HomeMy WebLinkAbout03-12-09PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU of INDIVIDUAL TAXES AND FILE N0. 21-09-,('X38
Po Box 2ao6o1 ~,~(~` ~~~~`~~`~~`+ ~'AXPAYER RESPONSE ACN 09101348
HARRISBURG PA 17128-0601 ash
l{~ DATE 01-13-2009
REV 1543 ~7{~A~ ~ ley ~~~ ~ i„ 4:„ `
ZOQ9 BAR 12 PM f2~ 25
~L~~~ ~..i~~ A
per ~;~N"~ `~ )~~
"~ ~~
CUP~.'~ ~ . L ., .
LOUISE NICHOLSON
39 LEE ANN COURT
ENOLA PA 17025
EST. OF JAMES BASHAM
SSN 226-28-4226
DATE OF DEATH 12-22-2008
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
MEMBERS 1ST FCU provided the Department with the information below, which has been used in calculating the
potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account.
If you feel the information is incorrect, please 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 accordance with the Inheritance Tax laws of the Commonwealth of
Pennsylvania. Piease coil i7I7i 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account Na. 21 0429-1 1 Date LO-31 -2001 To ensure vroper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 1 , 753. 86 payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 50. 000
Amount S
ubject to TaX
$ 8 7 6 . 9 3 NOTE: If tax payments are made within three
months of the decedent's date of death,
Tax Rate X . 12 deduct a 5 percent discount on the tax due.
C. The above informs ion is incorrect and/or debts and deductions were Daid.
JJJJ~~~~Complete PART 2~ and/or PART 3~ below.
PART If indicating a different to rate, lease state
relationship to decedent: ~~ IST~-~
TAX RETURN - COMPUTATION OF INT/TRUST ACCOUNTS ~~ l~r `~~ ~~~r':'~, s'ya'i~.~~4'~5~ ~ ~~'
TAX ON J
~wW-•~ri..
~.._
--~a~
LINE
1.
Date Established
1 ~
_
~ y
.
y (y `~i ~>~IE w o
t~„ ~,L '.Od ~ ~
2. Account Balance 2 $ ~ '1S 3 . ~~.+
3. Percent Taxable 3 X
4.
Amount Subject to Tax
4
$ f
s
S~y•
5. Debts and Deductions 5 r
1
R. Ia y, a,
6. Amount Taxable 6 $
7. Tax Rate 7 X
8. Tax Due 8 $ [~ ,
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
S
unaer penalties of perjury, I declare that the facts I have reported above are true, correct and
complete toy ~t~h~eJbest of;~,,my knowledge and belief. HOME C~~1 ) ~3~• 3a•~-~
/1~' ~~D~~~ WORK C )
T XPAYER SIG ATURE TELEPHONE NUMBER DATE
Neill Funeral Home, Inc.
3401 Market Street
Camp Hill, PA 170114428
(717)737-8726
Supervisor: Kevin J. Shillabeer
The following is a detailed bill for the professional services and/or merchandise arranged for
James H Basham
Date of Service :December 27, 2008
Statement Recipient : Louise P Nicholson Statement Date January 14, 2009
39 Lee Ann Court Contract Number : 741101000075
Enola, PA 17025 Arranger Name : Kevin J Shillabeer
Initial Selection Final Selection Difference
Funeral Director and Staff Services
Basic Professional Service Fee
Total Funeral Director and Staff Services
Care and Preparation of Remains
Embalming
Dressing and Casketing of Deceased
Total Care and Preparation of Remains
Use of Facilities and Related Services
Chapel Funeral Ceremony
Total Use of Facilities and Related Services
Transportation
Transferring Remains to Funeral Home
Funeral Vehicle/Hearse
Service Vehicle
Total Transportation
Other Goods and Services
Memorial Booklet
Service Folders
Flowers
Total Other Goods and Services
$2,680.00 $2,680.00 ---
$2,680.00 $2,680.00 -
$795.00 $795.00 ---
$395.00 $395.00 ---
$1,190.00 $1,190.00 --
$495.00 $495.00 ---
$495.00 $495.00 --
$495.00 $495.00 ---
$395.00 $395.00 ---
$395.00 $395.00 ---
$1,285.00 $1,285.00
$25.00 $25.00 ---
$60.00 $60.00 ---
$439.90 $439.90 ---
$524.90 $524.90 --
Initial Selection
Merchandise
Hartfield Poplar Casket -Full Couch $2,395.00
Total Merchandise $2,395.00
Cash Advance
Clergy /Religious Facility $125.00
Certified Copies $48.00
Newspaper Notice $200.00
Total Cash Advance $373.00
Total Services, Merchandise and Cash Advance $8,942.90
Total Charges (Total Services +/-Allowances + Taxes) $8,942.90
Less Cash Received ($8,942.90)
Unpaid Balance Due $0.00
Final Selection Difference
$2,395.00 ---
$2,395.00 ---
--- -($125.00)
$48.00 ---
$106.37 -($93.63)
$154.37 -($218.63)
$8,724.27 -($218.63)
$8,724.27 -($218.63)
($8,942.90)
($218.63)
Page 2 of 2