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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
JAMISON STEPHEN B
14 FULLER FARMS ROAD
TOPSFIELD, MA 01983
-------- fold
ESTATE INFORMATION: SSN: 122-09-9703
FILE NUMBER: 2107-0459
DECEDENT NAME: JAMISON PAUL W
DATE OF PAYMENT: 05/09/2007
POSTMARK DATE: 05/07/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 10/18/2006
NO. CD 008140
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
07115911 I $3.81
I
I
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I
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TOTAL AMOUNT PAID:
$3.81
REMARKS:
CHECK# 9036
SEAL
INITIALS: CJ
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COIlIllIIlWEAL TN OF PENIlSYLVANIA
IEPAImlENI' OF REVENUE
IdIUU OF INDIVIDUAl. TAXES
DEPT. 211Ul
HARRISIUR&, PA 17121.1611
..
T~f) ~.
~:. ~ (....u
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21"'01-04s1
07115911
04-10-2007
q '.n-9
hl~~ 10:
EST. OF PAUL W JAMISON
5.5. MO. 122-09-9703
DATE OF DEATH 10-18-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAYIN8S
iii CHECUNC
o TRUST
o CERTIF.
STEPHEN
14 FULLER
TOP$FIELD
CLEF
ORPHAt
" 'J' ~,~rrr'
Iw'J'--'L
B JAMISON
FARMS RD
MA 01983
f"
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PNe lANK has proYided the o....rtant wUh the infol'lllttion listed lIe1.. which IHI. b..n us.d In
calculatillll the ...tentiel t_ due. TlHlir records indic.ta that at t... death of the elIeYo clecodent, yau ware a joint _r/boneficla." of
this ~. If yau f..ltbi.a inf.....Uon is ~t"NICt, p1a_ _tun written correction f.... tho f1nonc101 iMtituti.... attach a _
to this fof'll end return it to the ...... ectdross. Thbecc~;b t....le in eccordMc. with t....lnherit_ T_ L.s of the Ca.._elth
-- -U-~.......7.\...:.... _...:a.t:A.* -... '",;. ~ > _t:. ....~. ......:.'l~h8' i~tl.) 7a~~.~ --------'-~- .-. .---,-----~---- .'----~--
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR F-ILI_"~PAYMENT INSTRUCTIONS
Account No. 5070074809 DIIte 08-11-2004 To i__ ';~r CNdit ta_~, two
Est.b11shed (2) copi.., of this noUn _ot KC_any your
_t to the itttIbt.r of Will.. .... check
PWObl. to. "Rqtriar of Wills, AtIHt-.
Account 1.1.nc.
Perc.nt T.x.b1.
A~unt Subj.ct to T.x
T.x R.t.
Potentl.1 T.x Due
x
507.70
16.667
84.'2
.045
3.81
TAXPAYE' RESPONSE
'..
x
IIJTE. If t_ _ts 2'" ..... within throe
(3) _ths of the docodeit~'s lIIrte of dHth,
YOU .. doduct . I<< di~...t t... t_ duo.
AntI i....rt~ t. duo will boo:Giie -.n~
nino (t) .onth. aft.r tho dots of death.
PART
[!]
[CHECK ]
ONE
BLOCK
ONLY
A. II Tho oboY. inf_tion end t_ due is correct.
1. Yau.. choo.. t. ....tt .....t t. the lte81ot.r of Wills wtth two _i.. of thi. notin t. oMain
a dis_t or awoid int.....t, or weu .. chock bax -A- end return thi. ItOtico t. the ...iotor of
Wills end an officlO1 ........nt will bo i.sued bw tho ~ OopertHnt of a.yOItUS.
I. 0 The oboYo ....t IHI. boon or wU1 be report.d and t_ paid with tho P.nnSll'lYORb Inh.ritanco T_ return
to bo fUad bw the docadent'. repre.ontattn.
C. 0 Th. oboYo info....tion t~ncorroct endIO~bts end doduo:tion. wore paid by yau.
You Mot _lat. PART I!J lIIllIIor PART I!.J bo1...
. '
PART
[!I
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
If YOU Indlc.te a dlffer.nt t.x r.t., pl.... st.te your
r.1.t10nsh1p to decedent:
PART
I!l
TAX RETURN - COMPUTATION
LINE 1. D.t. Estab11shad
2. Account 1.1onc.
3. P.rc.nt T.x.b1.
4. A~unt Subject to T.x
S. Debts .nd Deductions
,. A~unt Tex.b1.
7. r.x R.te
8. T.x Due
OF
1
2
3 X
4
5
,
7 X
8
TAX ON JOINTrfRUST ACCOUNTS
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line I of T.x C.-put.t1on)
I
.
-
Und.r pen.1tle. of perjury, I declare th.t the
....,.t. t. th. ...t .~~:... on. .,'1".
~ t;,L-~. ~ ~/~/07.
facts I h.we reported .bowe .r. tru., corr.ct and
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