Loading...
HomeMy WebLinkAbout01-0990 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z8060l HARRISBURG, PA 171Z8-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21-01- 9P~ 01148255 10-16-2001 REV-1545 EX iFP lD9-DDI Mrs. Ma.rtb.a. Flowers 311 Camp Ground Rd. DilIsburg, PA 17019 TYPE OF ACCOUNT EST. OF RALPH E JUMPER IX] SAVINGS S . S. NO. 17 7 -16 - 0 161 D CHECKING DATE OF DEATH 06-23-2001 D TRUST COUNTY CUMBERLAND D CERTIF. -A REMIT PAYMENT AND FORMS TO: ~ ~ ~ REGISTER OF WILLS ~UMBERLAND CO COURT HOUSE -..J /' / CALJSLE. PA 17013 /2 . . A '1f"../-f'.. e----Cc..d~ · r'61 /70/ i ~ ..J4ARTIIA [ngWED ? ~ M4I= ~iuM ~ ~WALNUT n PA 17~6 ALLFIRST FINANCIAL SERVICE has provided the Department with the inforllation 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 inforllation is incorrect, please obtain written correction froll the financial institution, attach a copy to this forll and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the COllllonwealth of Pennsylvania. Questions say be answered by ~alling C717} 787-83Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 87004937723677 Date 01-02-1970 Established Account Balance Percent Taxable AMount Subject to Tax Rate Potential Tax Due x 19.855.44 50.000 9.927.72 .15 1.489.16 TAXPAYER RESPONSE To insure proper credit to your account, two (Z) copies of this notice IIUSt accollpany your paYllent to the Register of Wills. Make check payable to: "Register df.,W~~~s, Agent". x NOTE: If tax paYllents are lIade within three (3) 1I0nths of the decedent's date of death, you lIay deduct a 5% discount of the tax due. Any inheritance tax due will becolle delinquent nine (9) 1I0nths after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [] The above inforllation and tax due is correct. 1. You lIay choose to rellit paYllent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you lIay check box "A" and return this notice to the Register of Wills and an official assessllent will be issued by the PA Departllent of Revenue. [] 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. ~The above inforllation is incorrect and/or debts and deductions were paid by you. ~You IIUSt complete PART ~ and/or PART ~ below. () DEBTS AND DEDUCTIONS CLAIMED If you indicate a different tax rate. please state your relationship to decedent: PART ~ TAX RETURN - COMPUTATION 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 OF 1 2 3 4 5 6 7 8 x TAX ON JOINT/TRUST ACCOUNTS // I ~~ /9',. ' rh- 5"# .i.f~ JIi- 0-. C'lll-o q:'. <:1 ~-? 9~ 9; ffi:: f; PART [!J DATE PAID PAYEE DESCRIPTION AMOUNT PAID correct and O~O ID~fe~D" 0 I COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z8D6Dl HARRISBURG, PA 171Z8-D6Dl *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21-6/-,990 01148256 10-16-2001 REV-1545 EX AFP 109-DDI ~T~: E~LOW~: LNUTT:oi~nM PA EST. OF RALPH E JUMPER S.S. NO. 177-16-0161 DATE OF DEATH 06-23-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT D SAVINGS [X] CHECKING D TRUST D CERTIF. !\Irs. Martha. Flowers 311 Camp Ground Rd DiDsburg, PA 17019 . ~ ~ ~ REMIT PAYMENT AND FORMS TO: ~ ~~ REGISTER OF WILLS ..3 / /I_.~.:A CUMBERLAND CD COURT HOUSE 17~6 I ~~~ CARLISLE, PA 17013 .(/~, ~ /'J::-, ALLFIRST FINANCIAL SERVICE has provided the DepartMent with the inforMation 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 P,...nsylvania. Questions May b.. al1swe,ed by calling (71;") 787'"83Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0097330159 Date 01-28-1980 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 7,695.47 50.000 3,847.74 .15 577 . 16 TAXPAYER RESPONSE To insure proper credit to your account, two (Z) copies of this notice Must accoMpany your paYMent to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax paYMents are Made within three (3) Months of the decedent's date of death, you May deduct a 5% discount of the tax due. Any inheritance tax due will beCOMe delinquent nine (9) Months after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [] 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. [] 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. ~Zhe above inforMation is incorrect and/or debts and deductions were paid by you. ~ou Bust cOMplete PART ~ and/or PART ~ below. If you indicate a different tax rate, please state your relationship to decedent: DEBTS AND DEDUCTIONS CLAIMED PART ~ TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax S. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF 1 2 3 4 5 6 7 8 TAX ON ~INT/TRUST ACCOUNTS ~' ?'S' ~/~j -'1 ~ ~~~q~4' X t.ll>OO" ;~t " ~~~ x correct and IJ elL 0 /O~3'&lbl DA E r 311 Campground Road Dillsburg, PA 17019 December 4,2001 Register of Wills Cumberland County Court House Carlisle, P A 17013 Dear Sir or Madam: I received the Information Notice and Taxpayer Response--Revised Notice to resubmit for the Estate of Ralph E. Jumper. I have completed the form (2 signed copies) with a typed itemized listing of expenses. I am also enclosing the form I originally submitted through the Register of Wills Office at the Cumberland County Court House in Carlisle, P A on October 30,2001. Following the guidance on the reverse side of the form for calculating taxes due, it appears to be $0 for the checking account. (TAB A) Since you returned the checking account form, I am also sending a REVISED submission (2 signed copies) for the savings account for the Estate of Ralph E. Jumper. Attached is an itemized listing along with a copy of the form I originally submitted through the Register of Wills Office. Again, following the guidance on the reverse side of the form for calculating taxes due, it appears the amount due is $420.22. I am enclosing a check for that amount. (TAB B) I hope this settles the affairs for my father's (Ralph E. Jumper) estate. Respectfully submitted, "~t.~ Martha E. Flowers, DAUGHTER Joint owner of checking and savings accounts Copy attached for: P A Department of Revenue Bureau of Individual Taxes Inheritance Tax Division Dept 28060 I ' Harrisburg, P A 17128-0601 ../ - IIcJ .. 6'/7--17' $-' ~ ~13 pfl/'I qO J--I/OJA~ pkf EXHIBIT A . , ... . COM~ONWEALTH OF PENNSYLVANIA DEP.RT~NT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE ~ REVISED NOTICE ~ ~ ~ FILE NO. 21 01-0990 ACN 01148256 DATE 11-20-2001 ~ REV-1543 EX AFP 109-00) EST. OF RALPH E JUMPER 5.5. NO. 177-16-0161 DATE OF DEATH 06-23-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT D SAVINGS [X] CHECKING D TRUST D CERTIF. MARTHA ~FLOWER '? [~TN S ~I'tu I ..l::J I 1.0.11 F'A MARTHA E. FLOWERS 311 Campground Road 11lddui11sburg, PA 17019 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ALLFIRST FINANCIAL SERVICE has provided the Department with the infoMlation listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction fro. the financial institution, attach a copy to this for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Com.onwealth of PIii'uls:;,lvania. QuestiClriSt iiay bii ail$wer"ed by caillng (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0097330159 Dat. 01-28-1980 Established Account Balance Percent Taxable Amount Subject to Tax Rat. Potential Tax Due x 7,695.47 50.000 3,847.74 .15 577 .16 TAXPAYER RESPONSE 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 peyable to: "Register of Wills, Agent". .X NOTE: If tax pay.ents are .ade within three (3) .onths of the decedent's date of death, you .ay deduct a 57. discount of the tax due, Any inheritance tax due will beco.e delinquent nine (9) .onths after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [] The above infor.ation and tax due is correct. 1. You .ay 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 "An and return this notice to the Register of Wills and an official assessment will be issued by the PA Depart.ent of Revenue. [] 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. [;lTThe above infor.ation is incorrect and/or debts and deductions were paid by you. ~ou .ust co.plete PART ~ and/or PART ~ below. PART [!] DATE PAID $0 DEBTS AND DEDUCTIONS CLAIMED If you indicat. a different tax rate, please state your relationship to decedent: PART ~ TAX RETURN - COMPUTATION OF LINE 1, Date Established 1 2. Account Balance 2 3. Percent Taxable 3 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 8. Tax Due 8 TAX ON JOINT/TRUST ACCOUNTS 11/88 $7.695.47 X 50.000 $3.847.74 - 5.243.20 $0 X rLEASE PAYEE SEE ATTACHED DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ filets I HOME ( WORK ( - ) TELEPHONE NUMBER -. I -. ~ CbHMONWEALTH OF PENNSYLVANIA DEPARThENT OF REVENUE BdREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE REVISED NOTICE * * * FILE ACN DATE NO. 21 01-0990 01148256 11-20-2001 * .EV-154S EX iFP lD9-DOl * EST. OF RALPH E JUMPER S.S. NO. 177-16-0161 DATE OF DEATH 06-23-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT D SAVINGS IX] CHECKING D TRUST D CERTIF. MARTHA~FLOWER 1!!'P[~ lIlAtND ,- !tuN'OM rA MARTHA E. FLOWERS 311 Campground Road 17l~~f)i11sburg, PA 17019 REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ALLFIRST FINANCIAL SERVICE has provided the Departllent with the infor_aUon listed below which has been used in calculating the potential tax due. Their records indicate that at tha death of the abova decedent, you were a joint owner/beneficiary of this account. If you feel this inforllation is incorrect, please obtain written correction froll the financial institution, attach a copy to this forll and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth ur- P6i1us,lvBnia. QUBstlc.nSt iiiay Lit illl'SWBI"sd by calli..g (717) 787-83Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0097330159 Dat. 01-28-1980 EstabUsh.d Account Balanc. P....c.nt Taxabl. AMount Subj.ct to Tax Rat. Pot.ntial Tax Du. x 7,695.47 50.000 3,847.74 .15 577 .16 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice gust accompany your pay_ent to the Register of Wills. Make check payable to: "Register of Wills, Agent". ,x NOTE: If tax payments are _ade within three (3) months of the decedent.s date of death, you lIay deduct a 57. discount of the tax due. Any inheritanca tex due will become delinquent nine (9) months efter the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. c=J The above information and tax due is correct. 1. You gay choose to remit pay_ent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you lIay check box "A" and return this notice to the Register of Wills and an official assessllent will be issued by the PA Department of Revenue. c=J The above asset has been or will be reported and tax paid with the PennSYlvania Inharitance Tax return to be filed by the decedent.s representative. [;lTThe above information is incorrect and/or debts and deductions were paid by you. ~ou must complete PART ~ and/or PART [!] below. PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED If you indicat. a diff.....nt tax ...at., pl.as. stat. you... ....lationship to d.c.d.nt: PART ~ TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Dat. EstabUsh.d 1 11/88 2. Account Balanc. 2 $ 7 . 6 9 5 . 4 7 3. P....c.nt Taxabl. 3 X 50.000 4. AMount Subj.ct to Tax 4 $ 3 . 84 7 . 74 5. D.bts and D.ductions 5 - 5.243.20 6. AMount Taxabl. 6 $ 0 7. Tax Rat. 7 X 8. Tax Du. 8 $0 fLEASE PAYEE SEE ATTACHED DESCRIPTION AMOUNT PAID I TOTAL lEnt.... on Lin. 5 of Tax COMPutation) I $ p....ju...y, I d.cla.... that the facts I have ....po...t.d above knowl.dg. .U.f 1 HOME ( WORK ( ) TElEPHONE NUMBER co.......ct and )1 INFORMATION FOR CHECKING ACCOUNT FOR RALPH E. JUMPER, DECEASED Date of Death: June 23, 2001 Joint Checking Account established in November 1988, (Account number: 97330159, Allfirst Financial Service Bank) in Ralph E. Jumper and Martha E. Flowers, daughter Amount in joint checking account upon death: Amount subject to tax: Expenses for funeral (Fogelsanger/Bricker) Paid 7/10/01 Donation to United Methodist Church (use of fellowship hall for lunch following funeral service) Paid 6/27/01 Stamps for thank you notes for flowers and expression of sympathy - Paid 7/3/01 TOTAL EXPENSES (cancelled checks can be obtained from bank upon request) EXPENSES INCURRED ARE GREATER THAN AMOUNT SUBJECT TO TAXES ($3,847.74) FINAL BALANCE FROM CHECKING (Please see attached stub for fmal payment from Allfirst Financial Service Bank) $7,695.47 3,847.74 -5,179.60 50.00 13.60 -5,243.20 - 5,243.20 $2,452.27 According to the reverse side ofRev-1543 EX AFP (09-00), as of 07/01/00 to present a lineal descendent (which is daughter, Martha E. Flowers, joint owner of account) pays 4.5%. However, with expenses being GREATER than amount taxable, no payment is due according to your method of calculation in Part 2, paragraphs 5 and 6. The form was sent to Martha E. Flower (name is Flower~) and the mailing address was incorrect (which was corrected on form submitted 10/30/01) through the Register of Wills Office, Cumberland County Court House. CORRECT MAILING ADDRESS: Martha E. Flowers 311 Campground Road Dillsburg, P A 17019 The revised notice was sent to 2 E. Main Street, Walnut Bottom, P A 17266 which was my father's (Ralph E. Jumper) address upon death. ~s~~ Martha E. Flowers, DAUGHTER .. . 2222428392 AMOUNT: ~ 'I5d I a 7 DATE: 8'~ 3 .-0 I PAYEE: rno.r~ E. FlowerS SOURCE OF FUNDS: ~1.. J~4 r1utkE . (lo\VfTJ DESCRIPTION: DI>A ACCT. NO.: <1'7j30/51 CK. CHARGE: {JIlt / . CONN~EALTH OF PENNSYLVANIA. DEPARTNENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z8D6Dl HARRISBURG, PA 171Z8-D6Dl *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 ACN 01148256 ATE 10-16-2001 TYPE OF ACCOUNT OF RALPH E JUMPER 0 SAVINGS NO. 177-16-0161 [i] CHECKING DATE OF DEATH 06-23-2001 0 TRUST COUNTY CUMBERLAND 0 CERTIF. ""~~ REMIT PAYMENT AND FORMS TO: ~ REGISTER OF WILLS CUMBERLAND CO COURT HOUSE ~ ..3 l ( ~~~LE, PA 17013 C~~, /#/-';10/ / MAR1HA E FLOWER 2 E MAIN SI ~AL"~I DUllmM fA ALLFIRST FINANCIAL SERVICE has provided the Department with the information 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 ebove address. This account is texable in accordance with the Inheritance Tax Laws of the Commonwealth or ~a..n~ylvanic. ~u3sti~n3 :ay b~ answar6d ~~ calling (717} 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0097330159 Date 01-28-1980 Established Account Balance Percent Taxable A.ount Subject to Tax Rate Potential Tax Due x 7,695.47 50.000 3,847.74 .15 577 .16 TAXPAYER RESPONSE To insure proper credit to your account, two (Z) copies of this notice must accompany your payment to the Register of Wills. Nake check payable to: ftRegister of Wills, Agentft. x NOTE: If tax payments are made within three (3) months of the decedent's date of death, yOU may deduct a SX discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Tax PART ill A. [ CHECK ] ONE BLOCK B. ONLY c. [] 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 ftAft and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. [] 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. ~The above information is incorrect and/or debts and deductions were paid by you. ~ou must complete PART ~ and/or PART ~ below. If you indicate a different tax rate, please state your relationship to decedent: PART ~ 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 1 2 3 4 5 6 7 8 x DEBTS AND DEDUCTIONS CLAIMED facts I have reported above ( ~ > ( -> PHONE NUMBER "I EXHIBIT B . CDR~EALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ' BUREAU OF INDIVIDUAL TAXES DEPT. ZB0601 HARRISBURG, PA 171Z8-0601 *' 11-/1-- INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21- ()/- 97'0 01148255 10-16-2001 REV-1S45 EX AFP lD9-DlI TYPE OF ACCOUNT EST. OF RALPH E JUMPER !Xl SAVINGS S. S. NO. 177-16-0161 D CHECKING . d 7': . DATE OF DEATH 06-23-2001 D TRUST -7 //J.U.LJ..-r~ ' COUNTY CUMBERLAND D CERTIF. ~--?~~ t? 'L!./ REMIT PAYMENT AND FORMS TO: MA'lNIIA E FI ~ l. J~REBISTER OF WILLS 2 -i: MAIN ~ CUMBERLAND CO COURT HOUSE ~IIT HBTTOM P.~. -U.266 /1 ~~ ~SLE, PA 17013 ~~ I-/l? / t0j /I Mrs. Martha Flowers 311 C3mp Ground Rd Dillsburg, P A 17019 ALLFIRST FINANCIAL SERVICE has provided the Depart.ent with the inforntion 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 for. and return it to the ebove address. This account is taxable in accordance with the Inheritance Tax Laws of the Co..onwealth of P8nnsYlvani~. ~u.s~ions .dY U~ 6nswel~u ~~ Galling (717} 787-8~Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 87004937723677 Date 01-02-1970 Established x 19,855.44 50.000 9,927.72 .15 1.489.16 TAXPAYER RESPONSE To insure proper credit to your account, two (Z) copies of this notice .ust acco.pany your pay.ent to the Register of Wills. Make check payable to: RRegister of Wills, AgentR. Account Balance Percent Taxable AMount Subject to Tax Rate Potential Tax Due x 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. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [] 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 or avoid interest, or you .ay check box RAR and return this notice to the Register of Wills and an official assess.ent will be issued by the PA Depart.ent of Revenue. [] 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. F;(The above infor.ation is incorrect and/or debts and deductions were paid by you. ~You .ust coeplete PART ~ and/or PART ~ below. PART ~ TAX RETURN - COMPUTATION LINE 1. Dat. Established 2. Account Balance 3. Percent Taxable 4. AMount Subject to Tax S. Debts and Deductions 6. AMount Taxable 7. Tax Rate 8. Tax Due TAX ON JOINT/TRUST ACCOUNTS If you indicate a different tax rate, please state your relationship to decedent: Under penalties of perjury, I declare that the facts COMPlete to the best of MY knowledge and belief. .~~ ~ ~~" u_ (2v~ ~JlN T PA ER SIB ATUR have reported above are true, correct and ~~;~ ~ ~(?~ ~j?:-41J1.(~3' /. TELEPHONE NUMBE{"""'" irATE 0 G I . CiJtIHgNIIEAL TH OF PE~lNSVLVANIA DEP~RTNENT DF REVENUE BUREAU DF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Z8-0601 '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 - 0 [- q q () 01148255 10-16-2001 REY-1545 EX AFP 109-101 TYPE OF ACCOUNT EST. OF RALPH E JUMPER iii SAVINGS S. S. NO. 177-16-0161 0 CHECKING ~ d"7 . DATE OF DEATH 06-23-2001 0 TRUST ~ _ COUNTY CUMBERLAND 0 CERTI~. ~ (}? -;f./ REHIT PAYHENT AND FORHS TO: MMtTIIA E f~ [. Y~REGISTER OF WILLS 2~ MAIN 5T CUMBERLAND CO COURT HOUSE ~IIT BellUM PA-1l..266 /1 (!~~~ ~SLE. PA 17013 ~~~ 1--/,4/~O; J1 Mrs. Mart"'. Flowers 311 Camp Ground Rd Di1Isburg, PA 17019 ALLFIRST FINANCIAL SERVICE has providad tha Departmant with the information listad balow which has baan used in calculating the potential tax due. Their records indicate that at the death of the above decedant, you were a joint owner/beneficiary of this account. If you feel this infor~tion is incorrect, please obtain written correction from tha financial institution, attach a copy to this forM and return it to the above address. This account is taxable in accordance with tha Inheritanca Tax Laws of the COMmonwealth of Penns)tivBnitt. ~....s1:1ons illldy i.t. &n:,:wBr,,,.i Ly (;.&111n9 {717} 7B7 e~27'. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 87004937723677 Date 01-02-1970 Established Account Balance Percent Taxable Anount Subject to Tax Rate Potential Tax Due 19.855.44 50.000 9.927.72 .15 1.489.16 TAXPAYER RESPONSE x Tax x PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. To in sura propar cradit to your account, two (Z) copias of this notice must accompany your paymant to the Register of Wills. Haks check payable to: "Registsr of Wills, Agsnt". NOTE: If tax paYMsnts are made within thres (3) months of tha decedsnt's date of death, you may deduct a 57. discount of the tax due. Any inheritance tax dus will became dslinquant nins (9) months after the date of daath. [] The above information and tax due is correct. 1. You may choose to rSMit payment to ths 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 Rsgister of Wills and an official assessment will be issued by the PA Department of Revenue. r=J The abovs asset has been or will be reported and tax paid with ths Pannsylvania Inharitanca Tax rsturn to ba filed by tha decedant's representative. F;tTha abovs information is incorrect and/or debts and deductions were paid by you. )C\You must complete PART [!J and/or PART ~ below. If you indicate a different tax rate. please state your relationship to decedent: PART ~ TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Anount Subject to Tax S. Debts and Deductions 6. Anount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS 1 /I/-t>r 2 fct) ?j~~". /f'Lf 3X ~')U~ 4 Cj~J ci~ 9. 'l.:t 5 ~J~t-.~ ~--I'f:w.:J,?, ~~. ~-- DEBTS AND DEDUCTIONS CLAIMED have reported above HOME (/} ( 7 ) WORK ( ) TELEPHONE NUMBE REVISED SUBMISSION INFORMATION FOR SAVINGS ACCOUNT FOR RALPH E. JUMPER, DECEASED Date of Death: June 23, 2001 Joint Savings Account established in November 1988, (Account number 87004937723677, Allfirst Financial Service Bank) in Ralph E. Jumper and Martha E. Flowers, daughter. Amount in savings account upon death: Amount subject to tax: $19,865.96 9,927.72 Expenses paid for funeral by cash or personal check (Not paid from joint checking account of Ralph E. Jumper/Martha E. Flowers): Food for funeral luncheon held at church & donation to to ladies of church who prepared & served food (Paid 6/29/01 by cash) Minister (Paid 6/29/01 by cash) Verizon Long Distance Calls for notification of death of father (Paid 7/23/01 by Martha Flowers, personal check) Donation to South Newton Fire Company (Paid 8/6/01 by Martha Flowers, personal check--in memory of Ralph E. Jumper) TOTAL EXPENSES: -260.00 -175.00 - 54.60 -100.00 $ -589.60 AMOUNT SUBJECT TO TAX MINUS EXPENSES $9,927.72 -589.60 TOTAL AMOUNT SUBJECT TO TAX $9,338.12 According to the reverse side of Rev-l 543 EX AFP (09-00), as of 07/01/00 to present, a lineal descendent (which is daughter, Martha E. Flowers, joint owner of account) pays 4.5%. With expenses being deducted, as shown above, using the method of calculation in Part 2, paragraphs 5 and 6 on reverse side of form, the tax due on the balance should be $420.22. A check for that amount is enclosed. The form was sent to Martha E. Flower (name is Flower~ and the mailing address was incorrect (which was corrected on form submitted 10/30/01) through the Register of Wills Office, Cumberland County Court House. CORRECT MAILING ADDRESS: Martha E. Flowers 311 Campground Road Dillsburg, PA 17019 The revised notice was sent to 2 E. Main Street, Walnut Bottom P A 17266 which was my father's (Ralph E. Jumper) address upon death. Respectfully ~ ~~owers, DAUGHTER 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 NO. CD 000603 FLOWERS MARTHA E 311 CAMP GROUND ROAD DILLSBURG, PA 17019 ACN ASSESSMENT AMOUNT CONTROL NUMBER ____u__ fold ---------- -------- 01148255 I $420.22 ESTATE INFORMATION: SSN: 177-16-0161 I FILE NUMBER: 21-2001- 0990 I DECEDENT NAME: JUMPER RALPH E I DATE OF PAYMENT: 12/05/2001 I POSTMARK DATE: 00/00/0000 I COUNTY: CUMBERLAND I DATE OF DEATH: 06/23/2001 I I TOTAL AMOUNT PAID: $420.22 REMARKS: MARTHA E FLOWERS CHECK# 2748 INITIALS: SK SEAL RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS \, /?-/-'/- ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 *' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEKENT~ ALLOMANCE OR DISALLOMANCE OF DEDUCTION~. AND ASSESSKENT OF TAX ON JOINTLY HELD OR TRUST ASSETS \~~;fG,:; DATE ESTATE OF DATE OF DEATH "02 JAN 18 P 3 :45 ~~~~T~UMBER SSN/DC ACN MARTHA E FLOWERS 311 CAMPSGROUND RD Clerk DILLSBURG PA a;r'~l;;'f , PA REY-1548 EX iFP 1l2-DOl 01-21-2002 JUMPER 06-23-2001 21 01-0990 CUMBERLAND 177-16-0161 01148255 Amount Remitted RALPH E MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ...... Rifi=is4-i-i)f-AFFi-fi2-:oo1------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 01-21-2002 ESTATE OF JUMPER FILE NO. 21 01-0990 TAX RETURN WAS: RALPH E DATE OF DEATH 06-23-2001 COUNTY CUMBERLAND ACN 01148255 S.S/D.C. NO. 177-16-0161 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICE ACCOUNT NO. 87004937723677 TYPE OF ACCOUNT: ()() SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 11-01-1988 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: PAYMENT DATE 12-05-2001 RECEIPT NUMBER CD000603 x 19.855.44 0.500 9.927.72 589.60 9.338.12 .45 420.22 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT. SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS. AGENT." AMOUNT PAID 420.22 420.22 .00 .00 .00 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE . IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. · ( IF TOTAL DUE IS LESS THAN $1. NO PAY"ENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRJ. YOU "AY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. J x DISCOUNT (+) INTEREST/PEN PAID (-) .00 \" /'?-/?-~ *' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEKENTL ALLOHANCE OR DISALLOHANCE OF DEDUCTIONl:;-t.AND ASSESSKENT OF TAX ON JOINTLY nELD OR TRUST ASSETS Recore. Re(j;,,{, :"--} ! "-.-' ( :_~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 111Z8-0601 REV-1541 EX AFP 112-001 of DATE ESTATE OF DATE OF DEATH FILE NUMBER 01-21-2002 JUMPER 06-23-2001 21 01-0990 RALPH E '02 JAN 18 P 3 '4~OUNTY CUMBERLAND . SNI'DC 177-16-0161 MARTHA E FLOWERS ACN 01148256 311 CAMPGROUND RD Clerk I Allount Rellitted \ DILLSBURG PA 17IGftmbb '- , '-~. FA MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ Rifi=is4-i-EX--iF:p--fi1f=ooi------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 01-21-2002 ESTATE OF JUMPER RALPH E DATE OF DEATH 06-23-2001 COUNTY CUMBERLAND ACN 01148256 FILE NO. 21 01-0990 TAX RETURN WAS: S.S/D.C. NO. 177-16-0161 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICE ACCOUNT NO. 0097330159 TYPE OF ACCOUNT: DATE ESTABLISHED ( ) SAVINGS ()() CHECKING ( ) TRUST ( ) TIME CERTIFICATE 11-01-1988 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions - Taxable Amount Tax Rate X Tax Due 7.695.47 0.500 3.847.74 5.243.20 .00 .45 .00 TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT. SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS. AGENT." AMOUNT PAID .00 .00 .00 .00 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE . IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. · ( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A ..CREDIT" ( CRJ. YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J