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Home My WebLink About01-29-09COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ~"' -F INDIVIDUAL TAXES DEPL 280fi01 HARRISBURG, PA 1J128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 010827 KAUFFMAN GREGG E 413 SUNSET LANE SHIPPENSBURG, PA 17257 foltl ESTATE INFORMATION: ssN: 1sa-zs-~azo FILE NUMBER: 2108-1 166 DECEDENT NAME: KAUFFMAN NANCY L DATE OF PAYMENT: 01/29/2009 POSTMARK DATE: 01 /28/2009 COUNTY: CUMBERLAND DATE OF DEATH: 11/09/2008 ACN ASSESSMENT AMOUNT CONTROL NUMBER 09100753 5766.01 REV-1162 EXI11-96) TOTAL AMOUNT PAID: REMARKS: GREGG M KAUFFMAN CHECK# 6204 SEAL INITIALS: WZ RECEIVED BY 5766.01 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS r ~. ~ x; .; :. ~; P; ,<<, ~~ --~ M ~ ~ - O ~ ~v v a ~ y G -N ~ , ~ .~ ~ ~~ y ~., ~ d v ~ !..~ ~:~~, i :~ ;:, .,.. ,:, .~~ ,.,~ ,.., ~ '~ ~ r ~~ ~ ~ ~ 1 ~' ~ ~ ~~ u ~ ~~V~(1`J dd'~~~ ~ ~a~p lug ~ ,: , , ~; ~ _~'i:J PENNSYL BUREAU OF INDIVIDUAL TAXES PD BOX 280601 HARRISBURG PA 17128-0601 NEV-354] EI( VANIA INHERITANCE TAX INFORMATION NOTICE AND FILE N0. 21 08-1166 ~~ -TAXPAYER RESPONSE AcN ~- 09100753 DATE 01-02-2009 2QQ9 JAt~ 29 AM I I ~ ! 2 C' ELK CF C ORPNFP' ~ ('~~! ART I ' "~. PA GREGG E KAUFFMAN ~` 413 SUNSET LN SHIPPENSBURG PA 17257 EST. OF NANCY L KAUFFMAN SSN 168-26-7420 DATE OF DEATH 11-09-2008 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. ORRSTOWN BANK provitlatl the Dapa rtment with the information below, which has been usetl in calculating the potential tax due. Records in tlicate that at the death mf the above-nom etl decetlent, you were a joins owner/beneficiary of this account. If you feel the info rmaH on is incorrect, please obtain written correckion fron the financial institution, attach a co antl return it to the above address. This account is taxable in accortlance with the Inheritance Tax laws of the Commonwealth of Pennsvly ania. Please call 17171 787-g32i wikh questions. pv to this form COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 696684 Data 01-30-2001 Established To ensure proper cretlit to the account, two Account Balance copies of this notice must accompany $ 10, 751.05 payment to the Register of Wills Mak Percent Taxable X . e check Dav able to "Rees ster mf Wills Agent" 50.000 , . Ampunt Subject to Tax $ ~t NOTE I Tax Rate 5,375.53 S f tax Daum ants are made within three X 1 5 months of the decedent's date of death, tl Potential Tax Due . a u etluct a 5 percent. d25gounp on the tax tlua 0 ~ ~ _ y '. 806.33 'vb - . Any Inheritance Tax due will become delinquent PART nine months after the tlate of tleath 0 TAXPAYER RESPONSE . A. ~y~ The above inf ormakion and tax tlua is correct u r CHECK . Remit paynent to the Register of Wills with two copies of this notice t a discount or ONE avoid interest, or check box "A'• and Wills and an official o obtain return this notice to th R ~ L BLOCK assessment will be issued by e eeisker of the PA Department of Revenue ONL Y B. ~ The abmve asset has been or will be reported and k . ax to ba fil ad by the estate representative. pa itl with the Pennsylvania Inheritance Tax return G. ~ The above inf orma Ion is incorrect and/or tlabts and tlatluctimns were Complete PART 2~ and/or PART 3r1 below, paid. PART If in tli eatln9 a different Yax rate, please State relationship tp tlece tle nt: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST LINE 1. Date Establish tl ACCOUNTS e ) 2. Account Balance 2 3. Pe re ent Taxable 3 X 4. Amount Subject Yo Tax 4 +fi 5. Debts and Deductions 5 6. Amount Taxable B 7. Tax Rate T ~( e. Tax Due y~ PART DATE PAID PAYEE IEn AMOUNT PAID - --^_ ~' pax computation) g Under penalties of pe r3ury, I tleclare that the facts I have reported above are true, correct and ~plata to the bast of //yyvv nowled 9e and belief. ~U ~~J,,.~i HOME (7/7 ) S-9~ 3'~ I/-------- ~~^~/ WORK k~ R SIGNATUR ~_. __..__. I /_ ~ [~_~~ c 8 DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION on 5