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HomeMy WebLinkAbout04-05-10COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) N0. CD 012568 ANTONICELLI DAVID 5805 STEPHEN'S CROSSING MECHANICSBURG, PA 17050 fold ESTATE INFORMATION: ss-v: oo0-00-0000 FILE NUMBER: 2110-0208 DECEDENT NAME: ANTONICELLI HELEN DATE OF PAYMENT: 04/05/2010 POSTMARK DATE: 04/01 /2010 COUNTY: CUMBERLAND DATE OF DEATH: 01 /23/2010 REMARKS: CHECK# 3877 SEAL ACN ASSESSMENT AMOUNT CONTROL NUMBER 10109124 ~ 5181.61 TOTAL AMOUNT PAID: INITIALS: DM RECEIVED BY: 5181.61 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~3..~ -{ • ~ t ~'~~ g I~ c~w.o~ i./ 6a~.I'1 X~ ~~ ~`5L~ ~9 `'% ~gt.t~i n.~ ~ '~" 7 t~ ~,~ ~ ' 7 ;'?~ ~" t , r:~ r7 ~? } f. ~n ~~ t ~ F... _. ~ -~ ~ v ~ ~ ^ ' Vf i .. V~ V ' ~ ~~: `~ ; .~ =. . PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE `~~ C~ "' AND FILE N0. 21 1 (7 BUREAU OF INDIVIDUAL TAXES PO BDX 280601 TAXPAYER RESPONSE ACN 10109124 FUIRRISBURG PA 17128-0601 ' DATE 02-17-2010 ~ m11.1543 IX AFP (03-00) ' TYPE OF ACCOUNT EST. OF HELEN ANTONICELLI ® SAVINGS SSN 178-22'7772 ^ CHECKING DATE OF DEATH 01-23-2010 ^ TRUST COUNTY CUMBERLAND ^ CERTIF. REMIT PAYMENT AND FORMS TD: DAVID ANTONICELLI REGISTER OF WILLS 5805 STEPHEN'S CROSSING 1 COURTHOUSE SQUARE 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 3oint 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 (717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 15332-00 Date 10-09-1973 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 2 ~ 150.17 payable to "Resistor of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax $ 358.37 months of the decedent's date of death, Tax Rate X .045 deduct a 5 percent discount an the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due ~ 16.13 nine months after the date of death. PART TAXPAYER RESPONSE 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. C ONE BLOCK B. ^ The above asset has been ar 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 informs ion is incorrect and/or debts and deductions were paid. CorDlete PART 2~ and/or PART ~ below. PART If indicating a different tax rate, please state ~ W"" m ~' , relationship to decedent: 3 ~~ 3 ,: ~ •, TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ~'. '~'' *`'`` wr~~ LINE 1. Date Established 1 ~ ..~.~.,~ ~« ~wrwww" ~~ 2. Account Balance 2 $ y„?, .;.L ~ ~ ~ x?<s;eE'sa~,ra, a-n~ .~,~' 3. Percent Taxable 3 , ~ 4. Amount Subject to Tax 4 $ .r~~ ~{ M` 5. Debts and Deductions 5 s rid ~ ~~ 6. Amount taxable 6 $ ~ 5, f f ~3~~ `~'~ t~ i ~_~~~~' ~~ ' 7. Tax Rate 7 X , '~ ' ' Vr 8. Tax Due 8 $ 4 Yd < . ..i~ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of erjur , I declare that the facts I have reported above are true, correcQt(~and compl e o the be of nowledge and belief . HOME C ~ ~1 ) ~~ ~ ~SQ 7 ~).i WORK ( ) DATE ~ TOTAL CEnter on Line 5 of Tax Computation) 6 PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 PD BOX 280601 TAXPAYER RESPONSE ACN lolos124 HARRISBURG~PA 1712$-0601 DATE 02-17-2010 • REV-1543 IX AFP (38-43) DAVID ANTONICELLI 5805 STEPHEN'S CROSSING MECHANICSBURG PA 17050 E5T. OF HELEN ANTONICELLI S5N 178-22-7772 DATE OF DEATH 01-23-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SgUARE 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 ]aint 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 C7171 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Under penalties of per ury, I declare that the facts I have reported above are t/~_rue, correc(t~jaQnd comp o th best o my kn edge and belief. HOME C~J1') ) l~~/ ~~~0 l WORK C TAXP YE SIGNATURE TELEPHONE NUMBER DATE PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 PO BOX 280601 TAXPAYER RESPONSE ACN 10109126 HARRISBURG PA 17128-0601 DATE 02-17-2010 REY-1543 IX AFP (03-38] DAVID ANTONICELLI 5805 STEPHEN'S CROSSING MECHANICSBURG PA 17050 EST. OF HELEN ANTONICELLI SSN 178-22-7772 DATE OF DEATH 01-23-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SgUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU provided the Department with the information 6alow, which has bean used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a ioint 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 lax laws of the Commonwealth of Pennsylvania. Please call (717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3LJ below. PART If indicating a different tax rate, please state ~""''" ,~ ~~ relationship to decedent: ^ 2 P~ °~k ~ ~itE~t~NtlE , TAX RETURN - COMPUTATION OF TAX OM JOINT/TRUST ACCOUNTS ~};',r_ __ `~ LINE 1. Date Established 1 ~ }` 2. Account Balance 2 ~ -„ `~' i3 ~ ~ ~~ 8~'' 1 3. Percent Taxable 3 X ~!~iM~ }it1 !I li'~ . * t '3~ ~~T'~i ~~~«', 4. Amount Subject to Tax 4 $ '~' >>~ .,»~~ 5. Debts and Deductions 5 - ~ • ~' ; 6. Amount Taxable 6 $ brr ~~'{ r '' 7. Tax Rate 7 X 8. Tax Due 8 $ ' ~{ 3 x' PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL Enter on Line 5 of Tax Computation) # Under penalties of p rjur I declare that the facts I have reported abotve are true, co re¢c~ and c to to the best f m knowledge and belief. HOME C 7`~) {pv~V^~U WORK C TA R SIGNATURE TELEPHONE NUMBER DATE PENNSYLVANIA INHERITANCE T INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AN D PD Bmt 280681 TAXPAYER RESPONSE HARRISBURG PA 17128-0601 REY-1543 IX AFP (OB-08) DAVID ANTONICELLI 5805 STEPHEN'S CROSSING MECHANICSBURG PA 17050 FILE N0. 21 ACN 10109126 DATE 02-17-2010 EST. OF HELEN ANTONICELLI SSN 178-22-7772 DATE OF DEATH 01-23-2010 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 bean used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a ioint owner/beneficiary of this account. If you feel the infanation is incorrect, please obtain written correction from the financial institution, attach a copy to this fore 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 (717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 15332-11 Date 12-31-1979 To ensure prover credit to the account, two Established copies of this notice wust accompany Account Balance $ 12 536 08 payment to the Register of Wills. Make check . , payable to "Register of Wills, Agent". Percent Taxable X 16.667 Amount Subject to TaX $ 2 089 39 N07E: 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 $ 9 4. 0 2 Any Inheritance Tax due will become delinquent nine months after the date of death. P RT TAXPAYER RESPONSE A 1 A. ~ The above information and tax due is correct. Reait payment to the Register of Wills with twa copies of this notice to obtain CHECK a discount or avoid interest, or check box "A" and return this notice to the Register of C 0 N E ~ 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 0 N L Y to be filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions ware paid. Complete PART 2~ and/or PART ~ 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 OF TAX ON JOINT/TRUST ACCOUNTS 1 2 $ 3 X 4 $ 5 6 7 X 8 $ PART DEBTS AND DEDUCTIONS CLAIMED 3 DATE PAID PAYEE DESCRIPTION AMOUNT PAID DATE Under enalties of pe ury, I declare that the facts I have reported above arm true,.e~corrbect and co let to t e best my owledge and belief. HOME C~17) ~~~ p50~ WORK C ) PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND F I L E Po Box zaoeol TAXPAYER RESPONSE ACN HARRISBURG PA 171x8-8681 • DATE REV-1543 IX ILFP (OB-OBS N0. 21 10109128 D2-17-2010 EST. OF HELEN ANTONICELLI SSN 178-22-7772 DATE OF DEATH 01-23-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS TD: DAVID ANTONICELLI REGISTER OF WILLS 5805 STEPHEN'S CROSSING 1 COURTHOUSE SQUARE MECHANICSBURG PA 17050 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 ioint owner/beneficiary of this account. If you feel the inforwation is incorrect, please obtain written correction from the financial institution, attach a copy to this fors 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 (717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 15332-04 Date 10-09-1973 To ensure proper credit to the account, two Established copies of this notice must accompar~ payment to the Register of Wills. Make check Account Balance 2 i 000.42 payable to ^Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax $ 333.41 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 Dua $ 15.00 nine months after the date of death. PART TAXPAYER RESPONSE ' d _ `~ , - 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 W311s and an official assessment will be issued by the PA Department of Revenue. C ONE B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return D N L Y to be filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Corplete PART 2~ and/or PART ~ below. PART If indicating a different tax rate, please state `? ~` a relationship to decedent: ' ~`~: ~< TAX RE TURN - COMPUTATION. OF TAX ON JOINT/TRUST ACCOUNTS ~'3~ ~ LINE 1. Date Established 1 2. Account Balance 2 ~ ~ `'Y ~ ~~ 3. Percent Taxable 3 X ~ „w~„ ~ °°' ° ~r° 4. Amount Subject to Tax 4 +r' 5. Debts and Deductions 5 - ~ '' 6. Amount Taxable 6 ~ ~: `~ ' -'~~ 7. Tax Rate 7 X e. Tax Due e ¢ ~*. z PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under pens ties of erju , I declare that the facts I have reported above are true, correct and to ~ the b of knowledge and belief. HOME C`? ~ 7 ) tD~(J ~ ~'~~ WORK C ) DATE TOTAL CEnter on Line 5 of Tax Computation) f PENNSYLVANIA INHERITANCE T INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AN D PO BOX 280601 TAXPAYER RESPONSE HARRISBURG PA 1712E-0601 REY-1543 IX AFP (OB-OB] FILE N0. 21 ACN 10109128 DATE 02-17-2010 DAVID ANTONICELLI 5805 STEPHEN'S CROSSING MECHANICSBURG PA 17050 EST. OF HELEN ANTONICELLI SSN 178-22-7772 DATE OF DEATH 01-23-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SgUARE CARLISLE PA 17013 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU provided the Department with the information 6elaw, which has bean used in calculatin8 the potential tax due. Records indicate that at the death of the above-named decedent, you were a point 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 (717) 7B7-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 15332'04 Date 10-09-1973 To ensure proper credit to the account, two Established copies of this notice must accomparry payment to the Reeistar of Wills Make check Account Balance $ 2, 000 .42 payable to "Register of Wills, Agent". Percent Taxable X 16.667 Amount Subject to NOTE: If tax payments are made within three TaX $ 333 41 . months of the decedent's date of death, Tax Rate X . 045 deduct a 5 vercent discount on the tax due. Potential Tax Due Any Inheritance Tax due will become delinquent $ 15 00 . nine months after the data of death. P RT TAXPAYER RESPONSE A 1 ~z A. ~ The above information and tax due 3s correct. Resit 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 Wills and an official assessment will be issued by the PA Department of Revenue. C 0 N E ~ BLOCK 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 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 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 ON JOINT/TRUST ACCOUNTS 1_ 2 3 X 4 $ 5 6 7 X 8 $ PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under pe lties of perjury, I declare that the facts I have reported above are tr^^u^^e,~coprreQ~t[~.and m etc o the b t of my knowledge and belief. HOME C"J~7 ) ~~'t! Os~+ WORK C ) DATE TOTAL CEnter on Line 5 of Tax Computation) # PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU DF INDIVIDUAL TAXES AND FILE N0. 21 PO BOX 280601 TAXPAYER RESPONSE AcN 10109118 HARRISBURG PA 17128-0601 ' DATE 02-17-2010 REV-1545 EX AFP (08-08) DAVID ANTONICELLI 5805 STEPHEN'S CROSSING MECHANICSBURG PA 17050 E5T. OF HELEN ANTONICELLI S5N 178-22-7772 DATE OF DEATH 01-23-2010 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-Waned decedent, you were a paint owner/beneficiary of this account. If you feel the inforwation is incorrect, please obtain written correction from the financial institution, attach a copy to this forty and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Cowwonwealth of Pennrilvania. Please call (717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 19792-00 Date 10-14-1977 To ensure proper credit to the account, two Established copies of this notice must acconpam AcCOUnt Balance ( ~ 170 .42 paywent to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 16.667 0 2 8.4 2 NOTE: If tax payments are Wade within three Amount Subject to TaX $ 1, 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 $ 46.28 nine months after the date of death. PART TAXPAYER RESPONSE 0 ;;~ A. ~ The above information and tax due 3s 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 Wills and an official assessment will be issued by the PA Department of Revenue. C ONE BLOC K B. ~ The above asset has been or will be reported and tax paid with the Pennrilvanfa Inheritance Tax return 0 N L Y to be filed by the estate representative. C. ~ The above informa ion is incorrect and/or debts and deductions were paid. Cowplete PART 2~ and/or PART 3U below. PART If indicating a different tax rate, please state relationship to decedent: P~ ~ ' ~' ~ RE'VEN~iE' TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ''~~ LINE 1. Date Established 1 2. Account Balance 2 ., q ` ~~ . ~~ r ~~ ~',y w.ww,i, ~ , X ~~ i g "` 3. Percent Taxable 3 ?~ .;.~ 4. Amount Subject to Tax 4 ~ rw~ww~ il(wwwwirM~wnnw.Nyww~.w 5. Debts and Deductions 5 r x ~ 6. Amount Taxable 6 7. Tax Rate 7 X ~"' . 8. Tax Due 8 $ ~ '~ _ , PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under nalties of perju , I declare that the facts I have reported above are t//ru/^-e~~, c(oyrr(~e(gyt~jand com to to the b st of knowledge and belief. HOME C ~ 1'~) (9~XJ r~+t7+D f (~ WORK C ) TAX SIGNATURE TELEPHONE NUMBER DATE ~ TOTAL CEnter on Line 5 of Tax Computation) S BUREAU OF INDIV PO BOX 280601 HARRISBURG PA PENNSYLVANIA INHERITANCE TAX AND FILE N0. 21 IDUAL TAXES 17128-peal TAXPAYER RESPONSE ACN 10109118 DATE 02-17-2010 • REV-1543 IX AFP (38-08) DAVID ANTONICELLI 5805 STEPHEN'S CROSSING MECHANICSBURG PA 17050 EST. OF HELEN ANTONICELLI SSN 178-22-7772 DATE OF DEATH 01-23-2010 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-named decedent, you ware a .joint owner/beneficfarv 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 BELDW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 19792-00 Date 10-14-1977 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 $ 6 ~ 170.42 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax Payments are made within three Amount Subject to Tax $ 1 ~ X28 .42 months of the decedent's date of death, TeX Rate X .045 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due $ 46.28 nine months after the date of death. PART TAXPAYER RESPONSE ,,D~~ 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 Resister of CHECK Wills and an official assessment w311 be issued by the PA Department of Revenue. ONE C BLOCK B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance lax return D N L Y 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 ~ 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 AMOUNT PAID IGNATURE TELEPHONE NUMBER DATE INFORMATION NOTICE Under penalti s of per ry, I declare that the facts I have reported above are true, correctQ/~jd eom et to t e best o my knowledge and belief. HOME C `1'77 b~ ~~~v , ~hA' WORK ( ) PENNSYLVANIA INHERITANCE T INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AN D Po Box zaoegl TAXPAYER RESPONSE HARRISBURG PA 17128-0681 ~v-isas a nFV coe-oe~ FILE N0. 21 ACN 10109120 DATE 02-17-2010 DAVID ANTONICELLI 5805 STEPHEN'S CROSSING MECHANICSBURG PA 17050 EST. OF HELEN ANTONICELLI SSN 178-22-7772 DATE OF DEATH 01-23-201D COUNTY CUMBERLAND REMIT PAYMENT AND FORMS TD: 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-named decedent, you were a ]ofnt owner/beneficiary of this account. If you feel the inforaation 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. 19792-11 Date 12-31-1979 To ensure proper credit to the account, two Established copies of this notice must accompa:ry Account Balance 632 29 payment to the Register of Wills. Make check . payable to "Register of Wills, Agent". Percent Taxable X 16.667 Amount Subject to TaX $ 1D5 38 NOTE: If tax paysents are ^ade 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 4.7 4 Any Inheritance Tax due will become delinquent nine months after th• dat• of death. P T TAXPAYER RESPONSE ~ 1 A 8 A. ~ The above information and tax due is correct. Resit 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 Wills and an official assessment will be issued by the PA Department of Revenue. ONE BLOCK ~ B. ~ The above asset has been ar will be reported and tax paid with the Pennsylvania Inheritance Tax return ON L Y to be filed by the estate representative. C. ~ The above informs ion is incorr~ect and/or debts and deductions were paid. Complete PART 2~ and/or PART L__f 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 DEBTS AND DEDUCTIONS CLAIMED Under penalti s of pe jury, I declare that the facts I have reported above are true-,^correc~~~ comp e o t a best f my owledge and belief. HOME C"')('1) ~5~..~~ FNf WORK C ) OF TAX ON JOINT/TRUST ACCOUNTS 1 2 $ 3 X 4 +fi 5 6 $ 7 X 8 ~ DATE DATE PAID PAYEE DESCRIPTION AMOUNT PAID PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AN D PD BDX 280681 TAXPAYER RESPONSE NARRISBURG PA 17128-0681 ~ mV-1543 IX IiP (08-4B) EST. OF HELEN ANTONICELLI SSN 178-22-7772 DATE OF DEATH 01-23-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FDRMS TD: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT ^ savlNCs ® 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 fron the financial institution, attach a copy to this forn and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Comsonwealth of Pennrilvania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 19792-11 Date 12-31-1979 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance 632 29 payment to the Register of Wills. Make check " . payable to Register of Wills, Agent". Percent Taxable X 16.667 Amount Subject to TaX $ 1 0 5 3 8 NDTE: 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 4.7 4 Any Inheritance Tax due will become delinquent nine months after the date of death. P RT TAXPAYER RESPONSE A 1 A. ^ The above information and tax due is correct. Renit 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 ~ B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 NL Y 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 ~ 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 DEBTS AND DEDUCTIONS CLAIMED Under penalti s of pe ury, I declare that tfie facts I have reported above aret_t^ru~e(, c~~orre t and eom to t e best o my knowledge and belief. HOME C~7~'~ ) tp+~(/ av~ WORK ( ) TA R SIGNATURE TELEPHONE NUMBER DATE DAVID ANTONICELLI 5805 STEPHEN'S CROSSING MECHANICSBURG PA 17050 OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 $ FILE N0. 21 ACN 10109120 DATE 02-17-2010 DATE PAID PAYEE DESCRIPTION AMOUNT PAID PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 Po BOX 280601 , TAXPAYER RESPONSE ACN 10109122 HARRISBURG PA 17126-0601 DATE 02-17-2010 REV-1543 IX AFP (40-09) TYPE OF ACCOUNT EST. OF HELEN ANTONICELLI ® SAVINGS SSN 178-22-7772 ^ CHECKING DATE OF DEATH O 1- 23 - 2010 ^ rRUST COUNTY CUMBERLAND ^ CERTIF. REMIT PAYMENT AND FORMS T0: DAVID ANTONICELLI REGISTER OF WILLS 5805 STEPHEN'S CROSSING 1 COURTHOUSE SpUARE MECHANICSBURG PA 17050 CARLISLE PA 17013 MEMBERS 1ST FCU provided the Department with the information below, which has been used in calculating the Dotential tax due. Records indicate that at the death of the above-named decedent, you were a point owner/beneficiary of this account. If you feel the inforoation 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. 19792-04 Date 10-14-1977 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 2 ~ 000 • 42 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax vayments are made within three Amount Subject to Tax $ 333.41 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 TBX Due $ 15.00 nine months after the data of death. P T TAXPAYER RESPONSE ~ ~ ~ ~~. .. 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 C 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 informs ion is incorr~ect and/or debts and deductions were paid. Complete PART 2~ and/or PART L_I 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 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 AMOUNT PAID Under penalties of erjury, I declare that the facts I have reported above are true, correc~cgt~Qand co to to the be of my kno ge and belief. HOME CZ ~ ~ ) ~~~ ~~JO / WORK ( ) DATE TOTAL (Enter on Line 5 of Tax Computation) # PENNSYLVANIA INHERITANCE T INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AN D PD Box zeo6pl. TAXPAYER RESPONSE HARRISBURG PA 17128-0601 eEV-ts~a a ~P coe-oe~ FILE N0. 21 ACN 10109122 DATE 02-17-2010 DAVID ANTONICELLI 5805 STEPHEN'S CROSSING MECHANICSBURG PA 17050 EST. OF HELEN ANTONICELLI SSN 178-22-7772 DATE OF DEATH 01-23-2o1D 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-named decedent, you were a point 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 forty 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 (717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 19792-04 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due Date 10-14-1977 Established $ 2,000.42 X 16.667 $ 333.41 X .045 $ 15.00 PART 0 CHECK C ONE BLOCK ONLY To ensure proper credit to the account, two copies of this notice must accompany payment to the Register of Wills. Make check payable to "Register of Wills, Agent". NOTE: If tax payments are Wade within three months of the decedent's date of death, deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent nine eonths after the date of death. L 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 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 vaid 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. Caeplete PART 2~ and/or PART 3~ below. PART If indicating a different tax rate, please state ~. relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ~ ~,~ ~~P' "~ ~ LINE 1. Date Established 1 ~ ,,,~,,,,,,,,,,~ ~~~ ~ ~~;' 2. Account Balance 2 $ . ; r. is ~ s. ~` ~„~ 3. Percent Taxable 3 X ~ 4. Amount Subject to Tax 4 S 5. Debts and Deductions 5 - ' 6. Amount Taxable 6 $ ( ` € `~~= ' 7. Tax Rate 7 X '~ ' €' ~' ' 8. Tax Due 8 ~ ~ `~ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, declare that the facts I have reported a^bove are t//,,r,ue~,/}eor c complete to the~est of my k wledge and belief. HOME C / ~ ~ ) (y'~~/'~~~ WORK C ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE TOTAL LEnter on Line 5 of Tax Computation) $ z R i ; L' i t;`i ; t, i ~~~I t V ~ 2t~~tt APR --~ PK 4~ 11 ~~w~~~~ ~'~URT CtI~R~ .. ' ~~ : t~! : f'p. .~-- ~ y ~ x r j ~ ~,... r' h cs"' ~ C/' ~' `~ a __-- ~ -- ~ (Q j' ., , .~ ~.J~ ~ ~- ~-~ ._~.~_ -