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Home My WebLink About07-16-09COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 01 1497 MURRAY MARSHA SIMPSON 855 ORRS BRIDGE ROAD MECHANICSBURG, PA 17050 ACN ASSESSMENT AMOUNT CONTROL NUMBER fold ESTATE INFORMATION: ss-v: i 88-22-7695 FILE NUMBER: 2109-0656 DECEDENT NAME: SIMPSON JACQUELYN DATE OF PAYMENT: 07/ 16/2009 POSTMARK DATE: 07/15/2009 COUNTY: CUMBERLAND DATE OF DEATH: 06/27/2009 REMARKS: RECEIPT TO ATTY SEAL CHECK#1120 09142495 ~ 512.99 09142494 ~ 512.99 TOTAL AMOUNT PAID: 525.98 INITIALS: CJ RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER dF WILLS BUREAU OF INDIVIDUAL TAXES PD BOX 260601 ~ ~. HARRISBURG PA 17128-0601 .. REV-3543 IX AFP PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE AND FILE N0. 21'U~-O{s+5(a ~" '~`• ~ /kY,ER RESPONSE ACN 09142495 .... ~~ .. DATE 06-12-2009 ~::;, ~~~ ~~~ ~ ~ ~~ ~ ~: z~ST. OF JACQUELYN SIMPSON SSN 188-22-7695 ~~~~~{~,~ DATE OF DEATH 06-27-2009 (~~P~?-~'~ ~+S COURT COUNTY CUMBERLAND CU~,1°"_ r, ,, 1 !'~~ f1/, REMIT PAYMENT AND FORMS T0: - v,.+ ~... f-t! FRANK MURRAY REGISTER OF WILLS 855 ORRS BRIDGE ROAD CUMBERLAND CO COURT HOUSE MECHANICSBURG PA 17050-2137 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 Fang Sylvania. Please call (717) 787-8327 with questions. COMPLETE PART I BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 172645-00 Date 12-15-1997 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 1 , 731. $1 Dayment to the Register of Wills. Make check " Day able to Register of Wills, Agent". Percent Taxable X 16.667 Amount Subject to Tax $ 288.64 NOTE: If tax payments are made within three months of the decedent's date of death, Tax Rate X . 045 deduct a 5 percent discount on the tax due. Potential TaX Due ~ 12.99 Any Inheritance Tax due will become delinquent nine months after the date of death. P T TAXPAYER RESPONSE ~ 1 , ~ ~`,, L &~R~ULT IH 0 ~~(~IAL TAX A~fi~SNENT" J A. ~ The above information and tax due is correct. j 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 0 N E [ Wills and an official assessment will be issued by the PA Department of Revenue. BLOCK 0 N L Y B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PAR7 2~ and/or PART n below. PART If indicating a different tax rate, please state relationship to decedent: __ TAX RETURN - COMPUTATION LINE I. Date 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 ~.pAB 1 2 3 X 4 +~ 5 ' 6 +fi 7 X 8 PART a DEBTS AND DEDUCTIONS CLAIMED OFFICIAL U5£ ONLY ~ AAP PA DEPARTMENT OF REVENUE 1 2 3 4 fi b 8 DATE PAID PAYEE DESCRIPTION eMniiur owrn Hoer penalti of ,per ury> I declare that the facts I have reported above are true, correct and plete to h st y knowledge and belief. HOME C WORK C ~ AXPAYER SIGNATU E TELEPHONE NUMBER DATE PENNSYLVANIA INHERITANCE TAX '~ INFORMATION NOTICE If~~ L, BUREAU OF INDIVIDUAL TAXES .. ..,;_ AND FILE NO. 21 '" V~ ~~ `~~ PD aox zao6ol ,-~ T ~~i4X~''~tiYER RESPONSE ACN 09142494 HARRISBURG PA 17128-0601 '''"_' ~~ DATE 06-12-2009 REV-1543 EX AFP (08-b8L ~~ `~"~" `~" ~~ TYPE OF ACCOUNT ~~~g `~~`' `5 ~~~ „~ ~ EST. OF JACQUELYN SIMPSON ® SAVINGS SSN 188-22-7695 ^ cHECKINc (~,~~~~ ~F DATE OF DEATH 06-27-2009 ^ TRUST 4RF~iA.~'S ~;C'URT COUNTY CUMBERLAND ^ CERTIF. ~l~p; . ~ , _,'`~.J ~-~ . ~ REMIT PAYMENT AND FORMS T0: MARSHA MURRAY REGISTER OF WILLS 855 ORRS BRIDGE ROAD CUMBERLAND CO COURT HOUSE MECHANICSBURG PA 17050-2137 CARLISLE, PA 17013 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. Please tali (717) 787-8327 with quastions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 172645-0 0 Date 12-15-1997 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance 1 , 731.81 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax $ 288.64 months of the decedent's date of death, TaX Rate )( . 045 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential T2X Due $ 12 • 99 nine months after the date of death. PART TAXPAYER RESPONSE T1 .1 i I?xS1t(T T AN II ~ ICIAL tAX AF55t4ENT CHECK ONE BLOCK ONLY above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. 8. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the estate representative. C. ^ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART ~ below. PART If indicating a different tax rate, please state ~FFIGIAL US£ ONLY ^ AAF relationship to decedent: PA DEPARTMENT OF R£V£N4S£ TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD x .r. _ .. _~ __._ . LINE 1. Date Established 1 1 2. Account Balance 2 $ 2 3. Percent Taxable 3 X 'S 4. Amount Subject to Tax 4 $ 4 5. Debts and Deductions 5 S 6, Amount Taxable 6 $ I 6 7. Tax Rate 7 X ~ 7 8. Tax Due 8 $ ~ $ PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) 8 / Unde penalties o p 7 ry,, I declare that the facts I have reported above are true, correct and ``yir~ete to t e t o /know/~ledge and belief. \\ ~L~C./2=~ WORK C ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE ~. M ~.. ,;~ ,, ~~ j~ ,~ ~ 33 n° Saa ~ ~~ a ~.A ~ N ~~~~ :,~ ~ '~ ,...~ ._ ZflO~ ~ 5 ~~ ~ ~ ~ ~~ CLERK ~F 0 AC`S "CURT 0 ~~ .:., i7't iii jii ..~:. }+i .,.:+ ~~~ .,..~ J