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Home My WebLink About02-14-08 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17126-0601 REV- 1162 EX(l 1 -96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 009303 KLINE JAMES S 618 MARTIN DRIVE MECHANICSBURG, PA 17055 ACN ASSESSMENT CONTROL NUMBER AMOUNT -~------ fold 08500027 $192.20 ESTATE INFORMATION: SSN: 177-24-5674 FILE NUMBER: 2108-0135 DECEDENT NAME: KLINE CATHERINE F DATE OF PAYMENT: 02/14/2008 POSTMARK DATE: 02/11/2008 COUNTY: CUMBERLAND DATE OF DEATH: 11/21/2007 TOTAL AMOUNT PAID: $192.20 REMARKS: CHECK# 1485 SEAL INITIALS: CJ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO BOX 2B0601 HARRISBURG PA 17128-0601 - c*,,~: CIT:P::::'NO~NE::OTNISC: " ... . lE l/'. REVISED NOTICE lE REV-is.... An> (7-00' . FILE ACN DATE NO. 21 ~O~-O(3S 08500027 01-31-2008 * * CLERf( (=IF ORPHA\J'S [OU:iT ~lJ\/r: - ~l- 0.1-\ EST. OF CATHERINE F KLINE S.S. NO. 177-24-5674 DATE OF DEATH 11-21-2007 COUNTY CUMBERLAND TYPE OF ACCOUNT D SECURITY [i] SEC ACCT D STOCK D BONDS 2008 FEB 14 M111: 34 JANET C JACKSON 20609 N 31ST AVE PHOENIX AZ 85027 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 AMERICAN FUNDS has provided the Departnnt 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 beneficiary of this asset. If you feel this information is incorrect, please obtain written correction from the transfer agent. 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 ceIling (717) 767-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 64665121 000 Valuation Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due x 17,983.92 25.000 4,495.98 .045 202.32 TAXPAYER RESPONSE 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 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. PART [!] 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. DThe 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. DThe above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. LINE 1. 000 Valuation 2. Percent Taxable 3. Amount Subject to Tax 4. Debts and Deductions 5. Amount Taxable 6. Tax Rate 7. Tax Due OF TAX ON ABOVE ASSET(S) 1 2 X 3 4 5 6 X 7 PART ~ TAX RETURN - COMPUTATION If you indicate a different tax rate, please state your relationship to decedent: PART [!] DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) * Under penalties of perjury, I declare that the facts complete to the best of my knowledge and belief. TAX have reported above are true, correct and ~-(ol- 9 g~1...q -//-:J.tJt:)8 DATE ( d?J.1) WORK ( ) TELEPHONE NUMBER HOME r i ) .. I ,.l 'f;' i? .v, "~~,.'; ~) .~..; {~" y+.~ ""tl'i ~;l Lt' ,",' Ii "" '1" 6;: ~i: ~,.. .... E :~:.! r;.;) ~II'...' ~:,l :t.~; J ~ ~ I J {<) ! ~-p ;~~~ : 1, i\ -I" ~l;) ~~~ ~-- ~ -:'.\ r -- r" ,~L~8 FE.E I L} ~\7i\ 1\: 34 ~ '. - LLt~; c:= Ot;'": ',', .3! ~I':"J": '.......~' ~~j ~~ ~ ~ ~ ?.r\ - ,~ - ~ - - - - ....: -- -- ~ - - - ..... - -- <<) " \J f'.. " '. ..:: - ..... :E .. .,,1 1;:J q c! (\l il'j tfj {1j .1.. j\'j .,.., ""I I:::. ."... "