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Home My WebLink About02-03-09 (2)COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE _~BIZREAyU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 1 ]128-0601 RECEIVED FROM: ENDRES GARY D 275 E SPRING VALLEY ROAD DILLSBURG, PA 17019 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1182 EX(11-96) NO. CD 010856 ACN ASSESSMENT AMOUNT CONTROL NUMBER - - ,o~d ESTATE INFORMATION: ssN: Oi9-20-sago 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 D ENDRES SEAL CHECK# 272 09105003 ~ 515,529.99 TOTAL AMOUNT PAID: 515.529.99 INITIALS: WZ RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE AND FILE N0. 21 OS-1164 BUREAU DF INDIVIDUAL TAXES ACN 09105003 PD BOX 280601 TAXPAYER RESPONSE HARRISBURG PA 171ze-gsBl DATE 01-21-2009 PEV-3543 E% RFr •~ GARY 275 EAST RD DILLSBURG ENDRES SPRING VALLEY ,.<i14 ~ :B -3 AM CLCE11~ Of ...I..: IV~LIC.ITLf~~r~' '.. . , PA 17019 EST. OF JOSEPH FERNANDES SSN 019-20-9330 DATE OF DEATH 10-12-2008 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 TYPE OF ACCUUNI ® SAVINGS CHECKING TRUST CERTIF. AMERICHOICE FCU provided the Department with the infornati on below, which has been used in calculating the potential Tax due. Records indicate that at the death of the above-non ed decetlent, You were a ]oink owner/beneficiary of This account. If you feel The inf a rm ation is incorrect. Dlease 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 acco rtlance with the Inheritance Tax laws of the Commonwealth of Pennsyivania. riease Call (7i7) 787-8J17 with Questions. COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS AcccunY No. 40156-18 Date 04-24-2008 To ensure proper credit tp the account, two Established copies of this notice must acconpanv payment to the Register of Wills. Make check Account Balance $ 103.533.25 payable to "Register of wills. Agent". Percent taxable X 100.00 NOTE: If tax payn ants era made within three Amount Subject Yo Tax $ 103,533.25 months of the decedent's date of death, Tax Rate X 1 5 deduct a 5 percent discount an the tax tlue. Any Inheritance Tax due will becone delinquent Potential Tax Dua $ 15.529.99 nine months after the date of death. a~ ® s~ a, ee ae . CHECK A. 1~t The above inf orn ation antl tax tlue is correct. lQY Remit Payment to She Register of Wills with Two copies of this a discount or avoid inkerest, or check boz "A" antl return This Wills and an official assessment will be issued by the PA Oepa notice notice rkment ko obtain to the Register of of Revenue. I ONE L BLOC K B. ~ The above asset has bean or will be reported antl Sax paid with the Pennsy lvania Inheritance Tax reku rn ONL Y ko be filed by The estate repro sent alive. C. ~ The above inf area ion is incorrect and/or debts and de C onplete PART 2~ and/or PART 3r~ below. ductions ware paid. If iodic at in9 a different Yax rate, please state PART relationship to decetlent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE i. Date Established 1 ,~~~ T. ~ ® ~ a ~~ i ~' y ~ i ~ ~~~g ~ ~ ~I~ "~' ~ ~ n,u ~4s ~ ',~~ ~ ~ f .v ,6. ,f ~ 2. Account Balance 2 ¢ ~ 3. Percent Taxable 3 X ~ ~ ~' e 4 Amount Subject to Tax 4 +~ ~`,. . 5. Debts and Deductions 5 ~~; ~; a 6. Amount Taxable 6 $ ° ;~ 7 Tax Rate T X e a ° i ~ tea: . 8. Tax Due B ^~ .~ „. ."~.,..~ a ~~ PART DEBTS AND DEDUCTIONS CLAIMED 0 nerF aArn PAYEE DESCRIPTION AMOUNT PAID Under penalties of pa riury, I decla ra that the facts I have re po rt ad above are tlI r/Iu22e, cor re c/t and compJ~/ate to ,(tlhe b[e~st //o~f ~my knowledge and belief. HOME C~~7 J v'I'J~~37~7 f~_/ Xl p/Gr~ /~', ~i6[GC/L(.~ WORK ( ) _~r~Or'I ___._-.._ ___... _....~ TCI FPNfINF NIIMAFR DATE r ---_ «; t- ~~, +r' ~~. ~' ,, w tt' ~; 1; !~ s;. f` ~ .~.. '7 ~.~ T,. ~O 7~ Y.> 'o a~ °~ o W rs~.o ,nom C7c`~~e0 ~i, ~ ~di, ~OG9 FEB -3 AW i I ~ 28 - CLERK C;F ORPHAI~I'S COURT nl ` .~ ,~ i •.1 IT'e .- C~ i i~ 1'.~ ! Ft I .~ .:..~ i:? 1~.. .,•a