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Home My WebLink About02-03-09COMMONWEALTH OF PENNSYLVANIA REV-1162 EX111-961 DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TA%EB ~Z~~. 280601 HARRISBURG. PA 1 ]128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 010855 ENDRES GARY D 275 E SPRING VALLEY ROAD DILLSBURG, PA 17019 ACN ASSESSMENT AMOUNT CONTROL NUMBER gold ESTATE INFORMATION: ssnl: ots-2o-9330 FILE NUMBER: 2108-1 164 DECEDENT NAME: FERNANDES JOSEPH DATE OF PAYMENT: 02/03/2009 POSTMARK DATE: 02/02/2009 CouNTY: CUMBERLAND DATE OF DEATH: 10/12/2008 REMARKS: GARY ENDRES SEAL CHECK# 2720 09104965 ~ 53.82 TOTAL AMOUNT PAID: 53.82 INITIALS: WZ RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS • PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE AND FILE N0. 21 08-1164 BUREAU OF tNDtvloual TAxgs .._~~, ,;~~~,.:!, TAXPAYER RESPONSE ACN 09104965 PO BOX 288601 HARRIS BURG PA 17128-0601 -__ ,, ,I ~., DATE 01-20-2009 acv-~s a2v :vM.w6di~ ....- p TYPE OF ACCOUNT 2009 FEB -3 ~~I ~ ~ ~ 28 EST. OF JOSEPH FERNANDES ® SAVINGS SSN 019-20-9330 ^ CHECKING /~~ rq ^" DATE OF DEATH 10-12-2008 ^TRUST VI.CI~~ + CERTIF. O~~'~`. '`~~ COUNTY CUMBERLAND ^ CUMt~~~r„ :dD ~ ~ REMIT PAYMENT AND FORMS T0: GARY ENDRES IYII REGISTER OF WILLS 275 EAST SPRING VALLEY CUMBERLAND CO COURT HOUSE RD CARLISLE. PA 17013 DILLSBURG PA 17019 AMERILHOICE FCU provitled the Department with the inf orn ation below, which has been used in calculating the potential tax due. Records indicate thak at the death of khe above-named tlecetlent. Yau were a Joint owner/beneficiary of Yhis account. If You feel the information is into rrecY, please obtain written correction fron the financial institutions attach a copy to this form antl return it to the above address. This account is tm~able in acco rtlance with the Inheritance Tax laws pf the Conmonw eaath of Penn sYlvaniz. Pleas^_ call O1]) 79]-832] with questions. COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 40156 Oat¢ 12-04-2006 To ensure proper credit to the account, two EStablished copies of this notice must accon pane pavm ent to the Register of Wills. Make check Account Balance $ 50 • BS payable to "Register of Wills. Agent'•. Part ent Taxable X 50.000 NOTE: If Saz pavments are made within three Amount SubJeck to Tax $ 25.44 months of the decedent's tlate pf death, deduct a 5 percent discount on She tax tlua. TaX Rata X 1 5 Anv Inheritance Tax due will become tleli nquent Potential Tax Due $ 3 • B2 nine months of [er the dake of tleath. PART TAXPAYER RESPONSE A. ~ Tha above inf ornation and tax due is correct. Remit pavnent to the Register of Wills with Ywo copies of this notice to obtain a discoun4 or avoid interest, or check box "A" and return this notice to the Register of r CHECK ~ Wills and an official assessment will be issuetl by the PA Deparkment of Rev¢nue. L ONE BLOCK B. ~ The above asset has bean or will be reporketl and tax paid with the Pennsylvania Inheritance Tax return ONL Y to be filed by the estate rev resentakive. C. ~ The above inf or~rm~,a ~ton is incorrect and/or debts and tleductions were paid. Complete PART ~-: and/or PART ~ below. ~e@s PART If Intl Se sting a differs nt tax rake, Pleas¢ state q x d ~ s ~i~ t~ '~ i f G. 9 relationship to decedent: a ~ ~~~ ~~ ~ TAX RETURN - COMPUTATION OF TAX DN JOINT/TRUST ACCOUNTS ~ II"" 1~ LINE 1. Daka Established 1 ~¢ a 2. Account Balance ~ '~ e~ :a X ~ 3. Percent Taxable 3 4. Amount SubJecY to Tax 4 $ e. ~, 5. Debts and Oeduetlons 5 q a~ 6. Amount Taxable 6 $ i 7. Tax Rate T X .a i 8. Tax Due B $ "r PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter ¢n Line 5 of Tax Computation? 8 Under penalties of periury. I tleclare that the facts I have reported above are true, eor sect and comp a to the [h?~ s~t ~9of my knowledge and belief. HDME C ~~ 7 ~ ~3Z - ~ 7~~ ~~ WORK ( ) a~S unu[ MIIMAFR DATE ~c r~, ~ ~~: ~~= ,~ ,~_i~ ., ~~.~;-- 209 FEB -3 QM I I ~ 28 CLERK OF ORPHAN'S, COURT CU~APER~ 1U CO., Ph ~, _~ ~`° ut m ~. ~, ~ r a i°,i r~ u_ r ~• C3 ti ~~ xa ~o >'" V ~ a~B ~_ W cud C7NC1 •.! i i•~ ~ r~ i :~ i,~i ~n -., ~:"~ ,~a ~.