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Home My WebLink About09-10-09REV-1162 EX(11-96) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NQ. CD 009910 DUPLICATE COOPER KAY L 220 ST JOHNS DRIVE CAMP HILL, PA 17011 -------- ~o~a ESTATE INFORMATION: sSN: 174-20-s4i2 FILE NUMBER: 2107-0761 DECEDENT NAME: COOPER KARL W DATE OF PAYMENT: 06/ 20/ 2008 POSTMARK DATE: 06/20/2008 COUNTY: CUMBERLAND DATE OF DEATH: 04/ 1 5/2007 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 ~ 52,609.73 TOTAL AMOUNT PAID: REMARKS: RECPT TO ATTY 52,609.73 CHECK# 5140 INITIALS: MAW SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER CDMMDNIJEAI,TN Df PENNS~'IVANIA DEPARTMENT OF REVENUE BUREAU OF INDIV10UAl TA%ES DEPT, xeosol HARRISBURG, PA 17128.0601 INFORMA AIND NO'~ICE _ ~;TA~P~~IER RESPONSE t ... r .. Rev-ISOp Ot ~ CA,~'e~t -~ } FILE N0. 21 07-0761 ACN 08137219 DATE 08-22-2008 Z~Q9 SEP I O Pt~i CE~ OF KARL W COOPER S.S, N0 174-20-6412. CLERK ~~- DATE OF~DEATH 04-15-2007 ORPH.'~~~~'~ vin JRT~COVNTY CUMBERLAND TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. ''~' ,"I!`' ^'`~ p REMIT PAYMENT AND FORMS 70: *s KARL E~COOPER REGISTER OF WILLS 16 LACOSTA AVE SM29 M14 CUMBERLAND CO COURT 'HOUSE CANCUN~OR00 77508 CARLISLE, PA 17013 MEXICO oC.99999 INTEGRITY HANK has provided the Devercrent with the inforoation listed below which hob boon used in calculating the eotentiel tax duo. Thoir records indicate that at tho death of tho above 09cedent, You veto a Joint owner/bonoficiarl~ of tnis account. If You feel this inforoation ib incorroct. please obtain written correction f~oo the flnancisl institution, attach a oooY to thls fors and return it to the above oddness. This eeceunt is taxable in accordance with the Inheritance Tea Laws of the Cearonwoalth of vennsylvenia. Ouestivns aeY be answered by calling (717) 797.8527. COMPLETE PART 1 BELOW ~ * '* SEE REVERSE SIDE FOR FILING AND PAYMENT .INSTRUCTIONS Acoount No. 1005833 Oats 05.25-2006 To insure proper credit to your account, two Established C2) eoDies of this notice suet aceoopsw vour pay.ont to the R.elster of Wi119. Matra check Account Galante 53 r 296.94 payable toe "Register of Wills. Agent". Percent Taxable X 100'0 NOTEI If !ax peY•ants ere aadv within ehroo Amount SubJect to TeX 53296.94 C3I ronths of cne decedent's date of desth, you aey deduct a SX discount of the tax duo. Tax Rete X •. 0 4 5 Any ;nheritanco tax due vi11 becore del3nquont Potential TaX Oue . 2 ~ 398.36 vino C9) aonths~ after tho dote of death. PART ~,,~,~7 TAXPAYER RESP~O~}NSE ~'4~+'!d[.i , M~~. ~ v _. _. ... ... ~t . ,. ...L +.' Y~`h A A: .,fin,, 4 ~ i ~ A. ~~ The above 9nforoatlon and taY due is Correct. 1 aedlscountoer avoid intareeystenor4youneav checkrDex MA11andireturn this neticohto tneiReolstortofn CHECK Wills and en official essesssent will be issued by the PA Dvoarteent of Revenue. ONE C $ L 0 C K 9. ~ The above asset has been or will be revortetl and tax paid with the Pvnnsylvenia Inheritance Tax return 0 N L Y !o be filed Dy tho decedent's representative. C. ~ Tho aDeve inforoation is incorrect and/or debts and 'deductions were oald Dy vvu. you rust co^vlete PART 2~ and/or, PART ® below. ;~ PART If you indicate a different tax rate, Dlsaso state your ''~~Y~' ~f:+; ralationshio to deordentr _ TAX RETURN - COMPUTATION LINE 1. Oats Established 2. Account Balance 3. Percent 7sxeble 4. Amount Sub~ect to Tax 5- Debts and Deductions 6, Awtount Taxable 7. Tax Rate C ~ 9. Tsx Due PART DATE PAib OF TAX ON JOINT/TRUST ACCOUNTS :~ L .~-9 6.4~s' ~~ °` 2 k 3 0 ~"~ *~ G o~ 8 {e • '~ ' ~I a. i~ 5 - L - O G _- h' ~~~-~ 6 + Y ~N ~ ~...~ ~ Axe 7 ~ k ~~ ~ ~~ 9 ~ ~~t~:~ ,:a DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on pine 5 of;7sx Computation) 3 Under Denalties of perjury, I declare that the facts I have rooorted above are true, oorract and ~, l complete to tF~e best/~g.f/~~ knowledee ana,/b,~l~ie.f~.HOME C ~ /'V _ .. , _....t./w"~~( S G~, ~Z- __ - I es WORK_`C~/7•,) ~~/1 -3?v/ ..u...-., ~,~ ~ni ,~ inns ~i_ •a,n Rev-548 EX (12-03) INHERITANCE TAX JC~~NTf SANK ACCOUNT ADVANCE PAYMENT WORKSHEET COUNTY FILE NUMBER INHERITANCE TAX RECEIPT NUMBER ~ DECEDENT'S NAME (LAST) ~ I COOPER, Karl W. !I DECEDENT ~ DECEDENT'S SOCIAL SECURITY NUMBER ~i '174-20-6412 INFORMATION , triKS i ~ DATE OF DEATH 4/15/2007 ZIP ADDRESS OF DECEDENT CITY STATE 220 St. Johns Drive Cam Hill PA 17011 i NAME OF FINANCIAL INSTITUTION i FINANCIAL ~ r Integrity Bank CITY STATE ZIP ADDRESS INSTITUTION 3345 Market Street Camp Hill PA 17011 i INFORMATION TELEPHONE NUMBER ( 717 )924-4900 TYPE OF ACCOUNT ^ SAVINGS ^ CHECKING ^ TRUST ®CERTIFICATE OF DEPOSIT ^ OTHER ACCOUNT ACCOUNT BALANCE (INCLUDE INTEREST TO DATE OF DEATH) ACCOUNT NUMBER INFORMATION 56,296.94 1005833 ACCOUNT TITLE AS APPEARS ON SIGNATURE CARD OR CD ORIGINAL DA TE ESTABLISHED Karl E. Coo er• Karl Coo er 5/25/2006 NAME (Last) (First) (Middle Initial) ~ • . • Coo er, Karl E. PERCENT TAXABLE j SURVIVING ADDRESS SM29. M14, Lot 21, 16 Lacosta Ave. JOINT OWNER clrr STATE ZIP CODE INFORMATION rancun Q ROO MX 77508 RELATIONSHIP TO DECEDENT TELEPHONE NUMBER ion ~ ) NAME (Last) (First) (Middle Initial) ADDRESS SURVIVING JOINT OWNER cITY INFORMATION I AD ERD SS SURVIVING JOINT OWNER '' cITY INFORMATION RELATIONSHIP TO DECEDENT NAME (Last) TAX RATE STATE TELEPHONE NUMBER (First) ZIP CODE (Middle Initial) STATE ZIP CODE RELATIONSHIP TO DECEDENT TELEPHONE NUMBER rAx Kett ~ ~ ~ • • _ Date Paid Payee Description Amount Paid ', 'I !~ P~CENT TAXA~ ~o r_3 m 3_: ~ ~ r_~ C t, ~- ,_ -r--, r ? TA3t S+5 ~ _ ._ 'i ~ ---i ~~_ _: ,'; ~ ' ,' r ~- PERCENTTAXA ~ Note: Please attach to receipt Total $ 0.00