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Home My WebLink About04-29-10,..:. i~~ i {..:. i.~ t F~~ i c,)a ;•..~ ~, (~ ~ ~ ~~~) ~~ ~ ~~ ,`` `O r,~ ~` 0 ~ ~ ~~ ~~ ~ ~j`\~~`. ~\ ~\ I '~`,' ~~\i ~, ~~\\ ~ V ~~ 1~1"~~ ~~ ~ '~ Nd~Q ,~ ~;~31~ i Q :~~ ~~ 6z ~d~ osoz ~ ..~ ~ rr ~ i ,~ „~ ~ ~ ~~ ~ ~, ~ r ~ ~ ~~ ~~.. ~~ ~ ~ ~; ~~ ~~r \\ ~ 4~ i t r~: ~~ "#E 1 eft., +,:` ~?tf i, f ~f; v ~7 ` M ~S ;~ -; ..;. ,.x F }r :(' ',Y 4 ~, ,.~- 'A.'. 'a - ., aiyMi... PENNSYLVANII~ INHERITANCE TAX INFORMATION NOTICE ,/ BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21"~(~~ C'~~`1 Po Bax zeo6ol '"'~==i'';i= {~'`AXPAYER RESPONSE ACN 10111152 HARRISBURG PA 17128-0601 _ - ,* ~'* REVISED NOTICE * * * DATE 04-20-2010 REV-1543 SEX-AFP"ca8~ue> ~.. ~ii~~~~'~i~~ ~~~~ ~~ nt ,_-•-rtr ~r~ ~ - l.i:_~~` `~ i ~~``I-~.' ." ~;~ ITT KATHRYN A SIMMONS 65 SUSSEX RD CAMP HILL PA 17011 EST. OF JANE M SIiANKS SSN 182-;?2-8372 DATE OF DEATH 0;?-03-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILL:i 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. FARMERS & MERCHANTS TRUST CO 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 joins: 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) 787-6327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMEWT INSTRUCTIONS Account No. 34-56102 Date 11-16-2006 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance payment to ache Register of Wills. Make check $ 6 295 70 " . , payable to Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to Tax NOTE: If tax payments are made within three ~` 3 147 85 ~ . months of the decedent's date of death, TaX Rate ~( , 1rj deduct a 5 percent discount on the tax due. Potential TaX Due Any Inheritance Tax due will become delinquent $ 472 18 . nine months after the date of death. P T TAXPAYER RESPONSE ~ ~ FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT. A. ~ The above informationand tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain C H E C K 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 BLOCK B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return O 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 TAX If indicating a different relationship to decedent: RETURN - COMPUTATION OF tax rate, please state TAX ON JOINT/TRUST ACCOUNTS OFFICIAL USE ONLY ~ AAF PA DEPARTMENT OF REVENUE PAD - LINE 1. Date Established 1 _ 1 2. Account Balance 2 +fi 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ 4 5. Debts and Deductions 5 S 6. Amount Taxable 6 $ 7. Tax Rate 7 X 7 8. Tax Due 8 $ g PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and om lete o the best of my •,knowledge and belief . HOME C 7/7 ) ~ 7'~ ~ ~(~ ~._~,d W O R K C ) ~j i4XPAYER SIGNA URE TELEPHONE NUMBER AT TOTAL (Enter on Line 5 of Tax Computation) $ ~~ _ _ _ __ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAIJ'OF INDIVIDUAL TAXES ~ ~- ~•'~-'~[ ~~';~ AND FILE N0. 21 ~~~ ~.:`7~7 Po Ba ; zaB6o1 :;'TAXPAYER RESPONSE ACN 10111153. HARRISBURG PA 17128-0601 °'-- '° ~ * * REVISED NOTICE * * * DATE 04-20-2010 REV-1543 E% RFP (OB-D8) 2Qa~ p~:~~ 29 ~~ I!' 20 -~„ ,~.~- ._ KATHRYN A SIMMONS 65 SUSSEX RD CAMP HILL PA 17011 EST. OF JANE M SHANKS SSN 182-22-8372 DATE OF DEATH o2-03-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. FARMERS & MERCHANTS TRUST CO 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 (717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMEINT INSTRUCTIONS Account No. 71-36099 Date 11-07-2008 To ensure proper credit to the account, two Establ ished copies of this notice must accompany Account Balance $ 10,695.49 payment to the Register of Wills. Make check Percent Taxable payable to "Register of Wills, Agent". X 50.000 Amount Subject to Tax $ 5, 347.75 NOTE: If tax payments are made within three Tax Rate months of the decedent's date of death, ~( lj deduct a 5 percent discount on the tax due. Potential Tax Due $ $02.16 Any Inheritance Tax due will become delinquent nine months after the date of death. P~r 1 TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX AS5E55MENT A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain C H E C K a discount or avoid i nterest, 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 Inheritance Tax return to be filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were Fraid Complete PART 2~ and/or PART 3~ below. . -• ~••~~~~~+~~y c •+iiin~ari~ pax race, Please slate relationship to decedent: TAX RETURN - COMPUTATION OF TA OFFICIAL U5E ONLY ~ AAF PA DEPARTMENT DF REVENUE X ON JOINT/TRUST ACCOUNTS ~ PAD LINE 1. Date Established I 2. Account Balance 2 3. Percent Taxable 3 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 X 7 8. Tax Due 8_ $ ~ rj/`-~ 1 $ PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DFSI'RTPTTf1N ....,,,.,r .,._... - ~ ~~rrr ~ yr rax computation) 8 Under penalties of perjury, I declare that the facts I have reported above are true, correct and com lete ,to the best of my ~owledge and belief. ~/.y ~ ~ HOME C z-%"'I~ WORK C ~ o? / n XPAYE SIGNATURE TELEPHONE NUMBER qT `~ Shippensburg Health Care Center 121WALNUT BOTTOM ROAD SHIPPENSBURG, PA 17257 (717)530-8300 Jane Shanks 01612 Jane Shanks 136 Cottage Rd Shippensburg, PA 17257 Balance Due: 1,680.00 Payments/ Charges Credits 01/Ol/i0 Balance Forward ---"--'"-"' 02/01/10 Rev Last Mo RC 01/26/10 ROOM AND BOARD 02/01/10-02/28/10 0.00 0.00 5,880.00 PVT 02/01/10 ADV R(70M AND BOARD 01/26/10-01/31/10 PVT 02/01/10-02/28/10 1,260.00 5 88 02/01/10 ROOM AND BOARD PVT 02/01/10-02/0'2/10 , 0.00 420.00 NOTES ~~~ ~ ~: ~ ~.~.,~i'1d~^ _ ~2 '~~ .- \:~ NO. O +t O ~ U S ~~ RECEIVED FROM ~ ~r'~^ ~ 1 ~~ ~" FOR C ~~ d~ NT H OW PAID A AMT. OE CCOU ~~ ~ L ~ ACCOUNT CASH "" ~.. (~ AMT. CHECK PAID BALANCE MONEY _ ~ / BY " _~ Off, DUE ORDER 02001 ~~• ® 8L808= Jane Shanks 01612 Please Remit: 1,680.00 ~'~- v` ~ )~'~ ~~