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HomeMy WebLinkAbout03-01-10REV-1162 EX(11-961 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT CRONIN SANDRA 18 CUMBERLAND ESTATES DRIVE MECHANICSBURG, PA 17050 ACN ASSESSMENT CONTROL NUMBER fold ESTATE INFORMATION: FILE NUMBER: DECEDENT NAME: DATE OF PAYMENT: POSTMARK DATE: COUNTY: DATE OF DEATH: SSN: 097-12-8905 2110-0199 KOZLOWSKI FELIX 03/01/2010 03/01 /2010 CUMBERLAND 10/07/2009 TOTAL AMOUNT PAID: REMARKS: SEAL CHECK# 1734 INITIALS: CJ RECEIVED BY: NO. CD 012407 AMOUNT 5977.90 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ti :. fL W r W R~ fU r .. m O N a~ 9 ;_z~ `~Gg ~> ~ 7d §N~~ x ru r r Q7 fL 0 W r r W ~~ ~I 3 i •',~ 'I! JI ~ ~ x~~ a~x z ~° x h cnn r N ~~0 ro~ 9 ~ t/~~, V ~ ~''+ O N V1 O d ~~ ~ N`~ N A CJ O ~. W 0 ~fr~ g 8 4 PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE (~ AND FILE N0. 21°-~~y~"~~ BUREAU DF INDIVIDUAL TAXES TAXPAYER RESPONSE ACN 09168135 PO BOX 288601 HARRISBURG PA 1712a-oeol DATE 10-23-2009 meV-1543 IX AFP (09-OB) EST. OF FELIX KOZLOWSKI SSN 097-12-8905 DATE OF DEATH 10-07-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. SANDRA CRONIN REGISTER OF WILLS 18 CUMBERLAND ESTATES CUMBERLAND CO COURT HOUS ~ DRIVE CARLISLE, PA 17013 ca -;- MECHANICSBURG PA 17050 ~ 4° r ,;?~ t 'r ~ MEMBERS 1ST FCU provided the Department with the infonation below, which has been usa~N-' ~ulatir~ the 1-r _,.,.:~ potential tax due. Records indicate that at the death of the above-named decedent, you were a ioint owner/bena "'oaf thi3ecounty ~~ If you foal the infonation is incorrect, please obtain written correction from the financial institution, atta apv to this forr=~= 1 and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the~Anwealth © C,'} gT'i Pennsylvania. Please call C717) 787-8327 with quest-sons. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS p Account No. 182035-05 Date 03-01-1999 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance $ 53,557.45 payable to "Register of Wills, Agent". Percent Taxable X 50 ~ ~~~ NOTE: If tax payments are made within three Amount Subject to Tax ~` 26,778.73 months of the decedent's date of death, X . 0 4 5 deduct a 5 percent discount on the tax due. Tax Rate Any Inheritance Tax due will become delinquent Potential Tax Due $ 1 , 205 • 04 nine months after the data of death. PART TAXPAYER RESPONSE ... .. . ;~ ~'~ ,°M .. A. ~ The 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 CHECK Wills and an official assessment will be issued by the PA Department of Revenue. BLOCK B. ~ The above asset has been or will b® reported and tax paid with the Pennsylvania Inheritance Tax return C ONE 0 N L Y be filed by the estate representative. C, ~e above informs ion is incorrect and/or debts and deductions ware paid. Complete PART 2~ and/or PART 3~ below. PART If indicating a different tax rate, please state a 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 DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE 7 , ~~ .¢ y- TyOYT~ALV~ ~ ~ de~Pena ies o P ]urY, dreeclar~-th3t'the complete to the b(~t of~ny knowledge and belief OF TAX ON JOINT/T ~~,T ACCOUNTS 5 7 6 '~ 7 X 1 d3-a/~ l 2 S 5 ~. 5~7. 3 X 5p. 000 4 DESCRIPTION AMOUNT PAID t ^epor~dTabove are true, correct and~~• ~ !/~ HOME .: { / ) 3 7" WORK X7/7 ) 7~.Q -~-Q~</ •2 a~/~' TELEPHONE NUMBER DAT October 29, 2009 Goods and Services Selected for Felix "Hank" Kozlowski Date of Services Selected: October 20, 2009 Charges for Services Selected :.......................................... ..... ....................... -Full Service Cremation (Package # 1) .................. $ 4,810.00 Charges for Merchandise Selected :................................. ..... ........................ ......................................... Casket (Rental Unit) $ 700.00 - - Cremation Urn (Blue Marble) $ 325.00 -Urn Engraving (Name &Dates) .......................... $ 30.00 -Urn Engraving (Naval Symbol) 40.00 Charges for Cash Advanced Items :................................. ..... ........................ -Newspaper Notice (Local) .................................. . $ 399.00 -Newspaper Notice (Out of town) ....................... $ 622.00 -Clergy Offering .................................................. ... .. $ .. $ 125.00 100.00 -Organist ...................... ................................. -Certified Copies (8 C~ $6.00 each) .................... .. $ 48.00 .. $ 352.00 ........................................................ -Flowers $ 50.00 ..................................... -Honor Guard Donation .. S 25.00 -Coroner Authorization Fee ............................... .. Total Due: ............................................ ................................. (Payment due within fifteen days, please) =~a~~ ~r . MYERS-HARMER ~'~-~~~~~~` FUNERAL HOME, INC. 1903 Market Street Camp Hill, Pennsylvania 17011 717-737-9961 Myers-Harner@comcast.net Mrs. Sandra A. Cronin 18 Cumberland Estates Drive Mechanicsburg, PA 17050 ....................... -Payment Received •••••••••••••••••••••••••""" Check #1732 11/13/09 (Sandy Cronin) Total Due :................................................................................ Robert H. Hamer Supervisor Dustin R. Baker Funeral Director ..... $ 4,810.00 ........ $ 1,095.00 ....... $ 1,721.00 ............................ $ 7,626.00 ......................... $ -7.626.00 .......................... $ - 0 ~> . Locally Owned And Operated ~' < n ~ o- ~ `~ 3 J ~ ~ _~ ~ •• ~ R ~ r ~ ~ .~~~ s~ >~ ~+ ^ ^ o ^ fmA~ ~~ ~~.~ ~ 3 0 ' ° S a ~' .. .. ~ -rt ~ ~ m 3 3 ~ a ~ ~` a A ~ _~ ..~ 0 o a o o^^ o o r oo O 3 ~ 3 ,~ ~: ;• ~ o~ c m~ c 3 r a ~" a °-° ~ n o m m C ~ ~ ~ ~ ~ m m m n 3 rn ~ _ ~ D r p -i p o ~ ., ~ ~ ~~ ' .:, ~ ,, ter' >., o a m ' ,~ m ~ 1 S '1 <c ~ 7 O o m ~ ~ ~ D ~ ~i' mom. ~ °-' e ~ C ~ `. .~ ~ . -~ - . ~_~ ~ ~ ~ - S $ cn .~ .. ~ .~ t s;< ~. ~; 7 e <•, O ^. + r p ~' ~; -+ O ry6 ~ ~ 3 ', ;. ~ , o ~ R ., -~ r ~ 3 ~ 7 _ t+ O ~ ~ ~ ~ 1 - - ' 1 ~ ~ o ; m z Z® c ~ o n t~ -~ O ~ ~ m = a - ~ ^ o - o -- ~~ O ~ m ~ O ) ~ © ~ ~ d .~~- .+ Z~= tmi~ ~ o^^ ~ ~ 3 ~ o o c .. r, z Z ~ p ~ ,`;~ a o "n Vim' ~ m -. '' < j~ ,.. ~ ~ T O n. n O Dental Services GroupTM The Laboratory Network 717-737-7422 004887 MARINAK.DOU.CAMPHILL Marinak &Glossner Dds, Pc 19 S 22nd St Camp Hill PA 17011 Infection Control Repair Custom ,Made ~DentaC~evice p M S Cronin 1.00 ICINFCO T 1.00 DREP 3.00 TBIOFIPIV1X1 Muth 8~ Mumma Dental Laboratory Suite 500 6360 Flank Drive Harrisburg PA 17112 tollfree (800) 932-0584 local (717) 540-5626 fax (717) 540-5642 1581068 Complete Dentures Ceramics p~~ ~~res prthodontics Crown & Bridge Cosmetics "To provide the products and services that assist our customers in achieving the highest degree of patient satisfaction and practice success" LIFETIME LIlVIlTED WARRANTY Bioform I ~ X1 Ant '~ ~~ ~~ ~~ -:` -~ $6.50 6.50 $84.00 ! 84.00 $16.00 ! 48.00 SUBTOTAL ' 138.50 ~-`~ 1581068 10/5109 r ~~~~ ~~~~ $138.50 Wayne. i~ TERMS• NET 10TH OF MONTH. A FINANCE CHARGE OF 1 z% PER MONTH (18% ANNUAL) WILL BE ADDED TO PAST DUE INVOICES -_- ------------------------------------ Account: 004887 Marinak 8~ Glossner Dds, Pc 717-737-742 CASE: 1581068 Cronin ~ou acaty ~e ~cat~;ciay ate. • , '~+ °,^+r; l it f IIE~ "'~ ~ •• ~'~•~.~+~' Your local lab and you are noiv "One tivith the Net-vork. " Dental Services Group is the largest net-vork of dental laboratories in North America. In the comi-zg months, yozi will see more changes and benefits of being "One with the Network. " Ask yozer accozmt representative for details. T/ ~ t%~~Q~~/ Y L~:fiaT.l/ ~~'~/ 2>~'>~i~.~ ~oaa~ ~7>7 J 697-~8~~ ~"~ 69~-~8~6 Sold To: S,,No-~ ~au~~ ~ ~ -?C`(~- itL1~ ~vU~2,Al. Date: "1 ~ ~; i ~ `~ Invoice #: 11~3og5~ ~ ~~ ~ ~ ~a c~ E.5- P cS '~ I~an~ 1\G ~ ~ v vr+~ v -- ~- SNELBAKER ~ BRENNEMAN, P.C. A PROFESSIONAL CORPORATION ATT(lR 1.iFYS AT 1 _AW WEST SHORE EMS -BLS 205 GRANDVIEW AVE SUITE 211 CAMP HILL, PA 17011 Phone #: (800) 367-0512 Federal Tax ID: 23-2463002 PATIENT NAME: FELIX KOZLOWSKI PATIENT NUMBER CALL NUMBER: INSURANCE: DATE OF CALL: TIME OF CALL: CALLER: 194328W FROM: TO: FELIX KOZLOWSKI 18 CUMBERLAND ESTATE REASON(S) MECHANICSBURG, PA 17050 FOR TRANSPORT INVOICE w~ ~'VFST SHORE ~'.~1E.RG[f~:C'l~ ~1FI)1('~~t_tiF`.R~~K'f_S 85342 WCS 194328W NONE 09/17/2009 10:46 AM HOLY SPIRIT HOSPITAL HOLY SPIRIT HOSPITAL GOLDEN LIVING CANCER DESCRIPTION OF CHARGE QUANTITY UNIT PRICE AMOUNT Wheelchair One Way Transport A0999 1.0 59.45 59.45 Transport Van Mileage A0999 1.0 3.74 3.74 ~ 3/~~ ~~al ~~~~ ~~' Total Char es 63.19 DESCRIPTION OF PAYMENT RECEIPT PAYMENT DATE AMOUNT Total Credits 0.00 PLEASE PAY THIS AMOUNT -INVOICE DUE UPON RECEIPT --- - --____._~ ~..~w.i ~~e~ •I•nJ AA X63.19 1'SC I V r7lvtGV vnwr~ ~ ~.- - w•+ • •~~ SNELBAKER F~ BRENNEMAN, P.C. A PROFESSIONAL CORPORATION ATTORNEYS AT LAW 44 WEST MAIN STREET MECHANICSBURG. PENNSYLVANIA 17055 RICHARD C. SNELBAKER KEITH O. BRENNEMAN 717-697-8528 P. O. BOX 318 FACSIMILE (717) 697-7681 Sandra A. Cronin 18 Cumberland Estate Drive Mechanicsburg, PA 17050 Re: Felix Kozlowski Dear Sandra: December 1, 2009 It was a pleasure meeting with you and your husband on November 30, 2009. After our meeting, I had the opportunity to check with a client who does vehicle title work. I was advised that you do not need to have a short certificate in order to convey title to the Saturn vehicle. You will need to produce the Will and a death certificate for your father. Since you are named the alternate Executor under your father's Will, you may need to produce evidence, usually in the form of a death certificate, of your mother's death in 2004. Based upon the information you provided to me and the ability to transfer title to the Saturn without the need of a short certificate, there does not appear to be any need for you to probate the Will. Enclosed please find my statement for our consultation on November 30, 2009. If I can be of any further assistance, please don't hesitate to let me know. Yours truly. ~ ~~~ Keith O. Brenneman KOB/sm Enclosure SNELBAKER & BRENNEMAN, P. C. Attorneys at Law 44 W. Main Street MECHANICSBURG, PENNSYLVANIA 17055 (717)697-8528 December 1, 2009 Sandra A. Cronin 18 Cumberland Estate Drive Mechanicsburg, PA 17050 For Professional Services Rendered Re: Felix Kozlowski 11/30/09 Consultation with client $75.00 ~~~ /d ~ I3o l PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE AND FILE N0. 21•-~0-~~{ BUREAU OF INDIVIDUAL TAXES ACN 09168134 PO BOX 280601 TAXPAYER RESPONSE HARRISBURG PA ln2B-oegl DATE 10-23-2009 mN-1543 IX AFP (00-OB) TYPE OF ACCOUNT EST. OF FELIX KOZLOWSKI ^ SAVINGS $$N 097-12-8905 ® CHECKING DATE OF DEATH 10-07-2009 ^ TRUST COUNTY CUMBERLAND ro ^ CERTIF. REMIT PAYMENT AND FORMS T0: ~_ ~+ SANDRA CRONIN REGISTER OF WILLS Z ~" CUMBERLAND CO COURT HOU ~~• 7 ~-+ 18 CUMBERLAND ESTATES ~ CARLISLE, PA 17013 ~ '`~ `~ DRIVE MECHANICSBURG PA 17050 ~ ~ ~ -" [~; ? r~z -~~._a ~w _ ~-' d the Depart id PV ment with the information below, which has been u i~i calculaKn ~~ e a MEMBERS 1ST FCU prov Records indicate that at the death of the above-named decedent, You were a joint owner/be iciary of tQa i ~ ttach a copy to d :~y c o s form ue. potential tax If you feel the infonation is incorrect, vlease obtain writ , , ten correction from the financial institution, a ordance with the Inheritance Tax laws of the Commonwealth of i and return it to the above address. This account is taxable n acc Pennsylvania. Please call C717) 787-8327 with questions. SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS COMPLETE PART 1 BELOW * Account No. 182035-11 Data 02-20-1999 To ensure proper credit to the account, n t two accompa y copies of this notice mus Established payment to the Register of Wills. Nake check nce ~` l B 405.35 payable to "Register of Wills, Agent". a a Account Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to TeX ~ 202 • 68 months of the decedent's data of death, deduct a 5 percent discount on the tax due. X Tax Rate . 0 4 5 Any Inheritance Tax due will becoee delinquent ~` 9 • 12 nine months after the data of death. Potential Tax Due TAXPAYER RESPONSE PART ~ ^ .. .. , .., .. ;, T "~ A. ~he above information and tax due is correct. ILJJ 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 CHECK Wills and an official assessment will be issued by the PA Department of Revenue. BLOCK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return C ONE 0 NL Y to be tiled by the estate representative. C. ^ The above informs Son is incorrect and/or debts and deductions were paid. Complete PART ~2 and/or PART ~ below. If indicating a different tax rate, please state _ Y.,,, PART 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 OF TAX DN JOINT/TRUST ACCOUNTS 1 2 3 X 4 $ 5 6 '~ 7 X 8 $ PART DATE PAID PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) 4 Under penalties of periury, I declare that the facts I have reported above are true, corre~ and complete to the best of mY knowledge and belief. HOME C / 7 ~ ~ WORK 17/ 7 ~ 7oZd ' oZ.Q/6 d' ,~l ~ i~~ ~e~~i~A-- TELEPHONE NUMBER DATE PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE (~ AND FILE N0. 21'' ~~'~~ 1.1 BUREAU OF INDIVIDUAL TAXES TAXPAYER RESPONSE ACN 09168133 PO BOX 280601 HARRISBURG PA 17128-0601 DATE 10-23-2009 aiV-1543 IX AFP (OB-09) TYPE OF ACCOUNT EST. OF FELIX KOZLOWSKI ® SAVINGS SSN 097-12-8905 ~ CHECKING DATE OF DEATH 10-07-2009 ~.a ^ TRUST CERTIF. _ ...x~ COUNTY CUMBERLAN m REMIT PAYMENT AND FORMS T0: ~ -~~-"-' REGISTER OF WILLS ~°` ~> ``~`~~ SANDRA CRONIN CUMBERLAND CO COURT HO ~ L''c~~ 18 CUMBERLAND ESTATES CARLISLE, PA 17013 ~ r~,.~` ~~- DRIVE u's `~ ~`~ MECHANICSBURG PA 17050 ~~O ~%:~ t ~~"~ 4 ~ .~„P,) MEMBERS 1ST FCU provided the Departaent with the inforaation below, which has been ~d in calcining the ^*_ potential tax due. Records indicate that at the death of the above-naaed decadent, you were a ]oint owner/beneficiary of ®s account. If you feel the information is incorrect, please obtain written correction frog the financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Coamonwealth of Pennrilvania. Plaasa call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 182035-00 Date 02-20-1999 To ensure proper credit to the account, two Established copies of this notice aunt accoapamr payaent to the Register of Wills. Make check Account Balance $ 6,835.48 payable to "Register of wills. Agent". Percent Taxable X 50'000 NOTE: If tax payaents are wade within three Amount Subject to Tax $ 3,417.74 aonths of the decedent's data of death, X . 0 4 5 deduct a 5 percent discount on the tax due. Tax Rate Any Inheritance Tax due will becoae delinquent Potential TaX Due $ 153.80 nine months after the date of death. PART TAXPAYER RESPONSE ,~:. 0 A, f Nhe above inforaation and tax due is correct. f i this notice to obtain LLL111000 Reait payaent to the Register of es o Wills with two cop "A" and return k b this notice to the Register of a discount or avoid interest, or t ox chec ill be issued by the PA Departaent of Revenue. CHECK Wills and an official assessmen w C ONE will be reported and tax paid with the Pennsylvania Inheritance Tax return B L 0 C K B. ~ The above asset has been or 0 N L Y to be filed by the estate representa tive. C. ~ The above inforsa ion is incorrrect and/or debts and deductions were paid. Coaplete PART 2~ and/or PART 3L.J below. PART If indicating a different tax rate, please state relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 $ 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 $ 5. Debts and Deduetlons 5 ~ 6. Amount Taxable 6 7. Tax Rate ~ X 8. Tax Due B $ PART DATE PAID PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION F FE'E` AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) $ Under penalties of perjury, I declare that the facts I have reported above are true, correc•-t~ and ..,.borate to the best of mY knowledge and belief. HOME C ~[-7~ `7g(i ~~~-~ !3 - - "- _ WORK C 7/ 7~ ~Io7-0 -~ USA FIRST-LASS FOREVIA !. USA FIRST-CLASS fC~tE~ t ~~-- - -h ~ USA FRST-CLASS r r '? 1 » r ~.° :~_ ~' `: ~~ ry~~ _L,~~:' :,.., ~.,~. ~.. ; ..C. -.o„r, . ,~..; .~ of , C' ti ~ ~. ~z a. ~~ ~V ~