HomeMy WebLinkAbout05-17-10PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE _
BUREAU OF INDIVIDUAL TAXES AND FILE ND'. 21 ~'~--~'~~~~
PD Box 280601 _ -, ` -~`-~~TI~XPAYER RESPONSE ACN 10115761
HARRISBURG PA 17128-0601 ,.,
REV-1543 E% AkP"[08-119) ~ '" ~`~,' '~ '~ DATE 03 - 16 - 2010
~~~~ ~~Y g .~ p ~• ~~ TYPE OF ACCOUNT
EST. OF KATHERINE P MORTON ^ SAVINGS
SSN 138-18-9048 ® CHECKING
CL~~~ ;.~
.
.
DATE OF
DEATH 12-31-2009
^ TRUSr
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n nLa ",t C' n
i~1~ri+~iY v- ~~{~~ COUNTY CUMBERLAND ^ CERTIF.
`~
C~±." ,_~~_; .. ~ ~.'~~ CWT REMIT PAYMENT AND FORMS T0:
JEAN A NICHOLSON REGISTER OF WILLS
33 TANNERY ROAD 1 COURTHOUSE SQUARE
DILLSBURG PA 17019 CARLISLE PA 17013
WACHOVIA BK NA 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 ]Dint 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. 1148066712769 Date 06- 11 - 1982 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance 2, 907.02 payment to the Register of Wills. Make check
Payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 1,453.51 months of the decedent's date of death,
Tax Rate X . 15 deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due $ 218 • 03 nine months after the date of death.
PART TAXPAYER RESPONSE
FAILURE TO RESPQND 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
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.
ONE
BLOC K 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 information is incorrect and/or debts and deductions were paid.
Complete PART 2^ and/or PART ~ below.
PART
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 b- fl- ~ ~CsZ
2 S ~.q b'1.0 Z
s x sa • oc~v
4 $ ~ X53 = 5
s - t o ~S~ s!
6 $ ~~'~• uC'~
7 X 1t~• ~S
OFFICIAL-USE ONLY ^ AAF
PA DEPARTMENT OF REVENUE
PAD
1
2
3
4
5
6
7
a
PART
DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
If indicating a different tax rate, please state
relationship to decedent:
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowledge and belief. HOME C7l? ) SUZ'~'~
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T Y AVCD CTGMATIIDC TCI CDLI l1MC AIIIMIICD 7lATC
Debts and Deductions Claimed
$60.00 Jan 4, 10 Fuel trip to Florida for Funeral
67.50 Jan 5, 10 Fuel trip to Florida For Funeral
51.09 Jan 5, 10 Fuel trip to Florida for Funeral
62.00 Jan 5, l0 Fuel trip to Florida for Funeral
65.00 Jan 8, l0 Fuel Return trip from Florida
65.00 Jan 8, 10 Fuel Return trip from Florida
Could not find rest of receipts so less coming home
$ 32.23 Paid to Giant Grocery for ingredients for large Pasta salad for open dinner for funeral attendees
159.99 Public Grocery for chicken for dinner
217.03 Sam's Club for food, paper products, plastic utensils, etc for dinner
10.00 To send Fax to cemetery office for forms for burial
150.00 To Immanuel Chapel for use of church
50.67 Balance owed to Church of God Nursing Home Carlisle, Pa
75.00 For Minister officiating service Rev. Francis
$1065.5 I Total debts for funeral for Katherine Morton
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TOM
S DILLSBURG t
EXXON ~ ~
313 S. US Rt. 15 North ~ ~~
t ~ NELCOME TO
Dillsburg
PA 17019 I
~ ~ADLER TRAVEL PI_A?_A
,
Manager: Kathy 8athory
4 ~ ~ 118 W. ATLANTIC ST,
:MPDRIA VA 23847
DILLSBURG EXXON '~ 134-634-4312
DILLSBURG, PA ~
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WE~---~~~E Td SHELL 5
120 W ATLANTIC ST 4 529 88002C
5100114
DEALER: 4202628-OAT EAi'~IEGC$ E;{F'fsES~ ~ :MPORIA VA 23847
Descr. qty amount ~
i Descr.
- -- qty
amount
-
Prepay CA#05 60
00 ~ UNLE CA #03 19.657G 1,09
' ~SCf. ~a1:Y ~, Q 2.599/ G LL--
Sub Tota I 60
00 _______
--~
Prepay f=uel
-80.00
.
Tax ._.~_
~ ,µ; ~ , ~ #>13 ?Fi.t~i
~ b~7.50
.
l-OTAL 60 _ 00 ~ ~.~~~ ~ Sub Tota I -28.91
CASH~~ PCEPciY fl~l .~ Tax 0.00
THANK YOU FUR ---~
~ TOTAL --~5 _ 9 1
CHOOSTNG TOM'S EXXON -12.~0
TO.kal
Y CASH $ -28.91
STORE #36 T,3x ~~ r
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VITAL -12_.,~ EG# 0 03 CSH#
002 DR# O TRAN# 35390
REG# 0002 CSH# 005 DR# O1 TRAN# 24$83 ~
Cf'~ ~ -I2.50
01/05/10 11:26:05
ST# 110
O 1 /04 / 10 l 9:37:08 ST# 36 . _,
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FLYING .l
TRAVEL PLAZA
9933 State Rd. N52
San Antonio, FL 33516
01-05-2010 Invoice q 1U4C0363
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REF UNR
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1 UNLEAOEO REG
TOTAL FUEL
CODE DESC
c-165 PREPAY FUEL
10TAL kETURNIREFUN(I
Amount Tendered
CASN
0503)
OTY }'RICE ANNT
23.856 2'199 62.00
62.UO
OTY PRICE ANNT
1 40.00- 80.00- N
18.00-
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Thanks far Choosing
RACEWAY #957
Florenco, SC 29592
TP45194637-992
RACEWAY95?
1891 W LUCAS STREET
FLORENCE SC 2958
DATE 91/98/18
TIME
AUTH# 425966
VISA
MORTON/ KATHERINE
PUMP PRODUCT PPG
99 REG X2.559
GALLONS TOTAL
26.492 X65.99
PLEASE COME AGAIN
Welcome to
KANGAROO E;~PRE.:>,;
312 W Brownlee
Starke FL 32']91
STORE II 1294
COPY
RecelPt 1680353
I---------------
`-Qty Name I'~ ice Total
i~ 1 UNLEADED b5.00 oS.uC~
Pump - 'q
(,allons 23.730
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REFUNp
TRANSACTION
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O u1i~y s +CCfiorra, Sovin~s, Every Day.
visit us on the Internet
www.GiantFoodStores.cor,
My goal is to ensure your satisfaction .
every t Us you shop with us. If there ~
is anything Wore I can do to improve
your experience please call or• write.
Don Lyter, Store Manager
Giant Food Store #310
B30 N. US Route 15
Dillsburg, PA 17019
Store Telephone: (717) 638-1230
Pharaacy Telephone: 1717) 638-1234
01/04/10 11:06AM
THANK YOU 48$00000000
BRTLI OIL 25.52
2 @ 1.09
BLK PEARL OLIVE
GNT OLIVES 1002
2 @ 4.29
PEPPERONI MINIS
HARD SRLRMI
1,11 lb @ 2.49 ;lb
ITAL. PLUM TOMAT W
GREEN PEPPER W
SC BONUSBUY SAVING5
Prlce you pay
SARGEN SL PRUL
SC BONUSB"v SAVINGS
~rlce you pay
2.18 F
1 .99 F
8.58 F
1 .38 F
2 . "7 6 F
B(: 2.83 F
.43-F
2.40
BC
3 . "t 9
3.99 F
.20-F
~,E BEFORE SAVING; 32.86
YOUR TOTAL SAVINGS 63
TOTAL AFTER SAVINGS 32.23
TAX PAID 0
****TOTAL 32.23
CASH
CHANGE 7.77
TOTAL NUMBER OF ITEMS SOLD 10
1/04/10 11:06 AM 0310 O8 0033 217
~****~ BONUSCARD SAVINGS SUMMARY ~*~~~
BONS'
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The UPS Store - #6039
916 D West Atlantic Street
Emporia, VA 23847
(434) 348-3581
01/05!10 11:43 AM
Savings Made Simple
CLUB MANAGER RALPH LA TL
( 727 ) 791 - 8081
Fax and Pull Tt (727)797-9742
E40
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01 /06/10 12:40
62
6420
006 3017
W HEMBER 101-+~*~1~*tltt2389
T HANK YOU,
LI VING PROOF MINISTRIES
E 82097 SHEDDS 300 T 7
52 N
923131 6 7/8 PLAT .
13
33 T
E 673974 COLE SLAY .
9
27 N
E 673974 COLE 5LAW ,
4
27 N
E 256435 2X MILK ,
2
77 N
E 726874 LEMONADE Q .
5
72 T
E 210578 LEMON TEA .
4
88 N
102651 SAGE PLAT 5 .
12
49 T
5
9 .
98 T
7
E 27005 CHOC
BRW E .
8
88 N
E 72553 RED GRA S .
86 N
7
E 725545 GREEN PES .
7
86 N
E 996875 RUGALAH '
88 N
6
E 996875 RUGALAH '
E 138170 MINI CO IE 5
98 N
E 908221 LEMON B DT .
6
98 N
E 968794 FRITOLA 2PK .
5
98 N
E 968794 FRITOLA 2PK .
5
gg N
372754 NAPKIN ,
12.66 T
738766 CUTLERY 9
42 T
E 138170 MINI COO IE .
5
98 N
E 206071 PINE SPE S .
3
98 N
E 22457 ITALBREA .
3
47 N
E 908221 .
6
98 N
LEMON BU T .
E 811291 DINNER R L 4.88 N
E 811291 DINNER RO L 4.88 N
E 130103 SALSA 6
97 N
E 130103 SALSA .
6
97 N
912979 BATTERIES .
12.68 T
0%AL
5 211.86
TAX 1 7
0
OTAL
CASH TEND 20.00
CHA DUE 2.97
~ ITEMS OLD 30
TCt 9996 5543 3 3 3374 34 42 8
1~1~111~~111~~11i fIl1~Q1~111111»IIIN~nINl111111
We are the one stop for all your
shipping, postal and business needs.
We offer all the services you need
to keep your business going.
001 500059 (018)
Fax - 1st Page
003 500060 (018)
Fax - Add'1. Pages
Reg Unit Price ~
TO $ 2.00
TO $ 8.00
QTY 8
1.00
SubTotal 10.00
Total $ 10.00
Cash $ 10.00
Receipt IO 83189588878415888386 009 Items
CSH: Angie Tran: 0769 Reg: 001
Thank you for visiting our store.
Please come back again soon.
Whatever your business and personal
+-needs, we are here to serve you. U
t'~ ~ f~(~,~S -~'o o IJ I,cl J~-
WE VALUE YOUR OPINION
WE WANT TU KNUW ABOUT YOUR SHOPPING
EXPERIENCE TODAY AT SAM'S CLUB
Please complete a survey about today's dub visit a!.
hMu:ltQwww. survey. s ams club. c om
ON OF FWE sly SAM UB 3FIOPPING ARDS
You must be 18 or older and a legal resident of the
United States to enter. No purchase necessary to wm
To enter without purchase and for official rules visit.
www_entry. survey.samsolub. com
~~reepstakes period ends on the date shown in the
otlrcial rules. Survey must be taken within TWO weeks
of today.
Esla encuesta IambiAn se encuentra en espaftol en la
paging de Internet.
Benefit Checking
04 1148066712769 031 30 0 9 66,449
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RTTENTION CUSTOMERS: TH1S PAGE IS BEING PROVIDED
AS PART OF YOUR MONTHLY STATEMENT BECAUSE WACNOVIA
RECEIVED A CHECK IMAGE FROM ANOTHER FINANCIAL INSTITUTION
!N PLACE OF AN ORIGINAL CANCELED CHECK(S). THE FRONT OF
EACH CHECK IS DISPLAYED A5 AN IMAGE. TH1S PAGE WILL APPEAR
IN YOUR STATEMENT ANY MONTH WE RECEIVE A CHECK IMAGE.
01/15/2010 thru 02/12/2010
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OS 1148066712769 031 30 0 9 68,977
ATTENTION CUSTOMERS: THIS PAGE 1S BEING PROVIDED
AS PART OF YOUR MONTHLY STATEMENT BECAUSE WACHOVIA
RECEIVED A CHECK IMAGE FROM ANOTHER FINANCIAL INSTITUTION
1N PLACE OF AN ORIGINAL CANCELED CHECK(S). THE FRONT OF
EACN CHECK /S DISPLAYED AS AN IMAGE. THIS PAGE WILL APPEAR
IN YOUR STATEMENT ANY MONTH WE RECEIVE A CHECK IMAGE.
12/16/2009 thru 01/14/2010
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