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HomeMy WebLinkAbout04-22-08 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 ROUSH BONNIE 477 OAK FLAT ROAD NEWVILLE, PA 17241 ______n fold ESTATE INFORMATION: SSN: 162-22-3658 FILE NUMBER: 2108-0107 DECEDENT NAME: ADAMS BETTY DATE OF PAYMENT: 04/22/2008 POSTMARK DATE: 04/22/2008 COUNTY: CUMBERLAND DATE OF DEATH: 01/23/2008 NO. CD 009595 ACN ASSESSMENT CONTROL NUMBER AMOUNT 08113413 I $49.12 08113414 I $9.56 08113415 I $197.94 08114077 I $239.35 08114078 I $21.92 08116403 I $290.17 08115781 I $335.42 101 I $8,856.52 I TOTAL AMOUNT PAID: $10,000.00 REMARKS: RECEIPT TO ATTY CHECK# 119 SEAL INITIALS: WZ RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280&01 HARRISBURG, PA 17128-0&01 *.-lr- :!:.-( .. _'~M i 1- ;--\'="',,-' ,,' '\, '1" ", r" ,/"-\ :~ "1:'" ,.". , .-'> ~ ,j ;~~..i&~ Efiij,P(~';-O';' INFORMATION NOTICE (,r AND \. iTAXPAYER RESPONSE (' FILE ACN DATE NO. 21 08- 0 1 07 08113413 04-08-2008 BONNIE ROUSH 447 OAK FLAT RD NEWVILLE 2008 APR 22 PH 12: 04 TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST IXl CERTIF. EST. OF BETTY F ADAMS S.S. NO. 162-22-3658 DATE OF DEATH 01-23-2008 COUNTY CUMBERLAND CLERK OF ORPHAN'S COURT CUM8ERl)~ND Co., PA REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PA 17241 MEMBERS 1ST FCU 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../beneficia..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..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 PennsylV'lnia. Questions may be answe..ed by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 43810-41 Date 04-16-1998 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". Acco~lnt Balance Pe..ce,nt Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART [!] 2,183.03 X 50.000 1,091.52 X .045 49.12 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. [CHECK ] ONE BLOCK ONLY A. ~ 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. 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 and/o.. debts and deductions we..e paid by you. You must complete PART ~ and/o.. PART ~ below. PART ~ TAX If you indicate a diffe..ent tax ..ate, please state you.. ..elationship to decedent: LINE 1- Date Established 2. Account Balance 3. IPe..cent Taxable 4. ,"mount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 PART DEBTS AND DEDUCTIONS CLAIMED [!] DATE PAID ~ PAYEE DESCR I PTI ON AMOUNT PAID . TOTAL (Ente.. on Line 5 of Tax Computation) Unde.. penalties of pe..ju..y, I decla..e that the facts I have ..epo..ted above a..e t..ue, correct and complete to the best of my knowledge and belief. HOME ( WORK ( TELEPHONE ) ) NUMBER DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2;80601 HARRISBURG, PA 1712B-0601 BONNIE ROUSH 447 OAK FLAT RD NEWVILLE q:r*I'~ "_.,,'_. ,\../, . .,J',.. _.,,.. \,~'1 : ,~..,'_ INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO.21 08-0107 08113414 04-08-2008 r-iflEvll~~I~:,~p' '~9-~;'l . ') 200B APR 22 PH 12: 04 TYPE OF ACCOUNT Ii] SAVINGS o CHECKING o TRUST o CERTIF. EST. OF BETTY F ADAMS S.S. NO. 162-22-3658 DATE OF DEATH 01-23-2008 COUNTY CUMBERLAND CLERK OF ORPHAN'S COURT CUI jnrn: \~ If"' r>r\ Ri^ - \t1::Lr'lJ~l ;J'...J 1.~,A)'1 - ,,", REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PA 17241 MEMBERS 1 ST FCU 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 PennsYlvania. Questions may be answ6red by calling (717) 787..8327. Account No. 43810-02 COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS 10-20-1998 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART [!] Date 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". x 424.71 50.000 212.36 .045 9.56 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. x [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. ~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 must complete PART ~ and/or PART ~ below. PART ~ TAX RETURN - COMPUTATION If yoU indicate a different tax rate, please state your relationship to decedent: UNE 1- Date Established 2. Ac:count Balance 3. P4lrcent Taxable 4. Amount SUbject to Tax 5. DElbts and Deductions 6. Amount Taxable 7. T.,x Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS 2 3 X 4 5 6 7 X 8 PART DEBTS AND DEDUCTIONS CLAIMED ~ DATE PAID ~ PAYEE DESCR I PTI ON AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) have reported above are true, correct and . Under penalties of perjury, I declare that the facts complete to the best of my knowledge and belief. TAXPAYER SIGNATURE HOME WORK ( ( ) ) TI:'I ~nlln"lr- .....&J1___ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 171Z8-0601 _'-ICE ~;':::~1NO~NESNp:TNISCEE FILE ACN DATE NO.21 08-0107 08113415 04-08-2008 -'. - '....,' f", ~r' ~" ~ik~lt:EX.AFe~O.'~1 BONNIE ROUSH 447 OAK flAT RD liIIEWVILlE 200B APR 22 PH 12: 04 TYPE OF ACCOUNT Ii] SAVINGS o CHECKING o TRUST o CERTIF. EST. OF BETTY F ADAMS S.S. NO. 162-22-3658 DATE OF DEATH 01-23-2008 COUNTY CUMBERLAND CLERK OF ORPH.AN'S COURT ,nCI"" I"~I'" r:n RA CU~i'i"J,.- -.lJ .c.\,"!. , 1". i ~)I".._, \:c... in '1'~./ ".J..... 'I REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PA 17241 MEMBERS 1 ST FCU has provided the Departllent 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 inforllation is incorrect, please obtain written correction from 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 Comllonwealth of Pennsylvania. QuestIons lIay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW · . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 43810-00 Date 05-22-1995 Established 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". Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART [!] 8,797.49 X 50.000 4,398.75 X .045 197.94 TAXPAYER RESPONSE NOTE: If tax paYllents are lIade 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 becolle delinquent nine (9) months after the date of death. [CHECK ] ONE BLOCK ONLY A. [J The above inforMation and tax due is correct. 1. You May choose to reMit paYllent 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. ~'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. [J The above inforMation is incorrect and/or debts and deductions were paid by you. You must COMPlete PART ~ and/or PART ~ below. PART ~ TAX RETURN - COMPUTATION If yOU indicate a different tax rate, please state YOUr relationship to decedent: LINE 1. D,ate Established 2. A,ecount Balance 3. PI~rcent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. TllX Due OF TAX ON JOINT/TRUST ACCOUNTS I 2 3 X 4 5 6 7 X 8 PART DEBTS AND DEDUCTIONS CLAIMED [!J DATE PAID ~ PAYEE DESCRIPTION AMOUNT PAID . have reported above are true, correct and 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. HOME WORK ( ( ) ) TAXPAYER SIGNATURE T~I CDunLIr- .........._...... COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRIS:BURG, PA 17128-0601 .~r ~-.-, ~,;. REV- i5~~ .E'i.: ~~_,.(;d.~;,~o;"- INFORMATION NOTICE AND cur.cTAXPAYER RESPONSE , i I ~'..":.." I FILE ACN DATE NO.21 08-0107 08114077 04-09-2008 BONNIE L ROUSH 447 OAK FLAT RD NEWVILLE . , 'v', If..._ TYPE OF ACCOUNT Ii] SAVINGS o CHECKING o TRUST o CERTIF. ZOOS APR 22 PH 12: O~EST. OF BETTY F ADAMS ~.S. NO. 162-22-3658 DATE OF DEATH 01-23-2008 COUNTY CUMBERLAND CLERK OF ORPHAN'S COURT CUM2FRLN'JD CO" PA REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PA 17241 MEMBERS 1 ST FCU has provided the Department with the information 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 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. 197028-05 Date 09-19-2001 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". Acc,ount Balance Per\~ent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART [!] 10,637.84 X 50.000 5,318.92 X .045 239.35 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. c=l 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 01' avoid interest, 01' 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 8. ~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 information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. .f you indicate a different tax rate, please state your relationship to decedent: PART ~ TAX 3 X 4 5 6 7 X B RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS I 2 LINE 1- Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. D,ebts and Deductions 6. Amount Taxable 7. Tax Rate B. Tax Due PART DEBTS AND DEDUCTIONS CLAIMED @] DATE PAID ~ PAYEE DESCR I PTI ON AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) $ Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME WORK ( ( ) ) TAXPAYER SIGNATURE TI:"'I....n..-...... COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 *.- ! i' ~ ~ i ,," j '. '-'."'./' "..:;,-;.- INFORMATION NOTICE AND OFF!~~~AYER RESPONSE FILE ACN DATE NO.21 08-0107 08114078 04-09-2008 ; (" BONNIE L ROUSH 447 OAK FLAT RD NEWVILLE CLERK OF ORPHAN'S COURT CUA~"--~" ".- "'^ P ~ '-\i" ..i, ;\\il) ! I! IA ~'i ;....- ;._ 1l..~;""";; \i'-,~ \"';\,..}, r "" PM 12: ~T. OF BETTY F ADAMS S.S. NO. 162-22-3658 DATE OF DEATH 01-23-2008 COUNTY CUMBERLAND TYPE OF ACCOUNT [XJ SAVINGS o CHECKING o TRUST o CERTIF. looa APR 22 PA 17241 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1 ST FCU has provided the Oapartment with the information listed below which has been us ad in calculating the potantial tax dua. Their records indicate that at the death of the above decedant. you wara a joint ownar/beneficiary of this account. If you fael this information is incorract. plaase obtain written correction from tha financial institution. attach a copy to this form and raturn it to tha abova address. This account is taxable in accordance with the Inharitance Tax Laws of the ComMonwaalth 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. 197028-03 Date Established 05-30-2002 To insure proper credit to your account, two (2) copias of this notice must accompany your paymant to tha Ragister of Wills. Maka check payabla to: "Register of Wills. Agent". x 974.22 50.000 487. 11 .045 21.92 TAXPAYER RESPONSE NOTE: If tax paymants ara made within threa (3) months of the decedent's data of death, you may deduct a 5% discount of tha tax due. Any inheritance tax due will bacoma delinquant nina (9) months after the data of daath. Account Balance Percent Taxable Amount SUbject to Tax Tax Rate Potential Tax Due x PART [!] [CHECK ] ONE BLOCK ONLY A. r=J The abova information and tax due is correct. 1. You may choosa to remit payment to the Ragistar 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 assassment will be issued by the PA Department of Revenue. B. ~The above asset has bean or will be reported and tax paid with tha Pannsylvania Inheritance Tax return ~to ba filed bY the decedant's rapresentative. c. r=J The above information is incorrect and/or debts and deductions ware paid by you. You must complete PART ~ and/or PART ~ below. x PART ~ TAX If you indicate a different tax rate, please state your relationship to decedent: RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE , 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 x PART [!] DATE PAID ~ DEBTS AND DEDUCTIONS CLAIMED 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. have reported above are true, correct and HOME WORK ( ( ) ) TAXPAYER SIGNATURE TI::'I ~DII"".- ........--- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1712B-0601 -~. '.:) f: C.:,f..~r.~~.,~AT1NODN NOTICE ~::i -- ;'.t.~it~AYER RESPONSE REV-lS43 EX AFP (09~OO) FILE ACN DATE NO.21 08-0107 08115780 04-10-2008 zoo a APR 22 PH 12: 04 EST. OF BETTY F ADAMS CLERK OF s.s. NO. 162-22-3658 ORPHAN'S C6UR~ATE OF DEATH 01-23-2008 CUME=qIN<D CO. ~UNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS [i] CHECKING o TRUST o CERTIF. ** BONNIE L ROUSH 343 G ST CARLISLE PA 17013 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 SOVEREIGN BANK 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 Pennsylvania. Questions may be answerpd bY calling (71 n 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS AccClunt No. 3381197134 Date Established 03-14-2007 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". Accclunt Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due x .00 100.00 .00 .15 .00 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. x 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. ~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 must complete PART ~ and/or PART ~ below. Xf you indicate a different tax rate, please state your relationship to decedent: i.I HE l. D...te 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 a. Tax Due a x PART ~ TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS x PART @] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID =1 TOTAL CEnter on Line 5 of Tax Computation) * Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME ( ) WORK ( ) TAXPAYER SIGNATURE TI=I I=pun....c ....II..'H'D 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 08-0107 08116403 04-17-2008 REV.lSli3 EX AFP (09.00) EST. OF BETTY F ADAMS S.S. NO. 162-22-3658 DATE OF DEATH 01-23-2008 COUNTY CUMBERLAND TYPE OF ACCOUNT [i] SAVINGS o CHECKING o TRUST o CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HQij$E CARLISLE, PA 07013 g ~O ex> =-::0 > cn -0 .." :T1 :r: (") :::0 :::0 '1> , ..... ... r- "? m . 'oJ 'r~"'-::O N MEMBERS 1 ST FCU . . has prov~de~ the Departllent with the inforllation listed below which h~~ G0~~ed in . (.-. - -, ,oo) calculating the potentul tax due. The1r records lndlcate that at the death of the above decedent, you were a J:g r/ber\'tllE!iclary of....' this account. If you feel this information is incorrect, please obtain written correction froll the financial in: io . at~ a C"'~lI: >::,J to this fora and return it to the above address. This account is taxable in accordance with the Inheritance T. ![J of the~Monwoalthf"; of Pennsylvania. Questions aay be answer-ed by calling 017> 787-8327. :o--{ .. ", COMPLETE PART 1 BELOW lE lE lE SEE REVERSE SIDE FOR FILING AND PAYMENT I~TRUCTIOQ .... r BONNIE L ROUSH 447 OAK FLAT RD NEWVILLE PA 17241 Accl)unt No. 197028-00 Date 09-20-2000 Established To insure proper credit to your account, two (2) copies of this notice must aCCOMPany your paYllent to the Register of Wills. Make check payable to: "Register of Wills, Agent". Accc)unt Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due 12,896.60 X 50.000 6,448.30 X .045 290.17 TAXPAYER RESPONSE NOTE: If tax payments are Made within three (3) 1I0nths 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 l!l [CHECK ] ONE BLOCK ONLY A. r=J The above inforaation 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 "An and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. B. ~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. X PART [!l 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 Estab11shed 2. Account Balance 2 3. f'ercent 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 X PART [!] DATE PAID 1 DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCR I PTI ON AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) $ Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knOWledge and belief. HOME WORK ( ( ) ) TAXPAYER SIGNATURE T~I ~pl.ln""l:" L1I1U''':.D COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1712B-0601 oM.~ ~! DC,-\'~-'--~,;- REV-1Sio3iRAF~ !(~~iIlI) INFORMATION NOTICE AND TFiCl~~PAYER RESPONSE FILE ACN DATE NO.21 08-0107 08115781 04-10-2008 .. 1! ' i BONNIE 343 G ST CARLISLE L ROUSH zoo a APR 22 TYPE OF ACCOUNT [i] SAVINGS o CHECKING o TRUST o CERTIF. PH 12= 04EST. OF BETTY F ADAMS 5.5. NO. 162-22-3658 DATE OF DEATH 01-23-2008 COUNTY CUMBERLAND CLERK OF 9~t!!,V~'s COURT CUL.. -.,[" 'r' A() R~^ ,'It: ..!;.__ ::_../,1J ",:' I i_j,~ ,J f"\ REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PA 17013 SOVERE Il;N BANK has provided the Department with the information listed below which has been used in calculati,ng the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this accolunt. If you feel this inforMation is incorrect, please obtain written correction from the financial institution, attach a COpy to this f'Drm and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pe"".ylvania. Qu""tion" may be answered by calling (1l7> 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 9857308218 Date 12-14-2005 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 ill 4,472.30 X 50.000 2,236.15 X .15 335.42 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. [CHECK ] ONE BLOCK ONLY A. 0 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. ~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. 0 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 . . Date Established 2. Account Balance 3. Percent Taxable 4. ,~mount Subject to Tax 5. :Oebts and Deductions 6. ,~mount Taxable 7. 'fax Rate 8. 'fax Due PART DEBTS AND DEDUCTIONS CLAIMED @J DATE PAID ~ PAYEE DESCR I PTI ON AMOUNT PAID have reported above are true, correct and TOTAL CEnter on Line 5 of Tax Computation) $ Under penalties of perjury, I declare that the facts complete to the best of my knowledge and belief. HOME WORK ( ( ) ) T~I~pl-lnN~ NII"'R~D TAXPAYER SIGNATURE