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Home My WebLink About10-07-09PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE c,~~ BUREAU OF INDIVIDUAL TAXES nn~nrr-., r.,-~-,;-,-. AND FILE NQ'. 21 ~~ ~ J FO BOX 80601 - - ~~~ 'HARRISBURG PA 17128-0601 -° 'T~d~CPd,YER RESPONSE ACN 09152144 REV-1543 EXAFP(OB-oe:~~~ `~*~~•-,*',~„DEVISED NOTICE * ~ * DATE 09-17-2009 c~.~li~ ~~;~ ~ _~ ~;',~ I : ~h TYPE OF ACCOUNT ST. OF ELEANOR WHITE ~ SAVINGS SSN 208-24-4639 ® CHECKING ~ ~' ~ DATE OF DEATH o7-24-2009 ~ TRUST ~ COUNTY CUMBERLAND ~ CERTIF. y1 - REMIT PAYMENT AND FORMS T0: MARY CRAMER REGISTER OF WILLS 3 CHARLES ROAD CUMBERLAND CO COURT HOUSE MECHANICSBURG PA 17050 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 tennsylvania. Please call (717) 767-8327 with questions. COMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR EYEING AND PAYMENT INSTRUCTIONS Account No. 166701-11 Date 08-15-2001 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 788.15 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 16.667 Amount Subject to TaX $ 131 .36 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 $ 5.91 Any Inheritance Tax due will become delinquent nine months after the date of death. P~r TAXPAYER RESPONSE 1 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 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 0 N L Y g, ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax ret urn to be filed by the estate representative. C. The above informs ian is incorrect and/or debts and deductions were paid. Complete PART ~ and/or PART ~ below. raKl •r 1nalcaLing a tllfferent 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. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due PAD OFFICIAL USE DNLY ~ AAF PA DEPARTMENT OF REVENUE OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 5 $ ` 6 7 X 8 $ PART DATE PAID PAYEE 1 2 3 4 5 6 7 8 DEBTS AND DEDUCTIONS CLAIMED DFSf'RTPTTf1N •- ~ amine ~ yr iax computation) g Under penalties of perjury, I declare that the facts I have reported (alb/ove are tr/u"e, co.{rr~ect and complete to the best of my knowledge and belief. HOME C// ~7 ) 7[~~ ~'J ~(1) WORK ( ) ! , TAXPAYER SIGNATURE TELEPHONE NUMBER DATE 00004238 Forest Park Health Center 700 Walnut Bottom Road Carlisle,PA 17013 Questions Concerning This Invoice? Biller Name Dianna @ Ext. 833 Phone 1-888-880-7090 Fax 1-814-265-1377 Email dchittester@guardianeldercare.net MARY CRAMER 318 CHARLES ROAD IMECHANICSBURG PA 17050 Please Detach and Return with your payment PAGE 1 Resident# 22839 Resident WHITE ELEONOR Discharge Date 07/23/2009 Statement Date 08/31/2009 Payments Posted Through 08/31/2009 ~ - __ - _ _ _ _ _. _ - - --- - -I I ~ CALL 1-888-880-7090 ~ I ~ DIANNA EXT 833 ~ I USE MASTERCARD/VISA/DISCOVER PAYMENT ENCLOSED j ~ DATE DESCRIPTION UNITS REFERENCE AMOUNT BALANCE ~~ / PRE~IQLIS-.~AL~CE 47 4 7 5 2 4 08 20/2009, ~tIVATE PAYMENT J CK 0000450025 t -475.24 I . ' ) .00 ~ ENDING BALANCE i .00 YOUR PAYMENT OF Forest Park Health Cent 1-888-880-7090 .00 IS DUE UPON RECEIPT WHITE ELEONOR 22839 MEMBERS 1ST FEDERAL CREDIT UNION. P.U. BOX 40 . MECHANICSBURG, PENNSYLVANIA 17055 jvo. 0000448850 Acct: XXXXXXX7O1 Teller: 0387 Date: 08/05/O9Time: 2:14pm --------------------------------------------------------- See receipt for reference Check Number: 00 0000448850 Purpose SHARE WITHDRAWAL Amount $408.50 Pay to MARY E CRAMER . ~_ 219 Norfh Hanover Street Carlisle, Pennsylvania 17013 ;.~ 1 ~ 717.243.4511 ~_~ ~' ~~ toll free 1.866.451.451 1 ~~~" = ;;~~'~~-~~ •~ ~~i~dr~' fax 717.243.3723 •~..., . • 'FUNERAL HOME ~ CREMATORY, INC. www.hoffmanroth.com infoC?hoffmanroth.com September 3, 2009 Mary Cramer 318 Charles Road Mechanicsburg, PA 17055 RE: Funeral Expenses for Eleanor White Dear Mary: We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to the following payment update. , . Enclosed you will find an itemized bill of all costs for the funeral of Eleanor White. The total amount of the bill was $10,059:26. Total amount of Insurance payments was $7,412.90, leaving a balance of $2,646.36. We are with the understanding that the bill for Eleanor is to be paid equally by the six children. Therefore, this statement is to let you know what your share of the funeral expense is. . $2,646.36 Total of outstanding bill after the insurance payments 5441.06 Your responsibility is 1/6 of the remaining bill Please make check payable to Hoffinan-Roth Funeral Home & Crematory, Inc in the amount of $441.06 and mail to the above address. Please make sure that your name and address are clearly marked so that proper credit is made. Since-y; - ~ Linda Pippl Office Manager ,''._~ U j ~J 5G' ~~c' ~,~~~ ~`,