointly (even if only one had income) enter this child's name here.
3 0 Married filing separately. Enter spouse's SSN above ..
and full name here.
~ 5 0 Qualifying widow(er) with dependent child (see instL)
6a ~ Yourself. If someone can claim you as a dependent, do not check box 6a. } Boxes
checked on
b 0 Spouse 6a and 6b
No. of children
on 6c who:
1
I
C Dependents: (2) Dependent's social (3) Dependent's (4),'y'}f qualifying
relationship to child for child
security number tax credit
(1) First name Last name you (see instr.)
0
0
0
0
0
0
. lived with
you
. did not live
with you due
to divorce or
separation
(see instr.)
Dependents
on 6c not
entered above _
Add numbers G
on lines
above ~
d Total number of exemptions claimed.
7 Wages, salaries, tips, etc. Attach Form(s) W-2.
7 0
8a 12
0
9a 0
0
10 0
11b 0
12b 10,716
13 0
14b 0
~ 15 10,728
0
0
Sa Taxable interest. Attach Schedule 1 if required.
b Tax-exempt interest. Do not include on line 8a. 8b
9a Ordinary dividends. Attach Schedule 1 if required.
b Qualified dividends (see instructions). 9b
10 Capital gain distributions (see instructions).
11a IRA 11b Taxable amount
distributions. 11 a see instructions.
12a Pensions and 12b Taxable amount
annuities. 12a see instructions.
13 Unemployment compensation, Alaska Permanent Fund dividends, and
u dut a.
14a Social security
benefits. 14a
20
o
~ 21 10,728
Form 1040A (2006)
~
~or'm 1040A (2006)
22
Tax,
credits,
and
payments
Standard
Deduction
for-
o People who
checked any
box on line
23a or 23b or
who can be
claimed as a
dependent,
see instructions.
o All others:
Single or
Married filing
separately,
$5,150
Married filing
jointly or
Qualifying
widow(er),
$10,300
Head of
household,
$7,550
If you have
a qualifying
child, attach
Schedule
EIC.
Refund
Direct
deposit?
See instructions
and fill in
45b, 45c,
and 45d or
Form 8888.
Amount
you owe
Third party
designee
Sign
here
Rosalia M Paez
Enter the amount from line 21 (adjusted gross income).
545-12-2034
22
Page 2
10,728
Check { ~ You were born before January 2, 1942, 0 Blind } Total boxes
if: 0 Spouse was born before January 2,1942, 0 Blind checked ~ 23a
b If you are married filing separately and your spouse itemizes
deductions, see instructions and check here
Enter your standard deduction (see left margin).
Subtract line 24 from line 22. If line 24 is more than line 22, enter -0-.
If line 22 is over $112,875, or you provided housing to a person displaced by Hurricane Katrina,
see instructions. Otherwise, multiply $3,300 by the total number of exemptions claimed on line 6d.
Subtract line 26 from line 25. If line 26 is more than line 25, enter -0-.
This is your taxable income.
Tax, including any alternative minimum tax (see instructions).
23a
Q
6,400
4,328
3,300
1,028
28
104
"\
29 Credit for child and dependent care expenses.
Attach Schedule 2.
30 Credit for the elderly ,or the disabled. Attach
Schedule 3.
Education credits. Attach Form 8863.
Retirement savings contributions credit. Attach Form 8880.
Child tax credit (see instructions). Attach
Form 8901 if required.
Add lines 29 throuQh 33. These are your total credits.
Subtract line 34 from line 28. If line 34 is more than line 28, enter -0-.
Advance earned income credit payments from Form(s) W-2, box 9.
Add lines 35 and 36. This is your total tax.
Federal income tax withheld from Forms W-2 and 1099.
2006 estimated tax payments and amount
applied from 2005 return.
40a Earned income credit (EIC).
b Nontaxable combat pay election. 40b
41 Additional child tax credit. Attach Form 8812.
42 Credit for federal telephone excise tax paid.
Attach Form 8913 if required. 42
43 Add lines 38, 39, 40a, 41, and 42. These are your total payments.
44 If line 43 is more than line 37, subtract line 37 from line 43.
This is the amount you overpaid. 44
45a Amount of line 44 you want refunded to you. If Form 8888 is attached, check here ~ 0 45a
~ b ~~~~~~ I xxxxxxxxx I ~ C Type: D Checking D Savings
Account I XXXXXXXXXXXXXXXXX
number .
~ 23b
o
o
104
o
104
o
104
0NO
I
Your signature f:, 11 ~ ()' Ii Date Your occupation Daytime phone number
Jolol. ,.tom? ~ eo n, l.L ,. W 10 {lUp D IZ[i" AU'" iu q AP ^ 01 retired
See lClstructlons. ..> v . i V::J
feep a copy Spouse's signature. If jOint return, both must sign. Dale Spouse's occupation
or your
records.
Prepare(s ~ I Dale I Check if D Preparer's SSN or PTIN
Paid signature self-employe<!
pre parer's Firm's name (or yours) EIN
use only if self-employed).
address, and ZIP cod Phone no.
KIA
24
25
24
25
26
26
27
~ 27
28
29
31
32
33
30
31
32
o
o
33
34
35
36
37
38
39
34
35
36
~ 37
o
38
39
40a
o
41
~43
~d
46
Amount of line 44 you want applied to your
2007 estimated tax. 46
47 Amount you owe. Subtract line 43 from line 37. For details on how
to pay, see the instructions.
48 Estimated tax penalty (see the instructions). 48
Do you want to allow another person to discuss this return with the IRS (see instructions>U Yes. Complete the following
Designee's Phone Personal identification I
name ~ no. ~ number (PIN) ~ .
Under penalties of perjury. I declare that I have examined thi$ return and accompanying schedules and statements, and to the best of my
knowledge and behef. they are true. correct, and accurately hst all amounts and sources of income I received during the tax year. Declaration
01 preparer (other than the taxpayer) is based on ~lIlnfor\"aliop 9twhich the preparer has any knowledge.
/" VII '- XtfflC-SC!J tiC'
~47
Form 1040A (2006)