HomeMy WebLinkAbout09-18-07 (2)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF 1~V-louAL TAXES
DEf!.T,... -2.fJf'O.'. - "
~U:tSI~G~ 'P~ l7128-:D6DI
'*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21-D1- ~~
ACN 07134263
DATE 08-10-2007
REV-15~ EX AFP C09- DO)
\ B ~\\ \'2.~ \ e
1\\ul St.?
_.-, I ilr
C\tt;~ C,C\ \B\ _,~
On""J\.-".'" '/ ,.", ,.~,:,),
r\r ~.'\;..,'," \" \ ' ! .
C\s\r~DEBORAH LUCY
LOT 9A
124 WOODS DR
MECHANICSBURG PA 17050
EST. OF JANET L KAUTZ
S.S. NO. 202-20-2047
DATE OF DEATH 02-26-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
o CHECKING
D TRUST
[i] CERTI F .
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MID PENN 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 infor.ation is incorrect, please obtain written correction fro. 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 Co..onwealth
of Pennsylvania. Q~csti:n~ ~ay ~c answererl ~ calling (717) 787-1327.
COMPLETE PART 1 BELOW
Account No. 416000680
Account Balance
Per-cent Taxable
Amount SUbject to Tax
Tax Rate
Potential Tax Due
PART
[!]
II II
II SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Date
Established
11-13-2004
To insure proper credit to your account, two
(2) copies of this notice .ust acco.pany your
pay.ent to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
x
5,116.17
50.000
2,558.09
.045
115.11
TAXPAYER RESPONSE
NOTE: If tax pay.ents are .ade within three
(3) .onths of the decedent's date of death,
yOU .ay 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
[CHECK ]
ONE
BLOCK
ONLY
A. ~ The above info,..ation and tax due is correct.
I. You.ay choose to re.it payment 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 Department of Revenue.
B. c=J 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. c=J The above infor.ation is incorrect and/or debts and deductions were paid by you.
You .ust co.plete PART 0 and/or PART ~ below.
OF
1
2
3
4
5
6
7 X
8
PART
~
TAX RETURN - COMPUTATION
If you indicate a differ-ent tax r-ate, please state your-
r-elationship to decedent:
LINE 1. Date Established
2. Account Balance
3. Per-cent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
PART
~
DATE PAID PAYEE
TAX ON JOINT/TRUST ACCOUNTS
X
DESCRIPTION
AMOUNT PAID
TOTAL (Enter- on Line 5 of Tax Computation)
.
Under- penalties of per-jur-y, I declar-e that the facts
complete to the best of my knowledge and belief.
have r-epor-ted above ar-e tr-ue, cor-r-ect and
HOME (, Ie) l..p q ,- Cc:>1 "S-
WORK ( )
TELEPHONE NUMBER DATE
~
TAXPAYER SIGNATURE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX( 11-961
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
LUCY DEBORAH A.
533 GOOD HOPE RD
MECHANICSBURG, PA 17050
-------- fold
ESTATE INFORMATION: SSN: 202-20-2047
FILE NUMBER: 2107-0852
DECEDENT NAME: KAUTZ JANET L
DATE OF PAYMENT: 09/18/2007
.
POSTMARK DATE: 09/17/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 02/26/2007
NO. CD 008700
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $115.11
I
'.
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: DEBORAH A LUCY
CHECK# 532
SEAL
INITIALS: DM
RECEIVED BY:
REGISTER OF WILLS
$11 5. 11
GLENDA FARNERSTRASBAUGH,
-REGISTER OF WILLS
2n r.... ",'- 'J \ /'') P ~." \? \ 8
ut!:::.:J 0 r~-.
('\ :::::y \iF
Ocr~~~I'~- I,', /t'1, I pT
rl.(:":' ,I "'_"'.< \ln~;
CU1\v~t ' \ , \-;-\
(J () ?J
,..,. J::' ~ (()
"I ..., 1~
C) -
,..,. -",
':..1 {J\ () ~ :"
...... --' (j)
a:..t ,-fb (0 -f-'
(... ro
t,j -,
r:..' -0 .,- 1
::t> Q)
:5 ()
{l... ...p,
"3-0
(b .w (\)
n.J:...r::r
;: ~ ~
,. '(J::O
-00)
J>\:J
y>~
:i r:J ..
BI (\) t
cy;'--t
~
~
1:>
.J f( ~
0 :c
f '-J )>
- \})
.. fi1
... '0
- m i'
f= ~ ....,..
~ ;) to...
- .,.-- ~j ~t)
- tQ
... r: (I) x c:
~
... ~ i1'
- ;:~, t)
- 1'~+
... ! -r~(f:'; . ' ,'~ '"i:j
... ('0 ,.... .. : 1~ - . "it)
- ~ ~
...
- ~ ;...;. ,....
- \4
... <>
- -1 ;-.'
- C
..... (/\
:: (0
-
...
...
-
-
=-