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Home My WebLink About09-25-09BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE AND FILE TAXPAYER RESPONSE ACN DATE REY'1543 Ex AFP C08-08) NO. 21 -(~G - L{ ~J 09129187 05-14-2009 TYPE OF ACCOUNT EST. OF KENNETH MCMANN ~ SAVINGS SSN 191-46-0613 ® CHECKING DATE OF DEATH 05-01-2009 ~ TRUST COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: ~* MARIE MCMANN REGISTER OF WILLS ~,,, 928 BELLE VISTA DRIVE CUMBERLAND CO COURT HOU~ c~ ENOLA PA 17025 CARLISLE, PA 17013 ~-_~ .°r~ -- ~=. - cn c - ->in N r~ ,~ i _ MEMBERS 1ST FCU provided the Department with the information below, which has been used ~))k.alculat3F~j the~- potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/benefy!c~zry~~f thi~-accounf. If you feel the information is incorrect, please obtain written correction from the financial institution, attadi~opy to s forer~-.-= and return ii to the above address. This account is taxable in accordance wi:.h the Inheritance Tax laws of the~uwdbn:w alth~ ~ ,_ .ern sylvaniz. Pl~s_~ call (717) ?97-9327 -ith questicrs. .L ~ ~~~ COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS ~ Account No. 335308-1 1 Date 07- 24 -2008 To ensure proper credit to the account, two Established copies of this notice ^ust accompany Account Balance $ 38 7 01 payment to the Register of Wills. Make check . payable to "Register of Wills, Agent". Percent Taxable X 10 0. 00 NOTE: If tax payments are made within three Amount Subject to Tax ~` 387.01 months of the decedent's date of death, Tax Rate X .045 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential TaX Due $ 17.42 nine months after the date of death. PART TAXPAYER RESPONSE ~AILL'8E TD 'RcSP~ivi, WIL1, r~'cSuLT ' IN vii'i' uFfiIGIAL ~Ax HSSESS'P"li_hT 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 H E C K 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 return 0 N L Y to be filed by the estate representative. C. ~ The above information is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART u below. PART If indicating a different tax rate, please state relationship to decedent: - TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debt and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS PAD • i 2 $ 2 3 X 3 `' $ 4 - ~ S 6 $ 6 7 X ~ $ $ 8 O~FI'~IAL USE ONLY ~ AAF PA DEPARTMENT OF REVENUE PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and ,~Fomplete to the best f my k wledge and belief. H OME C / ~ ~Q ~~ WORK C ~ TAX AYER S URE TELEPHONE NUMBER DATE IOIAL (Enter on Line 5 of Tax Computation) S ~St vNwl l.~~i,~.r 11ri.~e .tilr•.hani..ln,re, I'.4 i~!~5~ ;noun ?n~-z izN MEMBERS I° Membership Application ___ Account Number 335308 Account Name Last First Middle Initial Suffix G SSN/EIN 202-20-3988 Mccann Marie Address Date of Birth Home Phone Number 09/22/25 717-732-1051 928 Belle Vista Dr City State Zip Code E-mail Address Enola PA 17025-1306 Employer Work Phone Number Exteension Cell Phone Number RETIRED Joint Owner Last First Middle Initial Suffix TH D SSN/EIN 191-46-0613 MCCANN KENNE Address Date of Birth 09/07/54 Home Phone Number 717-776-0198 14 FOX LANE City State Zip Code NEWVILLE PA 17241 E-mail Address wn3pit@kuhncom.net Employer Work Phone Number Extension 717-605-1113 Cell Phone Number 717-580-2768 NAVY Eligibility _ Cumberland County - Live ! I, Adams i_ Perry '_] York ! Lebanon Dauphin i l Cumberland I, _, Borough of Shippensburg ~_ *Employed ~ _I Lives I "'Worship _' *School *Volunteer 'Relative 'Name & City:_ _. *On the line above, please indicate the name and city of your employer, church, school, volunteer organization or name of relative. W-9 Certification of Tax a er Identification Number (Social Security Number) Certification -Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number, and Taxpayer Identification Verification By signing below, I certify, in accordance with the IRS W-9 instructions and under penalties of perjury, that the Social Security number (SSN) shown is my correct identification number and that I am NOT, unless designated below, subject to backup withholding because, I have not been notified that I am subject to backup withholding as a result of a failure to report all dividends or interest, or because the IRS has notified me that I am no longer subject to backup withholdings. 'Xl I am a U.S. Citizen or Resident L ~ I am not a U. S. Citizen or Resident (Complete W-8 Form) '' I am subject to backup withholding The Internal Revenue Service does not require your consent to any provisions of this document other than the certifications required to avoid backup withholding. ~tin1~- ~ q'-1 ~Cp.-~~` X 07/24/08 Primary Signature Date 'X I am a U.S. Citizen or Resident __ I am not a U. S. Citizen or Resident (Complete W-8 Form) I am subject to backup withholding The Internal Revenue Service does not require your consent to any provisions of this document other than the certifications required to avoid backup withholding. X ,,,,,~~~~_ 07/24/08 _ ___ Date Joint Owner Signature __ ___ _ _ I/We have read and agree to the Members 15 Debit Card, EZ Call and/or Members 15rOnline terms and conditions, and the Electronic Funds Transfer (EFT) disclosure statement. I/We agree that the information above is true and complete and authorize Members 15` FCU to obtain any information necessary to this application. I/We hereby make application for membership in the Members 151 FCU. I/We agree to conform to its bylaws and amendments thereof, copies of which have been made available to me, and to subscribe for at least one (1) share. Members 15' FCU is hereby authorized to recognize any of i the signatures subscribed hereto in the payment of funds or the transaction of any business for this account and all sub-account. I/We acknowledge receipt of the Membership Account Agreement which contains all relevant contractual obligations for this account and all sub- accounts. I/We also acknowledge receipt of the Regulation Disclosure Pamphlet. ~ L ' ~~~ ~~ "" '^ Military ID Card X ~ ' - ' Signature MARIE G MCCANN ID Type ID Number Issue Date Exp Date X y~.~Z,J~l~~-~ State Driver's Lic na15214909 07/10/06 09/08/10 Signature KENNETH D MCCANN ID Type ID Number Issue Date Exp Date ACCOUNT SERVICES Account Number __ X Regular Savings I, ~ Hap E Savers ~ 'Gen Hap ~ Savings X~Checking -- _ _ . verdraft Protection So ~, g g urce -- - X Re ular Savin s j ~~ Checking !, 'Money Mgmt ~ ,'Supplemental I PSL ~ _'' Key Loan Signature Account Number Money Management Holiday Club Maturity Post Code To Acct Transfer Type Vacation Club Maturity Post Code To Acct Transfer Type. Supplemental Savings i Certificate of Deposit Type Maturity Post Code To Acct Transfer Type_ ,IRA Savings ID ID TD ID ': IRA Certificate Type Maturity Post Code To Acct Transfer Type ID_ !X VISA Debit Card (checking account required) X Primary Member ~x~' Joint Owner ~' M Card (fee applicable) AT Primary Member ,__' Joint Owner '~X~ ATM_Accessability ~XI Savings ~X~ Checking(POS) _~ PSL ~ _~~~ Money Mgmt , _~ Key ~~_ ;Supplemental X'' EZ Cail PIIv' required **** X Members Ist Online PIN required Bill Payer ___ Electronic Statement E-mail Address VISA Credit Card - ~~ Loans 335308 Signature Date o~/24/os ~1 ~, :; ,~ ~, ;,; ~~ ~~ r:. ~, ;.'s` ±i ;,., _`~} a ;! a ~ "s i''1 ~? Q• '- C[F ti ~ N ~ ~ l a~ ~ `y O ~ Y O td m C O z 3 c: a~ ~ O Z U ~ ~ C L i-.~ ~ ~ ~ ~-~~ .; r1 .; ~~ ~~ .t ~~ ~v:~"~~ ~` . ~ 1 ~ ,~ ~ ~ ,^_`~r~ ~~`~~`- ~~~ i l ~S !ti ~~~ 73 fl,~ 1,~3 i~f i~ ~PF i') m3 t ~! 4'•.. .~.q ~~~e ~iacr.t'~A55 FOREVER