HomeMy WebLinkAbout04-25-07
J CO""ONWEAL TH OF PENNSYLVANIA
, DE~t~ENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2801101
HARRISBURG. PA 17128-01101
*,
FILE
ACN
DATE
NO.21 01 402-
07100016 '-J
01-04-2007
INFORMATION NOTICE
,,- ..- AND
'.;:TAXPAYER RESPONSE
REV-1m EX AFP (0'.,'0)
DONNA J LOCK
~7~ ~nY ~TI I DR
CUAI1BCR3BYRS
TYPE OF
ACCOUNT
o SAVINGS
IiJ CHECKING
o TRUST
o CERTIF.
""~1 r~pp?i:;
.::. C,I, j h t l, '- \oJ
PM\2: 3 lEST. OF DORIS J KEGRIS
S.S. NO. 174-20-0809
DATE OF DEATH 09-15-2006
COUNTY CUMBE~k~_______
-"'-.---- ,.._~... -'.. ....--.....
,..- REMIT PAYMENT' AND FOR
REGISTER OF WILLS
CUMBERLAND CO COURT
CARLISLE, PA 17013
Cl, :~t
~ r7!etEl/tl lIVe-
r A 112-0 l/Jutm$td611 { AI 'f
/.;2-10 I
COMMERCE 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 info,..ation is incorrect. please obtain written correction froll the financial institution. attach a copy
to this fo,.. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Coa.onwealth
of PennsYlvania. Questions.aY be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW
Account No. 536268584
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
PART
[!]
IE IE
IE SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Date
Established
11-26-2003
To insure proper credit to your account. two
(2) copies of this notice Must acco.pany your
pay.ent to the Register of Wills. "ake check
paYable to. "Register of Wills. Agent".
x
1,249.82
50.000
624.91
.15
93.74
TAXPAYER RESPONSE
NOTE. If tax pay.ents are .ade within three
(3) lIonths of the decedent's date of death.
you aay deduct a 5X discount of the tax due.
Any inheritance tax due will beco.e delinquent
nine (9) .onths after the date of death.
x
A. ~ The above infor.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
a discount or avoid interest. or you .ay check box "A" and return this notice to the Register of
Wills and an official assess.ent will be issued by the PA Depart.ent of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
~ be filed by the decedent's representative.
C. ~The above infor.ation is incorrect and/or debts and deductions were paid by you.
You .ust co.plete PART ~ and/or PART [!] below.
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3
4
5
6
7
8
PART
[!]
TAX RETURN - COMPUTATION
If you indicate a different-tax r.te, pl~ase state your
relationship to decedent: JlAO(iIl""-P::ff;..
LINE l- Date Estab11snea
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. A.ount Taxable
7. Tax Rate
8. Tax Due
PART
~
DATE PAID
o/~/,,~
x
/;J.J.i,q I
- ~ (YP;;JI :3
o
X ,01/-5'
o
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
N~j) L- J/tA/JeeltL
DESCRIPTION
~l/AJP.~L, t::Y />EAJ5e<.
AMOUNT PAID
~tJ1s:q~
tV$ ~ I
TOTAL (Enter on Line 5
of Tax Computation)
.
and belief.
v-
have reported above are tru~~rrect and
HOME (7FJ )4~q -~f5 ~ I
WORK () t/~/O 1-
TELEPHONE NUMBER D TE
facts I
JNE I LL
.!~'unerHome lnc. ~_____
~
September 21, 2006
Ref No 1003366/ COO 0/3
Mrs. Donna Lock
3576 Foxhill Drive
Chambersburg. PA 17201
Services For: Doris J. Kegris
Services of Funeral Director and Staff. . . . . . . . . . . . . . . .. $
Washing and Disinfecting of Unembalmed . . . . . . . . . . . . .
Memorial Service . . . . . _ . . . . . . _ . . . . . . . . . . . . . . . . . . . . .
Transfer of Remains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hearse/Coach and Driver . . . . . . . . . . . . . . . . . . . . . . . . . . .
Crematory Service Fee .... . . . . . . . . . . . . . . . . . . . . . . . . .
Medical Examiner's Charge . . . . . . . . . . . . . .
Death Certificates ....... . . . . . . . . . . . . . . . . . . . . .
Deacon John A. Mowery . . . .. .....................
Patriot News Obituary .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Package Savings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Regal with Rose .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total Funeral Charges $
Adjustments (Payments) $
1.935.00
315.00
515.00
415.00
315.00
245.00
25.00
72.00
125.00
203.93
(490.00)
400.00
$4,075.93
(4,075.93)
Balance Due on Account $
$0.00
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