HomeMy WebLinkAbout03-09-09~DM~IOHWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601 ~~~~.~ , ~ ~.
HARRISBURG, PA 17128-0601 ., _, __,_ ~,;; -I~.,
~ ~ R6ii'lsp? Efi NPV <a4; bd.
Date 06-01-1999
Established
209 ~~Af~ -9 f'~? f2.~ 39
C! L~K {
ORP~~~Pv'S ~~t~URT
GAIL L HOLLENBACH
516 N 3RD ST
SUNBURY PA 17801
TYPE OF ACCOUNT
EST. OF ALICE H THOMAS ^ SAVINGS
S.S. N0. 200-24-7566 ® CHECKING
DATE OF DEATH 07'-25-2008 ^ TRUST
COUNTY CUMBERLAND ^ CERTIF.
REMIT PAYMENT AND FDRMS T0:
REGISTER OF WILLS
CUMBERLAND CO COURT H OUSE
CARLISLE, PA 17013
SUSQUEHANNA 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 1`inancial 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) 787-8b27.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 29449706
Account Balance
INFORMATION NOTICE'
AND
~'` TAXPAYER RESPONSE
FILE N0. 21'(,~-v(~~b
ACN 08144039
DATE 09-25-2008
1,514.29
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".
C. ® The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART 2^ and/or PART 3^ below.
PART If you indicate a different t x rate, please state your '
relationship to decedent:~~A ~
~;
TAX RETURN - COMPUTATION OF TAX (?N JOINT/TRUST ACCOUNTS D ....
LINE I. Date Established 1
2. Account Balance
3. Percent Taxable
4. Amount Subjeet to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
PART
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
1 U1C ~ ~ erc~ t=' U" f' .3 ~1~~G~D
a~ r ~ Ucct/~" P I oo, ~~o
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e e ~ e ~ -~'v-vie rcS~ ~ ~ U ~.E' :' .~ , d . Oct
TDTAL LEnter On Line 5 Of TaX GOmputatlOn) S `t / YO ,(00
Under penalties of perjury, I declare that the facts I have reported above~anre truer, correct and
complete to the best`` of my knowledge and belief. HOME C'~1U ) ZO~u c~~~Q
~~~ ~_~a-~C~,~,~ WORK C ) ~ CD ~ U
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
r ~ 1; L JG 1'~ 1'i "1' 1'.' 1J
1' U 1V L' l~.li L 1J 1 1S..L' li 1 V 1~ D V 1' li 1V1 L' 1S 1 li E!y 1 1V li.
P.O. Fwx 19244 ~, ' ' ' °'-~cT
February 11 . ?009 ~ ~'~ o, a
Springfield, ZClittois 62794-9244 ~ !- , ~ N
(217) 525-1712 ~`"u~~.I-~~L' ~
~~~.
Alice H Thomas 1, 550.00 FAX (217) 525-2104 .•°~~<•~P °
i1ML" V/
~STA B LAS
538111 3116
Gail L Hollenbach
_516 N 3rd St
SunburS' PA 17801
one purpose or tnJS >2erter is rwo-rota. rust, > ~4'Ollla JIKe to
ackno~~~ledge the payment of $ 250.00 made to the funeral home on
1/ 12/2009. The current balance of your account stands at $ 1, 550.00 .
Second, I request your estimate of when payment in full may be
expected for these services . If payment in full is possible at this
time, please use the enclosed business reply envelope to return the
balance. If payment in full is not possible at this time,. I request.
that you contact me upon receipt of this letter so that ewe may discuss
alter. riate payment arrangements .
I appreciate your prompt attention to this matter .
Our toll free number is 1-888-658-3332.
The undersigned is a debt collector.
Sincerely,
ORIGINAL 3116 = .~ ACCT. NO.
i
- .,.~.,
.~~
LAST BALANCE ~ 3, ~~,~_ G,,a
jINTEREST
n SATE YMENT
~ S'ctl9flS'aE
~~
~X
Funerai Services A~~~ t` `~f
yy Name o; Deceased
CHECK # ~ O~ _
CREDIT ~ !~ ~ weier
" CARD Z F[,:ti~RaI. I30~IE, L~iC.
OTHER
J
~y: /
N/l ~OG~
SUB TOTAL
CREDITS
LESS PAYMENT ~y ~ ~~
NEW BALANCE g a~ OAt9,up
~ n n w w
yvu racier ~lreel
~u-vcsur~ r, rr1 - /tsu
(UIUJ LtSt~-I /41
YV1V~+'1{~L+"1' 1V~1V Vlt, l~~lV1L`l'l+~~t,Y
Duly ~y, auurl
wwnt ~,nc~,n,a rr~rrat~~c i ~ rvw~rnc ~ winrvvn .civic i cn r
lceceivea on account per grave opening
of Alice H. Thomas: check from Gai:1 Hollenbach
Ior ~'~'OO.OU. rasa 1n IUll.
5amuei ~. uerr
aupi. , rnc.;
~~~ ~
avu racier ~ueei
~ulvtsunr, rri 1 Irsu 1
~5I u~ ~tso-1 I ~+ -
YV1V~1+'ttL+"1' lV1AlV Vt~, l~L1V1~`l'L~{,Y
//Lb/UtS
MAKE CHECKS PAYABLE TO POMFRET MANOR CEMETERY
Received on account: $1~5.GO per-$45.00 i~Q~:$~~~_~
& $150.00 Perpetual Care
Ior Hlice n. •1•nomas
ny cnec,~c Irom ua~l rlo.~ien.r~acn
PAID IN FULL
Samuel ~. lierr
~Upc. , Ylrll.
F~