HomeMy WebLinkAbout03-12-09 (2)PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE p
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BUREAU OF INDIVIDUAL TAXES + + + „
Po Box zao6ol + -r; ~_ ,T~4XPAYER RESPONSE ACN 09101347
HARRISBURG PA 17128-0601 ,..~ L-ii _, ~ ~ - DATE 01-13-2009
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REY-1543 EX AFP (OB-OBl
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CLE~?~C C
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 Drovided 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 Soint 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. Please call (717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 210429-00 Date 10-19-2001 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance
$ 37$
96 payment to the Register of Wills. Make check
"
. payable to
Register of Wills, Agent".
Percent Taxable X 50.000
Amount Subject to Tax
$ 1 8 9
4 8 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.
Potential Tax Due
$ 2 2.7 4 Any Inheritance Tax due will become delinquent
nine months after the date of death.
P
T TAXPAYER RESPONSE
~
1
A. ~ The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
CHECK a discount or avoid interest, or check box "A" and return this notice to the Register of
C 0 N E ~ Wills and an official assessment will be issued by the PA Department of Revenue.
B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
0 N L Y to be filed by the estate representative.
C. ~he above informs ion is incorrect and/or debts and deductions were paid.
omplete PART 2~ and/or PART 3^ below.
PART If indicating a different tax rate, please state
relationship to decedent: StST~,I~
TAX RETURN - COMPUTATION
LINE 1. irate Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
l 181t~ ~a.tl0 1
3 X S o
4 $ ~ $ 9.y~
s - O _ -, at-i . a-t
6 $
7 X
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to t[h~e best/,of my knowledge and belief. HOME ~~~ ) ~f3o,~,-3aaQ /~
~i~.-«~~ , %/~~°ncl~.Qo~~~ WORK C ) /
fXPAYER SIGNATURE TELEPHONE NUMBER DATE
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
S~eill 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 --
+ . V
Initial Selection Final Selection Difference
Merchandise
Hartfield Poplar Casket -Full Couch $2,395.00 $2,395.00 ---
Total Merchandise $2,395.00 $2,395.00 ---
Cash Advance
Clergy! Religious Facility $125.00 --- -($125.00)
Certified Copies $48.00 $48.00 ---
Newspaper Notice $200.00 $106.37 -($93.63)
Total Cash Advance $373.00 $154.37 -($218.63)
Total Services, Merchandise and Cash Advance $8,942.90 $8,724.27 -($218.63)
Total Charges (Total Services +/-Allowances + Taxes) $8,942.90 $8,724.27 -($218.63)
Less Cash Received ($8,942.90) ($8,942.90)
Unpa(d Balance Due $0.00 ($218.63)
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