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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG. PA 17128-0601
'*
INFORMATION NOTICE
. AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 0'"1 S~S-
07125537
06-08-2007
REV-1S43 EX AFP CU9-DDl
jL.1 \ 3 iV.\ II: LiG
EST. OF EDMUND J KALBFLEISCH
-n! S.S. NO. 069-14-3891
,p<.:.:,:'t" ('('. ::P.z\TE OF DEATH 07-23-2006
ORT!" '.' .....-..,. t:eUNTY CUMBERLAND
CU~ ",
TYPE OF
ACCOUNT
o SAVINGS
lil CHECKING
o TRUST
o CERTIF.
EVELYN C KALBFLEISCH
1214 BENT CREEK BLVD
MECHANICSBURG PA 17055
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
SOVEREIGN BANK has provid..d th.. D..part...nt with th.. info,..ation listed below which has b....n used in
calculating th.. pot..ntial tax du... Th..ir r..cords indicat.. that at th.. death of th.. abov.. d..c..d..nt. you w..r.. a joint own..r/b..neficiary of
this account. If you f....l this infor.ation is incorr..ct. pl..as.. obtain writt..n corr..ction fro. th.. financial institution. attach a copy
to this fo,.. and r..turn it to th.. abov.. addr..ss. This account is taxabl.. in accordanc.. with th.. Inh..ritanc.. Tax Laws of the Co..onwealth
of P..nnSYlvania. Qu..stions.ay ba answ..red bY calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0771023006
Date
Established
08-27-2002
To insur.. prop..r cr..dit to your account. two
(2) copi..s of this notic.. .ust acco.pany your
pay...nt to th.. R..gist..r of Wills. Mak.. ch..ck
payabl.. to: "R..gist..r of Wills. Ag..nt".
x
803.73
16.667
133.96
.15
20.09
TAXPAYER RESPONSE
NOTE: If tax pay...nts ar.. .ad.. within thr....
(3) .onths of th.. d..c..d..nt's dat.. of d..ath.
you .ay d..duct a 5X discount of the tax du...
Any inh..ritance tax du.. will b..co... d..linqu..nt
nin.. (9) .onths aft..r th.. date of d..ath.
Account Balance
Pel"cent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
x
PART
ill
[CHECK ]
ONE
BLOCK
ONLY
A. [] Th.. abov.. infor.ation and tax du.. is corr..ct.
1. You.ay choos.. to r...it pay...nt to th.. R..gist..r of Wills with two copi..s of this notic.. to obtain
a discount 01' avoid int..r..st, 01' you .ay ch..ck box "A" and r..turn this notic.. to th.. R..gist..r of
Wills and an official ass..ss...nt will b.. issu..d by th.. PA D..part...nt of R..v..nu...
B. [] Th.. abov.. ass..t has b....n 01' will b.. r..port..d and tax paid with th.. P..nnSYlvania Inh..ritanc.. Tax r..turn
to b.. fil..d by th.. d..c..d..nt's r..pr..s..ntativ...
C. ~ Th.. abov.. infor.ation is incorr..ct and/or d..bts and d..ductions w..r.. paid by you.
~You .ust co.pl..t.. PART ~ and/or PART ~ b..low.
PART
[!]
DATE PAID
/?>~.q(p
. 0 tI-~
14J3
DEBTS AND DEDUCTIONS CLAIMED
PART If you indicate a diffel"ent tax~ate,,;:t:~~tate YOUI"
~ I"elationship to decedent: J...I'tJ ~
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established 1 ~ - '2,; - 02-
2. Account Balance 2 ~O~, ~~
3. P8I"cent Taxable 3 X lliz. ~Jt.,
4. Amount SUbject to Tax 4 IS 3 ' q to
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7 X
8. Tax Due 8
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL (Entel" on Line 5 of Tax Computation)
.
pel"jul"Y. I declal"e that the facts I
my knowledge and belief.
have I"epol"ted above al"e tl"ue, cOl"l"ect
HOME (7( 7 )"Mr 112$ f1
WORK (11/) SZls 37ZK
TELEPHONE NUMBER
and
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DA E
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
KALBFLEISCH EVELYN C
1214 BENT CREEK BLVD
MECHANICSBURG, PA 17055
----~--- fold
ESTATE INFORMATION: SSN: 069-14-3891
FILE NUMBER: 2107-0585
DECEDENT NAME: KALBFLEISCH EDMUND J
DATE OF PAYMENT: 06/18/2007
POSTMARK DATE: 06/1 6/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 07/23/2006
NO. CD 008300
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
.~ --------
'~\' I $6.03
0712553~
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 110
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$6.03
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS.