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Home My WebLink About11-15-07 REV-1162 EX(11-96) COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-Q601 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 008976 RECEIVED FROM: BLEVINS JAMES F 103 HILL DR CARLISLE, PA 17013 ACN ASSESSMENT CONTROL NUMBER AMOUNT -------- fold 07146318 $769.82 ESTATE INFORMATION: SSN: 209-12-7639 07146319 I $163.38 FILE NUMBER: 2107-0886 I DECEDENT NAME: BLEVINS JOSEPHINE M I DATE OF PAYMENT: 11/15/2007 I POSTMARK DATE: 11/14/2007 I COUNTY: CUMBERLAND I DATE OF DEATH: 09/25/2007 I I TOT AL AMOUNT PAID: $933.20 REMARKS: CHECK#1003 INITIALS: CJ SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMHONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 ". ED ~IOiATION NOTICE (""',., O'i- VJlL! C' ' AND tlitr.raAYER RESPONSE FILE ACN DATE NO.21 07-0886 07146319 11-01-2007 EST. OF JOSEPHINE M BLEVINS ClERKQf..-i.S. NO. 209-12-7639 OAPHAN~OOltIATE OF DEATH 09-25-2007 CUMBERt)K) CO.,dIuNTY CUMBERLAND TYPE OF ACCOUNT [i] SAVINGS o CHECKING o TRUST o CERTIF. JAMES F BLEVINS 103 HILL DR CARLISLE PA 17013 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the Depart.ent with the infol'lletion listed below which has been used in calculating the potential tax due. Theil' 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 fol'll and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co..onwealth of Pennsylvania. Questions _ay be answered by calling (717) 787-1327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 50938- 05 Date 05-04-1987 Established To insure propel' credit to YOUI' account. two (2) copies of this notice .ust acco.pany YOUI' pay.ent to the Register of Wills. Make check payable to. "Register of Wills. Agent". Account Balance Percent Taxable A.ount Subject to Tax Tax Rate Potential Tax Due 7,261.34 X 50.000 3,630.67 X .045 163.38 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. PART ill ittk~:~;l;'::~~:k~~IC: :::~~:r~:::l:~~Zr~r~!S:~:~~1~;~Er~}t~~ii;ti~~~1~:-:!~~:i::~:!~~;o}:~~:t=:[:~tf~~~;{Zr(J:i:iltl:~~~i;tl~fj 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 01' avoid interest. 01' 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. c=l The above asset has been 01' will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. C. c=l The above infol'llation is incorrect and/or debts and deductions were paid by you. You .ust co.plete PART ~ and/or PART ~ below. X If you indicate a different tax rate, please state YOUI' relationship to decedent: PART I!l TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. A.ount Subject to Tax 5. Debts and Deductions 6. A.ount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 4 5 6 7 8 X PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Co.putation) facts I . and DATE -'''' p. .-...~.-,<,'- COMMOllflEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 11128-0601 INFORMATION NOTICE AND or1f4X~YER RESPONSE , ,~\lTj t FILE ACN DATE NO.21 07-0886 07146318 1l-01-2007 _-1543 TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST IX] CERTIF. ** JAMES F BLEVINS 103 HILL DR CARLISLE PA 17013 2881 HOY 15 PH f2: ,... OF JOSEPHINE M BLEVINS S.S. NO. 209-12-7639 ClERK OF DATE OF DEATH 09-25-2007 ~'S counCOUNTY CUMBERLAND CUM8ERl.AND 00..'11 REMIT PAYMENT AND FORMS TO: . . r REGISTER OF WILLS , CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has p..ovid.d the Depa..t..nt with the info...ation listed below which has b..n used in calculating the pot.ntial tax du.. Th.i.. ...co..ds indicat. that at the d.ath of the above d.c.d.nt. you w.... a joint own.../b.n.ficiary of this account. If you f..1 this info...ation is inco.....ct. pl.as. obtain w..itt.n co.....ction f..o. the fin.nci.l institution. attach a COPY to this fo... and ...tu..n it to the above add...ss. This account is taxable in acco..danc. with the Inh...itanc. Tax Laws of the C~.onw.alth of P.nnsylvani.. Qu.stions.ay b. 6nswa...d ~ calling (111) 1B1-8321. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 50938-40 Date 05- 05-2007 x 17,107.16 100.00 17,107.16 .045 769.82 TAXPAYER RESPONSE To insu... P"OP." c...dit to you.. account. two (2) copi.s of this notic. .ust acc~pany you.. pay..nt to the R.gist... of Wills. Mak. ch.ck p.y.bl. to. "Regist... of Wills. Ag.nt". Established Account Balance Pe..cent Taxable Amount Subject to Tax Rate Pot.ntlal Tax Du. x NOTE. If tax pay..nts a... .ad. within th.... (3) .onths of the d.c.d.nt's date of d.ath. you .ay d.duct a 5n discount of the tax du.. Any inh...itanc. tax due will b.co..d.linqu.nt nine (9) .onths aft... the date of d.ath. Tax PART [!] ii:~il:-~:,-r:::!r~-:-~~~:::~:i~~:~::,:r:~:::~'-::~~l::-]:~:~ir:~;~f7~~i~li::~:j~tW~~~~:~:~r~-~l ::~~r}~~t~~-::I:~t3 ~~--~;~~T~~~~:r~rl!1:jr:r:'i~'-U~:!~if}:.~:l~:lJ,~~j~r-:':-:i~i~*~~1~Pi~!ffi--~ ___n.r. _. __cr_____ :.t______ _______ 1..;, ,____ _____ ________.l__T________fr'__q):1.; ____:.t'"____'t '1"__or'x..'"J.:t:.P'_ ;t;:-<__.._..~ ..._..'-<t:"':>r.;'''..''1.,,'1:....__..........___....=.~..'1.~..~..''t:,{,_''t:-......- r",tthro-:r.n.ii.",_"..:..r.::-.:n-:.u:.m ......- ,.....:'-':.r-__....4r.nf........~_"t::.l"_~_ rn= .......-.,r. ...... ......___ .. .____..___........ _.. _..... _ _ __ .. .._............._...___"__r.._.. __....'1t ..r.._....__.._...._...."1..'t:'.t..._........_....._.. .......~_....rut:'f..'1.:.._ .._....___..... .:.'J.i".....tI.i'r_..'tt:..._....1-:.... -..... r-..r..;tuum:~~.....:\H:::.l".._.. ...~ ......:.r-......_....:::;i."t.'U'...........,.....~\.t"_.. m: A. ~Th. .bov. info....tion .nd tax due is co.....ct. 1. you.ay choos. to ....it pay..nt to the R.gist... of Wills with two copi.s of this notic. to obt.in . discount 0" avoid int....st. 0.. you .ay ch.ck box "A" and ...tu..n this notic. to the R.gist... of Wills and an official ass.ss..nt will b. issu.d by the PA D.pa..t.ent of R.v.nu.. [CHECK ] ONE BLOCK ONLY B. c:J Th. .bov. ass.t has b..n 0.. will b. ...po..t.d and tax paid with the P.nnsYlvani. Inh...itanc. Tax ...tu..n to b. fil.d by the d.c.d.nt's ...p...s.ntativ.. C. c:J The above info....tion is inco.....ct .ndlo.. d.bts .nd d.ductions w.... paid ~ you. You .ust co.Plate PART 0 andlo.. PART (!] below. x PART [!] TAX RETURN - COMPUTATION If you lndlcat. a dlff....nt tax ..at.. pl.as. stat. you.. ...latlonshlp to d.c.d.nt: TAX ON JOINT/TRUST ACCOUNTS LINE 1- Dat. Establlsh.d 2. Account Balanc. 3. p...c.nt Taxabl. 4. Amount Subj.ct to Tax 5. D.bts and D.ductlons 6. Amount Taxable 7. Tax Rat. 8. Tax Du. PART [!] DATE PAID PAYEE OF 1 2 3 4 5 6 7 8 x DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID I TOTAL (Ent... on Lln. 5 of Tax Computation) . P...ju..y. I d.cla... that the facts I my knowledge and b.li.f. HOME and DATE