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Home My WebLink About01-26-10COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.2S0601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ACN ASSESSMENT AMOUNT CONTROL NUMBER NO. CD 012280 SOLIDER JEANNE 619 W MAIN ST MECHANICSBURG, PA fold 17055-3246 ESTATE INFORMATION: SSN: ~0~-24-4375 FILE NUMBER: 2109-1 183 DECEDENT NAME: FERNBAUGH ANNA M DATE OF PAYMENT: 01 /26/2010 POSTMARK DATE: COUNTY: 01 /26/2010 CUMBERLAND DATE OF DEATH: 1 2/ 10/2009 TOTAL AMOUNT PAID: REMARKS: CHECK# 3773 INITIALS: CJ SEAL RECEIVED BY: REV-1162 EX111-96) $147.28 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES PD BDX 280601 HARRISBURG PA 17128-0601 m:Y-1543 IX AFP (00-00) PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE r,,,._,_.;,,~ ~ AND ' • . ' ~-~ -.f..~~~~ RESPONSE ~ ~ku ~....1 i of ~ ~. .. FILE N0. 21 09-1183 ACN 10102329 DATE 01-18-2010 ZO1O ~A~ 2f~ ~~ i2.~~. OF ANNA FERNBAUGH SSN 101-24-4375 C~~R~ r'~ DATE OF DEATH 12-10-2009 (~{ tORPNf'd4~~S v~URTCOUNTY CUMBERLAND ~v~~~?`~4~' t~;~l~ ~~~, MIT PAYMENT AND FORMS T0: JEANNE SOUDERS REGISTER OF WILLS 619 WEST MAIN STREET 1 COURTHOUSE SgUARE MECHANICSBURG PA 17055 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 Pennsylvania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 3950-00 Date 10-09-1956 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 3, 901.26 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to Tax ~ 1 , 950.63 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 ~ 87 78 Any Inheritance Tax due will become delinquent nine months after the date of death. PART TAXPAYER RESPONSE a ,,,,, A. ~ j/The A 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. BLOCK 0 N L Y B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheri tance Tax t to be filed by the estate representative. re urn 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 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 1_ 2 ~ 3 X 4 ~ 5 - 6 7 X 8 $ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION aun,,.,r .,. _.. --- --- -- - - ..umpu~a [10n/ ~ Under penalties of perjury, I declare that the facts I have reported ab~fo/ve are~ru , correc complete t/o~ the be of my nowledge and belief. HOME C // ) 7 ~~-~/ (.~E!~/ WORK C ) ~lI TAXPAYER SIGN TORE Tr) rnunur .,,,..n~„ _ _ __ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES ,^~r -~ AND FILE N0. 21 09-1183 PO BOX 280601 ~^,r t. HARRISBURG PA nlzB-0601 - .,~ ~ ;'~7~PAYER RESPONSE ACN 10102330 REV-1543 IX AFP (Od OB) ~~ ~ ~~/~ ~ ~~ DATE 01-18 - 2010 ZO~Q JAIL 26 ~ i2~ QO oRpe~~~. J,~. ~~}'t~,r"",="~~ ~C',! !~i ~'_ JEANNE SOUDERS 619 WEST MAIN STREET MECHANICSBURG PA 17055 EST. OF ANNA FERNBAUGH SSN 101-24-4375 DATE OF DEATH 12-10-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE 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-pawed 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 fop and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pennsylvania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 3950-05 Date 06-05-2003 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 2, 988.93 Payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to Tax $ 1,494.47 NOTE: If tax payments are made within three months of the decedent's date of death, Tax Rate )( .0[15 deduct a 5 percent discount on the tax duo. Potential Tax Due $ 67.25 Any Inheritance Tax due will become delinquent nine months after the date of death. P~r TAXPAYER RESPONSE ~ ..~.~; CHECK C ONE BLOCK ONLY ine 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. 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 PART 2~ and/or PART 3~ 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. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due PART DATE PAID PAYEE OF TAX ON JOINT/TRUST ACCOUNTS 1 2 ~ 3 X 4 5 6 7 X 8 DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) ~ Under penalties of per ry, I declare that the facts I have reported abAove are tru , correct nd ~`~ ///complete to the ,best my knowledge and belief. HOME ( %~"1 ) ~r ~~ ~0~~ ~C..~. '~ ~~ (\ TAXPAYER SIGNAT RF WORK__C_ ) ~~G ~~