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Home My WebLink About04-25-08 COMMONWEALTH OF PENNSYLVANIA HEV-1162 EX( 11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA ~", ... ,,...... RECEIVED FROM: INHERITANCE AND ESTATE TAX ......., OFFICIAL RECEIPT ..... 009624 ..,.. NO. CD '11... ',f:4 "'~<. "... - - ADAMS THOMAS L ....., "'.... 1 0 STONE LEDGE ROAD 4.' ~.. NEWVILLE, PA 17241 ...... _. - ...- ACN 'I." ASSESSMENT AMOUNT CONTROL NUMBER __n____ fold ---------- -------- 08113417 I $12.77 ESTATE INFORMATION: SSN: 162-22-3658 I FILE NUMBER: 2108-0107 I '"i'"," -.",...... DECEDENT NAME: ADAMS BETTY I - .... ..... 04/25/2008 I ,--!." DATE OF PAYMENT: ","'lI ,,'t." POSTMARK DATE: 04/25/2008 I '..... .......' - COUNTY: CUMBERLAND I .... """"...- -- DATE OF DEATH: 01/23/2008 I - -, ...... I - .r.... TOTAL AMOUNT PAID: $12.77 REMARKS: CHECK# 235 SEAL INITIALS: CJ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS - ...... ..... ..... ...... - REGISTER OF WILLS - ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2B0601 HARRISBURG, PA 1712B-0601 C~'''\~'~'I~* ,\ " /"; f;" ...... '. - .' ':"'., I",,' :b _ 1 )' ~';;''': ,:"I-i~~;-~ .-' .' "J~_ f,,_'. ;1. "/,"' ;~-~5i;. ,EX N\P!'."dOl THOMAS 10 STONE NEWVILLE 2008 APR 25 PM 2: 43 CLER!< OF OR, ,.P.,HAi\i':::, 1'"'(lI/RT 0111' ".:" ' : ",,'..-, __',.I I vlJ ,., f r'.r"""'\ r t.A, L ADAMS LEDGE RD PA 17241 INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO.21 08-0107 08113417 04-08-2008 EST. OF BETTY F ADAMS 5.5. NO. 162-22-3658 DATE OF DEATH 01-23-2008 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST [i] CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the DepartMent with the inforllation listed below which has been used in calculating the potential tax due. Theil' records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this infor.ation is incorrect, please obtain written correction fro. the financial institution, attach a copy to this forM and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co..onwealth of P.r.n~~lv~ni3e Que~tiun5 may be answered by ceIling (7!7) 787-8327. Account No. 197028-44 COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS 12-29-2006 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". Date Established Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due 567.38 50.000 283.69 .045 12.77 TAXPAYER RESPONSE x x PART ill NOTE: If tax pay.ents 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 becolle delinquent nine (9) months after the date of death. [CHECK ] ONE BLOCK ONLY A. ~ 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 "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Depart.ent of Revenue. 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 infor.ation is incorrect and/or debts and deductions were paid by you. You MUSt co.plete PART ~ and/or PART ~ below. PART [!] TAX RETURN - COMPUTATION If you indicate a different tax rate, please state YOUI' relationship to decedent: OF TAX ON JOINT/TRUST ACCOUNTS :.rNE 1. Oat.. 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 x 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 ~he b~st ~my knowledge and belief. ../ .A........-- L. { ~ TAXPAYER SIGNATURE $ correct and 6'6 t ~ 1-'= I"'; , 'f"! ~ <t """ '" :.,;...: !1 G- r", 'd' OJ ct -, 8 , ....i 00 l~~ U) " ~ Cl' Q,. tt <( ( 'ti" :r (:~ I ~ ~ ''ll ,:. ..Ilt:ot II ~ I ~; ~J4 ..: CIl II :&:~:!: .; " t""\-""^,....,..\r-r"\. "r:C'Ar ",... " ..'..1,,: L " ',. 2000 APR 25 PM 2: 43 -- -- -- CLEfiK OF ORPH/'N'S CO!..)RT j CU1/<:::r'j T, Pf\ -= -= ,- -- J J -= -- -= - -- - "- -- - -- ..:: -- - c{) a C -= "- .... u 10.1 iri ~) ,.) .lti ~) .,.., n 'r.. 'i"l <;...;. "