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Home My WebLink About07-09-07 (4) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2B060l HARRISBURG, PA l7l2B-060l *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 bl 0\#\3 07127703 06-20-2007 REV-1543 EX AFP (09-00) TYPE OF ACCOUNT EST. OF FLORENCE S MONTIJO D SAVINGS S.S. NO. 183-16-9805 0 CHECKING DATE OF DEATH 05-03-2~7 g D ,[~ST COUNTY CUMBERLAND~~ ;:: lil, ~~~TIF. REMIT PAY.~~D F~S Tdi} .~~ REGISTER OF =w$ts , ':'--1 ~r'-~ CUMBERLAND <SQ ~T lI8USL.) C:J CARLISLE, P4:;'~13 C)c-:; '-)00 -0 .. i....' 0.1::Jt -,'! L- . C) ~ ~~: p; .c:- LINDA C BEATY 205 W MAIN ST SHIREMANSTOWN PA 17011 - PSECU has provided the Department 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 information is incorrect, please obtain written correction from the financial institution, attach a COpy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by.cal~ing (7l7) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0183169805 Date Established 09-22-1999 To insure proper credit to your account, two (2) copies of this notice must accompany your payment to the Register of Wills. Make check payable tOI "Register of Wills, Agent". Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART [!] x 16,556.14 50.000 8,278.07 .045 372.51 TAXPAYER RESPONSE NOTE I If tax payments are made within three (3) months of the decedent's date of death, you may deduct a 5X discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. x A. c:l The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. [CHECK ] ONE 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. ~The above information is incorrect and/or debts and deductions were paid by you. ~ You must complete PART ~ and/or PART ~ below. OF 1 2 3 4 5 6 7 8 PART ~ TAX RETURN - COMPUTATION If you indicate a different tax rate, please state your relationship to decedent: 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 [!] DEBTS AND DEDUCTIONS CLAIMED 5 of Tax Computation) . facts I have reported above~re true, correct HOME (]/7) 7~7 7Z67~ WORK () (e._O;1 TJ:I J:p...nNJ: NIIMRJ:1:l AT HfH';':'>i;I'..;lIMU~\;t b;.^f"1-.MU"~W " Us.;....~ n ~1lI111m!1 E1mmI~1.!m!mI1!I1m!1M 02/16/07 1 03/09/07 03/09/07 02/16/07 1 03/09/07 03/09/07 3 E Destruction Of Lesion Fir 17000 702.0 Medic DEDUCT Pa~ent Accept Assign Adj. 3 E Destruction Of Lesions 2- 17003 702.0 Medic DEDUCT Pa~ent Accept Assign Adj. 63.21 0.00 -4.09 59.12* 61.38 0.00 -23.34 38.04* (U-rlj S~( '"" ~~, dv ,?l;> ?t.,. r \ () t 01 ~ y ill t< E-This bill applied against your deductible. You are responsible to pay us. ,lAKE CRUMAY PARNES ASSOCIATES, INC 104 ERFORD ROAD CAMP HILL, PA 17011 PAT# I-FLORENCE S MONTIJO PRV# 3-BARTON, JOHN 0., M.D. Ph: (717) - 7 Acct/J: 23402 Date: 05/30/07 Page 1 of 1 <-A Robert L. Mannal 6925 Frankford Avenue FUN ERA L H 0 M E, INC. Janice H. Mannal SUPERVISOR 215-624-8989 Fax 215-624-9022 Mrs. Linda C. Beaty 205 W. Main Street Shiremanstown, PA 17011 Services Rendered For: Florence Anna Montijo Professional Services Baron, 20ga, Basic Facilities & Equipment Automotive Equipment Merchandise Cash Advances Grave Opening Newspaper Notices Certified Copies of the Death Certificate Clergy Flowers Total Cost Payments May 17,2007 Madison National Life Ins. $ Co. Linda C. Beaty $ Linda C. Beaty $ May 30, 2007 June 11,2007 Total Due: $ $ $ $ $ $ $ $ $ $ $ 1,400.00 258.91 30.00 150.00 428.00 $ $ 5,803.74 Philadelphia, P A 19135 June 12, 2007 2,410.00 1,165.00 590.00 845.00 65.00 2,266.91 7,341.91 7,341.91 $ 0.00 rxJ f1iJ rJli- (JOt] ) Discover More Card Account Summary IllllliiiiCardmember since 1997 Closing Data: May 23,2007 page 1 of 3 = ,Account Number 60 11 0023 .4073 8616 Previous Balance $1 ,018.62 ili!i& ;Payment Due Date June 22, 2007 Payments And Credits 1,032..49 IIIIIIiiii Minimum Payment Due $15.00 Purchases + 651.7.4 ==ri Credit Limit $10,000.00 Cash Advances + 0.00 !!!!!! Credit Available $9,362.00 Balance Transfers + 0.00 Cash Credit Limit $5,000.00 ~ a-g.. + 0.00 = Cash Credit Available $5,000.00 New Balance = $637.87 = , 1A s .t.( 'C".. I You may be able 10 avoid Periodic Finance Cha~ ~ the_ .'7 P~6~ 3D2,s' INl2bJ)\\b~~ve;;;t~3~i~4 JN/~f ~_L-- !!!!!!!!!l _\Cashback Bonus. 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