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HomeMy WebLinkAbout04-14-08 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBUIiG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT OKORN ALFRED K 12 BRANDYWINE DRIVE MECHANICSBURG, PA 17050 _uu_n fold ESTATE INFORMATION: SSN: 185-12-5953 FILE NUMBER: 2108-0415 DECEDENT NAME: OKORN AGNES M DA TE OF PAYMENT: 04/14/2008 POSTMARK DATE: 04/14/2008 COUNTY: CUMBERLAND DATE OF DEATH: 02/11/2008 NO. CD 009543 ACN ASSESSMENT CONTROL NUMBER AMOUNT 08113500 I $191.38 08113501 I $191.61 08113499 I $234.87 08113498 I $162.62 08113497 I $162.58 08113496 I $239.30 08113495 I $191.66 08113504 I $62.65 08113503 I $231.49 TOTAL AMOUNT PAID: $1,668.16 REMARKS: CHECK# 2253 SEAL INITIALS: AJW RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2BD6Dl HARRISBURG, PA 17128-0601 '* FILE ACN DATE NO. 21 6'8' 04IS 08113500 04-08-2008 INFORMATION NOTICE AND TAXPAYER RESPONSE REV.154~ EX AFP (09-00) TYPE OF ACCOUNT EST. OF AGNES M OKORN 0 SAVINGS S.S. NO. 185-12-5953 0 CHECKING DATE OF DEATH 02-11-2008 1"0.) 0 TRUST COUNTY CUMBERLAND ~O ~ [Xl CER:'f:,lf. -0.. rn REMIT PAYMENT-~D FOR~TO: >~ REGISTER OF W))!;;I;;!$P::::O ~< CUMBERLAND COI C@~ H()y'sE :~ CARLISLE, PA ::leMI;t$.t::- [9 )c'o c-:) C") Q ::1': ;!'::!a -n """1 L :::c ':'J ~ 0 "_ ;;:;:; ALFRED K OKORN 12 BRANDYWINE DR MECHANICSBURG PA 17050 ,......) C.) PSECU has provided the Department with the information listed below which has been used iO,..) 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 calling (717) 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 8003172924 Date 07-21-2006 Established 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". Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART [!I 8,953.26 X 50.000 4,476.63 X .045 201.45 TAXPAYER RESPONSE NOTE: 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. A. ~ 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=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 information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 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 ~ DATE PAID PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID * TOTAL (Enter on Line 5 of Tax Computation) Under penalties of perjury, I declare that the facts I complete to the best of my knowledge and belief. czffi~?? ~~ have reported above are HOME (7/7) WORK ( ) T~I ~pl-lnNI= NUMBER COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2B0601 HARRISBURG, PA 17128-0601 '* FILE ACN DATE ./ NO. 21 0'7) 61.\ I S 08113501 04-08-2008 INFORMATION NOTICE AND TAXPAYER RESPONSE REV-15li3 EX AFP (09- 00) TYPE OF ACCOUNT EST. OF AGNES M OKORN 0 SAVINGS S.S. NO. 185-12-5953 0 CHECKING DATE OF DEATH 02-11-20O,W ~ 0 TRUST COUNTY CUMBERLAND '-: 53 =:c ~F. '-~j "'j'>} .,;0.- !-'j'-, ~-'-\ REMIT PAYH~~f)m) FO~ TO~"_<"f~ REGISTER OF wtft~ ':.j .:-] CUMBERLAND C,Q'-OO~T HQtISE ~n r'!l CARLISLE, PA-'ctY~3 ' '~..J -)~;2 ~:l ~ Q :x -1'[ ::D~ a ~ > W <J) c) W 'ff PSECU has provided the Department with the information listed below which has been used in calculatin9 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 for. 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 callin9 (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS ALFRED K OKORN 12 BRANDYWINE DR MECHANICSBURG PA 17050 Account No. 8003172924 Date 07-21-2006 Established 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". Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART I!I 8,963.96 X 50.000 4,481.98 X .045 201.69 TAXPAYER RESPONSE 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. A. fVf 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. r=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 information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 PART ~ TAX RETURN - COMPUTATION If you indicate a different tax rate, please state your relationship to decedent: LINE , 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 PART l!] DATE PAID PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID t TOTAL (Enter on Line 5 of Tax Computation) Under penalties of perjury, I declare that the facts I complete to the best of my knowledge and belief. /,~~~ - ... - -......... have reported above are true, correct and HOME (7/7) ~ </7 - 1.1:-.51 / WORK () V/~08 TELEPHONE NUMBER DA E COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 '* FILE ACN DATE ./ NO.21 b'6 6Lt'~ 08113499 04-08-2008 INFORMATION NOTICE AND TAXPAYER RESPONSE REV-iS'! EX AFP (09-00> ALFRED K OKORN 12 BRANDYWINE DR MECHANICSBURG TYPE OF ACCOUNT PA 17050 EST. OF AGNES M OKORN S. S. NO. 185-12-5953 (") DATE OF DEATH 02-11-20&~~ COUNTY CUMBERLAND' :~I ,__ '";,.j", -,_..1 REMIT PAYM~Ni~~ REGISTER OF Wi~~ CUMBERLAND ce' eo,~T CARLISLE, PA.'11':n-t3 ""-...' ........- . .:(J ::D '---1 ;> o SAVINGS o CHECKING [lI;RP"ff ~~t;:.gJt F . ..".) {;:7"~ TO:' ..j tel '" = = 0:. :0.. v :::r.] FOW .c- HOUSE > :x w w r--., 4(1 (:J f'~, t-i':'1 PSECU 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 fro. 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 Com.onwealth of Peonsylvenia. Questions .ay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 8003172924 Date 07-21-2006 Established 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". Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART [!] 10,988.14 X 50.000 5,494.07 X .045 247.23 TAXPAYER RESPONSE 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. A. ~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 Oepartment of Revenue. [CHECK ] ONE BLOCK ONLY B. r=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. r=J The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 0 and/or PART 0 below. OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 PART ~ TAX RETURN - COMPUTATION If you indicate a different tax rate, please state your relationship to decedent: LINE l. 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 [!] DATE PAID PAYEE DEBTS AND DEDUCTIONS CLAIMED 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. a~~_f<::(!~ have reported above are true, correct and HOME COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2B0601 HARRISBURG, PA 17128-0601 '* " 6~ ott I) INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO.21 08113498 04-08-2008 REV~lS43 EX AFP (09.0Q) TYPE OF ACCOUNT EST. OF AGNES M OKORN ",0 SAVINGS S.S. NO. 185-12-5953 ~O go CHE~NG DATE OF DEATH 02-11-2008 -~~ ;:o--'m COUNTY CUMBERLAND :~P;g [i] ;~~. -7 'Tl - ,-.- REMIT PAYME~r~FORMpO: I :''1) REGISTER OF WtJ.j",~"-" l.J CUMBERLAND CO.... 1;W. .__ iit H~E ':~...) CARLISLE, PA.J.1;!ll'~::It -::::i -.0 - C-) :TJ-l s> rq .> W C~) W ALFRED K OKORN 12 BRANDYWINE DR MECHANICSBURG PA 17050 PSECU has p..ovided the Depa..tment with the info..mation listed below which has been used in calculating the potential tax due. Thei.. ..eco..ds indicate that at the death of the above decedent, YOU we..e a joint owne../beneficiar-y of this account. If you feel this info..mation is inco....ect, please obtain w..itten co....ection f..om the financial institution, attach a copy to this fo... and ..etu..n it to the above add..ess. This account is taxable in acco..dance with the Inhe..itance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answe..ed by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 8003172924 Date 07-21-2006 Established To insure proper credit to your account, two (2) copies of this notice must accompany you.. payment to the Registe.. of Wills. Make check payable to: "Registe.. of Wills, Agent". Account Balance pe..cent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART [!] 7,608.06 X 50.000 3,804.03 X .045 171.18 TAXPAYER RESPONSE NOTE. If tax payments a..e made within th..ee (3) months of the decedent's date of death, yoU may deduct a 5% discount of the tax due. Any inhe..itance tax due will become delinquent nine (9) Months afte.. the date of death. A. lQ The above info..mation and tax due is co....ect. ~l. You may choose to ..emit payment to the Registe.. of Wills with two copies of this notice to obtain a discount 0" avoid inte..est, 0" you may check box "A" and ..etu..n this notice to the Registe.. of Wills and an official assessment will be issued bY the PA Depa..tment of Revenue. [CHECK ] ONE BLOCK ONLY B. r=J The above asset has been 0.. will be ..epo..ted and tax paid with the PennSYlvania Inhe..itance Tax ..etu..n to be filed by the decedent's ..ep..esentative. C. [] The above info..mation is inco....ect and/o.. debts and deductions we..e paid by You. You must complete PART ~ and/o.. PART ~ below. OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 PART [!j TAX RETURN - COMPUTATION If you indicate a diffe..ent tax ..ate, please state you.. relationship to decedent: LINE l. Date Estirblish..d 2. Account Balance 3. Pe..cent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due PART [!] DATE PAID PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID TOTAL {Ente.. on Line 5 of Tax Computation} $ perjury, I declare that the facts I my k owledge and belief. have reported above are true, correct and HOME (7/7) ~r"7 - '-~I WORK () /; lJ-/aJT TELEPHONE NUMBER /DA~e COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRIS8URG. PA 17128-0601 '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 I) <tJ d-\\S' 08113497 04-08-2008 REV-1543 EX AFP (09.00) TYPE OF ACCOUNT EST. OF AGNES M OKORN D SAVINGS S.S. NO. 185-12-5953 D CHECKING DATE OF DEATH 02-11-20It8.> ,...", D TRUST COUNTY CUMBERLAND :;:;';0 ~ [i] CE~}F. REMIT PAYK~~~ND FO~ TO .~? REGISTER OF WI!it&2:::o .'1:5 CUMBERLAND CP:eoURT ~SE ,,~J CARLISLE, PAr._, Y7M3"- .,.2:1 . ';;'0 () Q -r: ~ ~'..j '__ ::1r ~-j :::0 r"'~ .'._ -; a ,J :i=:! -. r.... ( il W t.....-.:) PSECU has provided the Department with the inforaation listed below which has been use~ 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 inforaation 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 bv calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS ALFRED K OKORN 12 BRANDYWINE DR MECHANICSBURG PA 17050 Account No. 8003172924 Date 07-21-2006 Established 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". Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due 7,606.11 X 50.000 3,803.06 X .045 171.14 TAXPAYER RESPONSE 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 [!] [CHECK ] ONE BLOCK ONLY A. IVI The above information and tax due is correct. ~ 1. You may choose to reait payaent 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. 8. [] 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 aust complete PART ~ and/or PART ~ below. X PART ~ TAX RETURN - COMPUTATION If you indicate a different tax rate. please state your relationship to decedent: OF TAX ON JOINT/TRUST ACCOUNTS liNE 1- Date Established 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 PART ~ DATE PAID PAYEE X DEBTS AND DEDUCTIONS CLAIMED DESCR I PTI ON AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) $ Under penalties of perjury. I declare that the facts to the best 0 my k owledge and belief. 7 have reported above are true. correct and ( 711) ~? 7 - A.1-~~ I WORK ( ) / t2S" TELEPHONE NUMBER A HOME COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2B0601 HARRISBURG, PA 1712B-0601 '* .-' FILE ACN DATE NO. 21 O~ OL.\ 1'7 08113496 04-08-2008 INFORMATION NOTICE AND TAXPAYER RESPONSE REV.1543 EX AFP (09-00) TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST Ii] CERTIF. EST. OF AGNES M OKORN S.S. NO. 185-12-5953 DATE OF DEATH 02-11-2008 COUNTY CUMBERLAND C) ~ >" 0 c:::. REMIT PAYHE~~ND FOR~TO: REGISTER OF W,ht;t."'S') ;g CUMBERLAND CO ~~T HucSE CARLISLE, PA J...11ll3 _ --f ~ .... ("',-... d~'i-,J ^ - ) ~ ::0 ~-; . ,x.' '=::"1 , , C...... ~ ",j ~!.'J (-:J f"rl {'----. ~/ ALFRED K OKORN 12 BRANDYWINE DR MECHANICSBURG PA 17050 J::2. .:Jc C:":) ~ ":;1 ;~.~ ,e;;; S? PSECU has provided the Department with the information listed below which has been useA..ln '. /) ,-, calculating the potential tax due. Their records indicate that at the death of the above decedent. you were a joint owne~neficiary.at this account. If you feel this information is incorrect, please obtain written correction fro. 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 Com.onwealth of Pel1nsylvania. Ciuestions may be answer..d by calling (71 n 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 8003172924 Date 07-21-2006 Established 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". Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART [!] 11 , 195.59 X 50.000 5,597.80 X .045 251. 90 TAXPAYER RESPONSE NOTE: If tax payments are .ade 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. A. I\i1 The above infor.ation and tax due is correct. ~ 1. You may 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 lIay 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. r=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. r=J The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. OF TAX ON JOINT/TRUST ACCOUNTS I 2 3 X 4 5 6 7 X 8 PART ~ TAX RETURN - COMPUTATION If you indicate a different tax rate. please state your relationship to decedent: LINE l. 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 [!] DATE PAID PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) $ perjury, I declare that the facts wledge and belief. have reported above are true, correct and (7//) ~?7'-:L~ WORK () 1:. C>~ TfLfPHONf NUMBER DA<<' HOME COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2B0601 HARRISBURG. PA 1712B-0601 '* ./ NO. 21 0<6011 IS 08113495 04-08-2008 INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE REV-1543 EX AFP (D9-00l TYPE OF ACCOUNT EST. OF AGNES M OKORN D SAVINGS 5.5. NO. 185-12-5953 D CHECKING DATE OF DEATH 02-11-2008 D TRUST COUNTY CUMBERLAND D ~ [i] CERTIF. REMIT PAYM~~CiND FOR~O: REGISTER OF WIt~ ~ CUMBERLAND CO~ H~E CARLISLE, PA ~1.~ ~ (J) ;? ;; .' ~~-? C: ) ':::-d--il b :;5 :.-c ,--; a PSECU has p..ovided the Depa..tment with the info..mation listed below which >:jI,~s been used i"n r - "'1/ calculating the potential tax due. Thei.. ..eco..ds indicate that at the death of the above decedent. you we..e a joint owne..~eficIary(o~ this account. If you feel this info..mation is inco....ect. please obtain w..itten co....ection f..om the financial institution. ~ach a COpy; to this fo..m and ..etu..n it to the above add..ess. This account is taxable in acco..dance with the Inhe..itance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answo..ed by calling (717) 787-B327. COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS ALFRED K OKORN 12 BRANDYWINE DR MECHANICSBURG PA 17050 :,'tJ rl! (>-) <:::> (:'.j /,>/ C:J C) -_on Account No. 8003172924 Date 07-21-2006 Established To insure proper credit to your account, two (2) copies of this notice must accompany you.. payment to the Registe.. of Wills. Make check payable to: "Registe.. of Wills. Agent". Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART [!] 8,966.57 X 50.000 4,483.29 X .045 201.75 TAXPAYER RESPONSE NOTE: If tax payments a..e made within th..ee (3) months of the decedent's date of death. you may deduct a 5% discount of the tax due. Any inhe..itance tax due will become delinquent nine (9) months afte.. the date of death. A. ~ The above info"lIation and tax due is co....ect. ~ 1. You may choose to ..emit payment to the Registe.. of Wills with two copies of this notice to obtain a discount 0.. avoid inte..est. 0.. you may check box "A" and ..etu..n this notice to the Registe.. of Wills and an official assessment will be issued by the PA Depa..tment of Revenue. [CHECK ] ONE BLOCK ONLY B. [] The above asset has been 0.. will be ..epo..ted and tax paid with the Pennsylvania Inhe..itance Tax ..etu..n to be filed by the decedent's ..ep..esentative. C. [] The above info..mation is inco....ect andlo.. debts and deductions we..e paid by you. You must complete PART ~ andlo.. PART ~ below. OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 PART [!I 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 [!] DATE PAID PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) $ of perjury, I declare that the facts I f~and belief. have reported above are t..ue, correct and HOME (7/7) r; f' 7 - :t... 4-~~/ WORK () 7/'/-/015 Ti=1 i=PI..InNi= NIIMRI=R DAfl ' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 ~<::6 64IS 08113504 04-08-2008 REV-1543 EX AFP (09-00) TYPE OF ACCOUNT ALFRED K OKORN 12 BRANDYWINE DR MECHANICSBURG PA 17050 EST. OF AGNES M OKORN D SAVINGS S.S. NO. 185-12-5953 [i] CHECKING DATE OF DEATH o2-11-2oo~ "" D TRUST COUNTY CUMBERLAND(~;O ~ D CERTIF. REMIT PAYH~~~ND FO~ TO REGISTER OF W.i~...~~$? -0 CUMBERLAND CO ~T ~SE CARLISLE, pA-oci~ 3 .c- l,.."'~ ;:JO Q-1i \....._~ .:(] --/ h (~~~) ::&': -+:; C3 ,~) -. } ~T~J PSECU has p..ovided the Depa..tment with the info....ation listed below which has been us.M.>in J C. ; calculating the potential tax due. Thei.. ..eco..ds indicate that at the death of the above decedent, you we..e a joint owne~eneficiarY'if this account. If you feel this info..mation is inco....ect. please obtain w..itten co....ection f..om the financial institution. attach a copy to this fo..m and ..etu..n it to the above add..ess. This account is taxable in acco..dance with the Inhe..itance Tax Laws of the Commonwealth of Pennsylvania. Questicns May be answe..ed by calling (717) 787-8327. COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 8003172924 Date 07-21-2006 x 2,931.28 50.000 1,465.64 .045 65.95 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must accompany you.. payment to the Registe.. of Wills. Make check payable to: "Registe.. of Wills, Agent". Established Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due x NOTE: If tax payments a..e made within th..ee (3) months of the decedent's date of death, you may deduct a 5% discount of the tax due. Any inhe..itance tax due will become delinquent nine (9) months afte.. the date of death. PART [!] [CHECK ] ONE BLOCK ONLY A. !'VI'The above info....ation and tax due is co....ect. ~ 1. You may choose to ..emit payment to the Registe.. of Wills with two copies of this notice to obtain a discount 0.. avoid inte..est. 0.. you may check box "A" and ..etu..n this notice to the Registe.. of Wills and an official assessment will be issued by the PA Depa..tment of Revenue. B. [] The above asset has been 0" will be ..epo..ted and tax paid with the Pennsylvania Inhe..itance Tax ..etu..n to be filed by the decedent's ..ep..esentative. c. [] The above info..mation is inco..rect andlo.. debts and deductions we..e paid by you. You must complete PART ~ andlo.. PART ~ below. x PART [!] TAX RETURN - COMPUTATION If you indicate a different tax rate, please state your relationship to decedent: OF TAX ON JOINT/TRUST ACCOUNTS LINE 1- Date Established 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 PART [!] DATE PAID PAYEE x DEBTS AND DEDUCTIONS CLAIMED DESCR I PTI ON AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) $ perjury, I declare that the facts my k owledge and belief. have reported above are true, HOME (/17) ~ r'/ WORK ( ) TFI FPHONE NUMBER correct and :t~~ . 1t10~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 *' FILE ACN DATE NO. 21 0'60'''h<'; 08113503 04-08-2008 INFORMATION NOTICE AND TAXPAYER RESPONSE REV-IS'! EX AFP C09-00> TYPE OF ACCOUNT EST. OF AGNES M OKORN 0 SAVINGS S.S. NO. 185-12-5953 0 CHECKING DATE OF DEATH 02-11-2008 0 TRUST COUNTY CUMBERLAND Q ~!Xl CERTIF. REMIT PAYHENf~D FOR~O: ~C; REGISTER OF Wl~~~ _~ ~Q CUMBERLAND coCfWR.t HUJttSE CARLISLE, PA'-l~~ _ i C/) X .&:- /~:? C") ;,::! -,.,:0. ~.:..) :Js ::r: ' , ~....:_-, - ~ 'J -, <::;) ( ~~ )2:-. .. f":......../ PSECU has p..ovided the Depa..tment with the info..mation listed below which has been use~ ... '1 calculating the potential tax due. Thei.. ..eco..ds indicate that at the death of the above decedent, you we..e a joint owne.. neficiafY~~ this account. If you feel this info..mation is inco....ect, please obtain w..itten co....ection f..om the financial institution, a tach a copy' to this fo..m and ..etu..n it to the above add..ess. This account is taxable in acco..dance with the Inhe..itance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answe..ed by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS ALFRED K OKORN 12 BRANDYWINE DR MECHANICSBURG PA 17050 Account No. 8003172924 Date Established 07-21-2006 To insure proper credit to your account, two (2) copies of this notice must accompany you.. payment to the Registe.. of Wills. Make check payable to: "Registe.. of Wills, Agent". Account Balance Pe..cent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART ill x 10,829.96 50.000 5,414.98 .045 243.67 TAXPAYER RESPONSE NOTE: If tax payments a..e made within th..ee (3) months of the decedent's date of death. you may deduct a 5% discount of the tax due. Any inhe..itance tax due will become delinquent nine (9) months afte.. the date of death. x A. fVf The above info..mation and tax due is co....ect. ~ 1. You may choose to ..emit payment to the Registe.. of Wills with two copies of this notice to obtain a discount 0.. avoid inte..est, 0.. you may check box "A" and ..etu..n this notice to the Registe.. of Wills and an official assessment will be issued by the PA Depa..tment of Revenue. [CHECK ] ONE BLOCK ONLY B. [] The above asset has been 0.. will be ..epo..ted and tax paid with the Pennsylvania Inhe..itance Tax ..etu..n to be filed by the decedent's ..ep..esentative. C. c=J The above info..mation is inco....ect and/o.. debts and deductions we..e paid by you. You must complete PART ~ and/o.. PART ~ below. OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 PART ~ TAX RETURN - COMPUTATION If you indicate a diffe..ent tax ..ate, 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 [!] DATE PAID PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) . perjury, I declare that the facts owledge and belief. have reported above are true, correct and (//1) ~?/ - ~+~'l. () -~g- Ti=1 i=ploInNI= NIIMBI=R Ai. t.. HOME WORK COMMONWEJ\LTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT,28060'j HARRISBURG, PA 17128-0601 REV-1162 EX( 11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT OKORN ALFRED K 12 BRANDYWINE DRIVE MECHANICSBURG, PA 17050 -------- fold ESTATE INFORMATION: SSN: 185-12-5953 FILE NUMBER: 2108-0415 DECEDENT NAME: OKORN AGNES M DATE OF PAYMENT: 04/14/2008 POSTMARK DATE: 04/14/2008 COUNTY: CUMBERLAND DATE OF DEATH: 02/11/2008 NO. CD 009544 ACN ASSESSMENT CONTROL NUMBER AMOUNT 08113502 I $357.95 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 2253 SEAL INITIALS: AJW RECEIVED BY: REGISTER OF WILLS $357.95 GLENDA FARNER STRASBAUGH REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO.21 <9?>0~1~ 08113502 04-08-2008 REV.lS43i EX AFP (09.00) TYPE OF ACCOUNT EST. OF AGNES M OKORN 0 SAVINGS 5.5. NO. 185-12-5953 0 CHECKING DATE OF DEATH 02-11-2008 0 TRUST COUNTY CUMBERLAND [i] CERTIF. REHIT PAYHE~~D FORH~O: REGISTER OF WI'~ 00 CUMBERLAND COCQIJ.RJ H~E CARLISLE, PA ~,lD~ ~ . ;;'s !E ..- C/) X ) "'-, ~.;O S-d ." ::ta., '" ~ .:! -:H PSECU has provided the DepartlRent with the information listed below which ~ bien used l? . C) calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a Joint owner/~efici~f~J.{,l this account. If you feel this inforMation is incorrect, please obtain written correction fro.. the financial institution, ach a COpy,< to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of t Commonwealth of Pennsylvania. Questions .ay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS ALFRED K OKORN 12 BRANDYWINE DR MECHANICSBURG PA 17050 -l:- Account No. 8003172924 Date 07-21-2006 Established To insure propel' 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". Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due 16,746.14 X 50.000 8,373.07 X .045 376.79 TAXPAYER RESPONSE 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 beco..e delinquent nine (9) months after the date of death. PART [!] [CHECK ] ONE BLOCK ONLY A. ~ 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. B. E:J 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. r=J The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. LINE l. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 4. Amount Subject to Tax 4 S. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 8. Tax Due 8 PART ~ DATE PAID PAYEE X PART [!] TAX RETURN - COMPUTATION If you indicate a different tax rate, please state your relationship to decedent: OF TAX ON JOINT/TRUST ACCOUNTS X DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) $ Under penalties of perjury, I declare that the complete to the be:t~f m~ ~Wledge and belief. ttlJ;~ ~~ c;~ facts I have reported above are true, correct and .t.1- ( 7/7) ~ 'I' 7 WORK ( ) TELEPHONE NUMBER HOME g