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HomeMy WebLinkAbout07-28-09COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SOLOMON MARTHA O 3812 LEYLAND DRIVE MECHANICSBURG, PA 17050-7634 REV-1162 EX111-96? NO. CD 01 1537 ACN ASSESSMENT AMOUNT CONTROL NUMBER fold ESTATE INFORMATION: SSN: 1s3-76-s7s8 FILE NUMBER: 2109-0697 DECEDENT NAME: ODONNELL VIRGINIA P DATE OF PAYMENT: 07/28/2009 POSTMARK DATE: 07/27/2009 COUNTY: CUMBERLAND DATE OF DEATH: 06/01 /2009 09143290 ~ 530.00 09143291 ~ $36.36 09143292 ~ 543.43 TOTAL AMOUNT PAID: REMARKS: SEAL CHECK# 3230 5109.79 INITIALS: AJW RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS PENNSYLVANIA INHERITANCE TAX BUREAU OF INDIVIDUAL TaxES I N F O R MA T I O N N O T I C E PO BOX 280601 A N D HARRISBURG PA 171zs-acol TAXPAYER R E S P O N S E REV-1543 Ex qFP (09-OB) FILE N0. 21 UC) ()~nC1`~ ACN 09143290 DATE 06-12-2009 EST. OF VIRGINIA P TYPE OF ACCOUNT ODONNELL SSN ® SAVINGS 193-16-6798 DATE OF DEATH ^ CHECKING o6-01-20~,~ COUNTY CUMBERLAND ~' ^ TRUST MARTHA 0 SOLOMON 3812 ~~ REMIT PAYMENT AND FORMS T0: '°_~ c.- `-~~ ^ CERTIF. LEYLAND DR MECHANICSBURG REGISTER OF WILLS ~~~~ ~` PA 17050-7634 CUMBERLAND CO COURT Hol1SE.~~m CARLISLE , PA 17013 ~' ,:~^„\ ~ r. ~; PSECU ~~ ~i potential tax due. Rec d provided the Depart ~ _~ ~ - r s indicate that at the death of the above-named decedent, If you feel the information is incorrect, ment with the information below, which has been used in calc~ ting the please obtain written correction from the financial institution, attach a co Pennsylvania. Please call (7iTl 787-8327 with ]oint owner/beneficiary of this account. and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonw COMPLETE PART 1 BELOW * questions. pv to this form SEE REVERSE SIDE FOR FILING earth of Account No. O1 9zt «~,, ., ,. AND PAYMRN'r ruc. r., ..___ -----~,..,.~o-J1 Date --•• ~..,,,icu~,I1UNS 09-29-1980 Established To ensure proper credit to the account, two Account Balance copies of this notice must accompany Percent Taxable $ 1 , 403.73 payment to the Register of Wills. Make check X payable to "Register of Wills, Agent". Amount Subject to Tax 50.000 TaX Rate $ 7U1 , $7 NOTE: If tax payments are made within three ~( months of the decedent's date of death, Potential Tax Due • 15 deduct a 5 percent discount on the tax due. PART $ 105.2$ Any Inheritance Tax due will become delinquent nine months after the date of death. TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX A• ~ The above information and tax due is correct. ASSESSMENT Remit payment to the Register of Wills with two copies of this notice to obtain C 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 b BLOCK v the PA Department of Revenue. 0 N L Y B' ~ The above asset has been or will be re orted and tax to be filed by the estate representative. paid with the Pennsylvania Inheritance Tax return C• ~7he above information is incorrllle---c~~~t and/or debts and deductions were Complete PART 2^ and/or PART ~, ~ below. U u paid. PART If indicating a different tax rate, relationship to decedent:-~ pre se state TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 2. Account Balance 2 3. Percent Taxable / ~C~ ~ 7~ 3 X ~ ~~ 4. Amount Subject to Tax 5. Debts and Deductions 5 $ , ~ / ~,~ 6. Amount Taxable $ ~~ 7. Tax Rate ~ X _~_ B • Tax Due ' ~' ~~ PART B $ ~ ~ `l ~ DATE PAID PAYEE OFFICIAL USE ONLY PA DEPARTMENT OF REVENU~EAAF PAD I 2 3 4 5 6 7 - i 8 DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION Under oenair;,... _ TOTAL (Enter on Line 5 of Tar r..M...,._~. AMOUNT PAID complete to the bestcoPVry' 1 declare that the facts I p -V" S my knowledge and belief. have re orted above are _ true, correct and HOME ( ~ ~ ~ ~~ ` XPAYER IGNAT R WORK ( ~ '~ --- ~ . _.. PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES A N D PO BOX 280601 HARRISBURG PA 171zB-g6B1 TAXPAY E R R E S P O N S E REV-1543 E% qFP (OB-09) FILE N0. 21 0~1 ~l~~j`1 ACN 09143291 DATE 06-12-2009 EST. OF VIRGINIA P ODONNELL SSN 193-16-6798 DATE OF DEATH 06-01-2009 COUNTY CUMBERLAND REMIT TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. MARTHA 0 SOLOMON PAYMENT AND FORMS T0: { ~.3 REGISTER OF WILLS `'-, 3812 LEYLAND DR :-~ C-~ MECHANICSBURG CUMBERLAND CO COURT HOU~~ ~~ PA 17050-7634 CARLISLE, PA 17013 ~ ~'= • ;: ~ ~~ .._ :_r c7 _- . (T~ ~"'- i ,_ _, t -- provided the Department with the information below, which has been used--3p~alculatyng'p the potential tax due. Records indicate that at the death of the above-named decedent, you were a Soint owner/beneficiary of thin account. If you feel the information is incorrect, please obtain written correction from the financial institution, attac ~' and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth dfl-. Pennsylvania. Please call (717) 787-8327 with questions. ~ copy to t~ form COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0193166798-S4 Date 03-10-1998 To ensure proper credit to the account, two EStablished copies of this notice must accompany Account Balance $ 1,7U1.02 payment to the Register of Wills. Make check Percent Taxable X payable to "Register of Wills, Agent". 50.000 Amount Subject to Tax $ NOTE: If tax payments are made within three 850.51 TaX Rate X months of the decedent's date of death, . 1 5 deduct a 5 percent discount on the tax due. Potential Tax Due $ Any Inheritance Tax due will become delinquent 127.58 PART nine months after the date of death. TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT A• ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain C 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. B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tar ro+,~.... 0 N L Y to be filed by the estate representative. C PART If inrlir~+;.... ^ _ - --'~_~_~~< < x rate ase state 2 relationship to decedent:_ f~il~i+l'F~ - TAX RETURN - COMPUTATION LINE 1. 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 PART 0 OF TAX ON JOINT/TRUST ACCOUNTS z- $ i,7 G pm ~ `7 3 X ~ .3-C' 4 $ c~.1YG? ....5- ! 5 - ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3LJ below. OFFICIAL USE ONLY Lj`AAF` PA DEPARTMENT OF REVENUE PAD 1 2 3 4 5 6 7 8 DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION TOTAL CEnter on Line 5 of Tax Computation) Under penalties of $ perjury, I declare that the facts I have reported above are true, correct and complete to the best o my knowledge and belief. HOME C~/~ ~ 73oZ-vZoZt~CY TAXPAYER SIGNATURE WORK ( ~ ~_~ _„~ DATE PAID PAYEE PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU DF INDIVIDUAL TAXES AN D Po Box zsocBl FILE HARRISBURG PA 171za-o6ol TAXPAY E R R E S P O N S E ACN REV-1543 EX AFP (DB-OB) DAT E N0. 21 ~; ~ C l~ ~i '~ 09143292 06-12-2009 EST. OF VIRGINIA P ODONNELL SSN 193-16-6798 DATE OF DEATH 06-01-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: MARTHA 0 SOLOMON TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. 3812 LEYLAND DR REGISTER OF WILLS ~-~ :~ CUMBERLAND CO COURT H `"- MECHANICSBURG PA 17050-7634 j ~o CARLISLE, PA 17013 r-~ ~.) c_ ~Y._ ,-_ -_ i.7__. ~.-, r- - 1 ~ - _.. PSECU _ provided the Department with the information below, which has been use B-"3nl~calcuT~#ing the potential tax due. Records indicate that at the death of the above-named decedent, J ' If you feel the information is incorrect, please obtain written correction from the financialainstitutionr,/aenef..i.¢iary of . and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of t~e Commonweal ofaceount:t Pennsylvania. Please tali C717i 787-8327 wiih t~ichja copy to~this fgrm-- t.~ o COMPLETE PART 1 BELOW * SEE4REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0193166798-S7 Date 07-12-2006 Established To ensure proper credit to the account, two copies of this notice must accompany Account Balance $ 21 , 949.31 Payment to the Register of Wills. Make check Percent Taxable X payable to "Register of Wills, Agent". 50.000 Amount Subject to Tax ~` 10, 974.66 NOTE: If tax payments are made within three Tax Rate X months of the decedent's date of death, . 1 5 deduct a 5 percent discount on the tax due. Potential Tax Due $ 1,646.20 Any Inheritance Tax due will become delinquent PART nine months after the date of death. TAXPAYER RESPONSE FAILURE TO F2ESP~ND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT" A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain C 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. B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax rar~~~„ 0 N L Y to be filed by the estate representative. C PART If indicating a different relationshi t taxy~ rate, please state p o decede nt:_ /~~ ~^1, ~-.~r, TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1 . Date Established 1_ ~_ ~ Z ., ~QQ ~ 2. Account Balance 2- $ ~ ~ lf,.~ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 $ % (J ~~ -j ~~ (~, ~` d 5. Debts and Deductions 5 - 6. Amount Taxable $ ~ I 7. Tax Rate T X " ~`~-may 8. Tax Due 8_ $ ~~ ,7 rHRI DATE PAID PAYEE ,. y. - t7 _`t-U - ~- d OFFICIAL U5E ONLY ~ AAF PA DEPARTMENT DF REVENUE PAD 1 2 3 4 5 6 7 8 DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION .J AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) ~ Under S t. ~ -=t% penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best f my knowledge and belief. HOME C /7 ~ ~.3~ -ad k'br X AYER SIGNATURE WORK C ~ .~..~Ja-nos V~The above information is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3L1 below. -~. _ _ - n ~1rs. Marsha O. Solomon - 3812 Leyland Drive _ - Mechanicsburg, PA 17050 For the Service of V irginia P. O'Donnell We sincerely appreciate the confidence you have placed in us and will continue to assist ~e ~ a :. ~:~. ~.. ~~ we can. Please feel free to contact us if you have any questions in regard to this stateaiea;. T;.~ _c~i'~o~.~.':a; is an itemized statement of the services, facilities, automotive equipment and merchandise t hz: ~~c.; ~e.~.ct.~ when making the funeral arrangements. ~ Terms ~ Due Date Account n Net 30 ~ 7!3!2009 2009041.0 ____ Description A mount '.SERVICES & MERCHANDISE » Traditional Funeral Service ~.7~0.00 20 Gause Steel Burgundy/Silver Casket 1,999.00 Reflections Stationery Set 135.00 Total Services and Merchandise ~ 7.88.1.00 i CASH ADVANCE ITEMS ~ Death Notice, Harrisburg Patriot ' 2-12.87 10 Certified Copies of Death Certificate 60.00 Hairdresser 40.00 Clergy Honorarium 175.00 Organist Honorarium 125.00 Soloist Honorarium 75.00 Altar Servers 15.00 Flowers, Casket Spray ~ 200.00 fff, Grave Opening ! 900.00 I Total Cash Advances { 1,832.87 i Immediate Pay Discount -Thank you! -117.68 '~ ~ ~~ UW \~ \ ! .~ ~ r. ;+ ^~ Total Sy.559.19 Payments/Credits ~t~.o~~ 5 ;`~~;~ ~' } - ~' Ba{ance Due ~~ -= l ?~osptce oz ~en~ra~ ?enasylvan~a Invoice 1320 L•i~giestown load Harris~urg, ?P. i711C Invoice Number 33C9 Voice: ;,-,_-; Invoice Date 32-1000 Fay:: ?1;-234-0375 `~ b/30/x9 _---~~- • ~... ~ Pale. .~. ~; i:..; i . - x -..~_.__. ____ __. 1 Resident: ,;- ;~ ~ {' ¢s _~ ; f_~~;~;~~; rfi virginia P. O' Donne' ± _R- r vl~`.~r,: /a var~ha Solomon ~~{ ""• .,r`~ 3812 Leyland Drive N_echanicsnurg, 3F1 17050 Resident ID: o ` Dor_r_e_1V ' Payment Terms Due Uate i Net ' ~ Days ' 71;5/09 ,_- - ~ Description Amount :es?den`ia Care - ~ur_e 1, 2CC9 I 34G.Ov i I ~ 1 ~ ~ ~ ~ ~,ryt.. ... . '.. .. ..yz ~ i Please note our new office address -- 1320 Linglestown Road, Harrisburg PA 17110 Total Invoice Amount Checl:lCredit Memo No: Payment/Credit Applied TOTAL Thank you for choosing Hospice of Central ~'ennsylvania. 39C.CC 3A0_CC CGS,, CUMBERLAND COUNT'S ''` .AGING & COM1VItJNITY SERVICES '~ 16 West' HIGH S'I'RIiLl', Stlrrc 100 Cnttt.tsLE, P~~ 17013 ~ ~ (717) 240-6110 Ott i-888-697-0371 L-'x1' 6110 Ra ®`~bMll~itt'`' ~ ~ t~ HAx: (717) 240-6118 Orte Team ...One Mirrian Gary Eichetberger CAainnan Richard L. Rovegno Vice CGainxan INVOICE FOR SERVICES Barbara B. Cross Secretary Terry L Baricy Director Virginia P O'Donnell 3812 Leyland Dr c Mechanicsburg, PA 17050- t ~~ ~~ ~~~ ~ Invoice Number: April-09-O'Donnell Invoice Date: dune ?, 2009 SERVICE PROVIDED: ADC-Full Day MONTH OF SERVICE: April, 2009. ACTUAL COST PER Futl Day (-~ 42.45 YOUR REDUCED SLIDING FEE SCALE RATE PER Ful! Day ~~ 2.97 TOTAL Ful! Day(s) OF SERVICE YOU RECEIVED ~-- 14.00 PLEASE PAY THIS AMOUNT [~ 41.58 Payment Due Upon Receipt of Invoice. Payment Is Delinquent if not paid by 3une 29, 2009. Contact CCOA if any issues. Make Checks Payable To: CUMBERLAND COUNTY OFFICE c~F e~tu~ INVOICE FOR SERVICES -FILE COPY Virginia P O`Donnell 3812 Leyland Dr Mechanicsburg PA 17050- Invoice Number: May-09-O'Donnell Invoice Date: July 2, 2009 SERVICE PROVIDED: ADC-Full Day MONTH OF SERVICE: May, 2009 $ PAID ACTUAL COST PER Fuil Day 42.45 YOUR REDUCED SLIDING FEE SCALE RATE PER Full Day ~~ 2.97 TOTAL Full Day(s) OF SERVICE YOU RECEIVED ~ 6,00 PLEASE PAY THIS AMOUNT [- 17.82 Payment Is Delinquent if nat paid by July 27, 2009. Contact CCOA if any issues. DATE PAID AMOUNT PAID CHECK NUMBER BALANCE DUE DEPOSIT DATE © ~ 2- 32~ r- ~~ I EMAIL US AT aging@ccpa.net OR VISIT OUR WEBSITE AT www.ccpa.net f aging ~~-, .7 ~~ ~ ~ ~ ~ ~ -~ .--~ ~~~ /~ .~ ~ ~ j S C'L +~ /I ~~K ~ ~, _,S ~~ ~ ~~ ~ ~~ _~_----= `~~~ ~ ;ru ,. ~~~~ ~~~ ,t eX~ ""r .~ ~ ,; ~~ a ~ E~ f ~ ' ?~ s ~` x'I~ t -~, ~ uL. `~' x. i. W ~ ~:: t ice- ,~ N Q n '"e ... _ .i ^ Ns0 r ,. s Vii ~r~ . ii ~ _ _ 'R y o W $~ ~ T `k g' cv~,~~ I `~ n'" 'tif. r i C S ; ~,, a ~ LPL .. ~r il~~ '6` '~ r-~ ~ ~ `e'll) f ~~~ 4:.:.~ + ~t _ w (~ v~y t ~ ~ _ p n- .. } .~. c$ ~ ~~ err': ' ~ • P i i ~ ':3 ~~ x ~~ ;.* ,. 7 ~s-,- i ~ ~ 1~ -' .. 'fit F' ~~ -_ ~~ _ %.{ 1 ~~ ~ 4 ~ ~~ ~ ~ I:. ~ ~ ,. ~ ~ f ~'~ ~ ~~ ~y ~ ~: ~. ~.. .. ~ ' ~ ~~ ~ ~~ ~z4r _ '.N.n~ ~ a`ih ~ _ ~ J_ 1 ~ , "r - r 3 c .L :t