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HomeMy WebLinkAbout06-09-10 (2)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 NO. CD 012873 MCAULIFFE EMILY G 45 WEST VIEW CARLISLE, PA 17013 fold ESTATE INFORMATION: sSN: 383-40-0536 FILE NUMBER: 2110-0503 DECEDENT NAME: ORLOWSKY JAMES M DATE OF PAYMENT: 06/09/2010 POSTMARK DATE: 06/09/2010 COUNTY: CUMBERLAND DATE OF DEATH: 04/ 18/2010 REMARKS: CHECK# 2942 SEAL ACN ASSESSMENT AMOUNT CONTROL NUMBER 10125686 ( $1 1,462.69 TOTAL AMOUNT PAID: INITIALS: SAP REV-1162 EX(11-96) $1 1,462.69 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES ~,_ PO BOX 280601 ~ ~~ HARRISBURG PA 17128-0601 ~.,~.,~,~, ,. ti~~~E PENNSYLVANIA INHERITANCE INFORMATION NOTICE AND ``ter t~# TAXPAYER RESPONSE ,` , ,j ., n TAX FILE N0. 21 `~~'"~ JO~ ACN 10125686 DATE 05-06-2010 TYPE OF ACCOUNT Z~IO JUM `9 ~~ ~' ~~ EST. OF JAMES M ORLOWSKY ^ SAVINGS SSN 383-40-0536 ~ CHECKING (;~,~~~ Q~ DATE OF DEATH 04 -18 - 2010 XC~ TRUST Q~~P,~'~+cj t,~~JRT COUNTY CUMBERLAND ~ GERTIF. CU~vr~:~~_,f~vi~ fJ~~, ~~, REMIT PAYMENT AND FORMS T0: EMILY G MCAULIFFE REGISTER OF WILLS 45 WEST VIEW 1 COURTHOUSE SQUARE ~~ CARLISLE PA 17013 CARLISLE PA 17013 ~,~,- e ~~' ,LJ S~~ AS /~ ~ ~ ~ t f?~~ 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 accordan~:e with the Inheritance Tax laws of the Cnmmortvaa7.+h of.-- Pennsylvania. r'lease call c717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 282288-05 Date 03-30-2009 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ ZSU,4Jy.yJ payable to "Register of Wills, Agent". Percent Taxable X 100.00 NOTE: If tax payments are made within three Amount Subject to Tax $ 80,439.93 months of the decedent's date of death, ~ TaX Rate ~( ~ 1j deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due $ 12, 065.99 nine months after the date of death. PART TAXPAYER RESPONSE :.. :.f h:: :5' x>}n'f r 'r 'G`r'~:2,•~".":•'`:.'f l,' 'i f:' /'l l!;.`•,'•:'•f:iGf kry vrf ~ ' !.k ~:c/"'.: fl,,y 'o:,h': ~ .ly,• ;• f' r ' ,fl%' %' •f,:: ' ' :; " 'fh• ` .. 4"if ! ) ' r + s~. ~ `~ •' %< z ' % + rr , l.r, r ::i. p•: f . %` r, o.3irk 2 ; Gy e f:l `. i:S . rr•!;F;F':. %:/~ rY y54 ~.rrf.>,,.: .64ni.. :r.~ Y 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. ONE BLOCK B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY to be filed by the estate representative. C. ~ The above informa 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 '~~~'~/~f~;~~~ ~'' • . relationship to decedent: f ,.f•.,,:. max, r! s, °~• J~ ~,,.~y 'f'~F 1~~~~` G'l• ~~ 'rr f rrf ~•.`+,• : .~;:•;: y.:{: ~ :k. G TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ~ f•:~'~{`• l •~'~~'•~`~%f •:~`~" • ~.• r~"''' `: :'F .. =.:7.,: t': i»' ' fi %'!f ~../%~ f' ;#:: , G:,q:•!j`;ry;:: y LINE 1 . Date Established 1 •kf '' ~ ~'`~i f~f.,~`~` ,9'l' • ~•" ;,<;s•,: '•",'•ui: :i%: ;'% r:~ lt:f': G` ','4,°: i::7/f.'.` ':' :':rJ..u.::6 ~'~:Y:'ri ~',•4•:.c'''^•lP., f,:f` i?} .•`.:t~l ;~r ,f ' ` ` l'`frf'+i ~$'ji:%6'C4 •:~''.f:'•f. . r~': f'J , `~ ~:y .0 :~'p %fVF } f'":1,:4 2. Account Balance 2 ~'. ,~ 1,;: •~, ~>„ " f%i„ ,l ,l ~• ~~%1~'%..%~F y.., "f ' 1 •`• ` :r r~ "'/:. ro{9ff `rl' f/:L:. .1, '`'f i4.°F~,•%r' ;4~~/r •4: !!~~..~,N.l„~:, ~~41:~''f•'la f fa'4":"• %~'••:~;: X '^' °'sf o f f ~J• 'y.,cf X ./•6. ~•.. i'' `.e<%f,:y? ,.r'%. S:%:w'f,`!1`:. s,%r,' •R• l~;^,~if,,~; .r,/`~~n,'r.;;! f. lji • :..~!,,~'.¢rr •?r,,;%;rl 3. Percent Taxable 3 ~<;:~~;''~.h~,•,'r~. . :<, .. :.:lt,,l f.rr:. <i~'i'~.f:~al f • /i<f•.,f;;•!'li x,14 ,,:;,%,;.,;u, ~:::. f~n<~ : sy< .;,~?r•;:;<:?a~ .:, :'~„ ,~,~'~'~/,,,.~ :~ :;f.•.~,atf'..:'u~14,f;`s<~~....1 f%' ~'„r. ifr . 5:. $ :::c "•`/.,` ~ff...r,.l..:.l. .Jr + % ~....:.. //~ /l. fiff : p.Y •L•.'.,::";'/T;'..fv;,J~=4.. ~lh`':5:. ?.'.`::: 4. Amount Subject to Tax 4 ~~::~:°~r:~!~~•: ~ ' ,'1,14~~ 'S:f' !ir :y,.:f .;.~rsfl~fy~:%n5'4~:o~~F r`:z ~'ff'%`''s':~%l•'% )~<s'% ~:i:.~,,,luT.., r!f`•%i~:f r,~r' .% s' ,,,,:53,'• 'ors/9 sG.. %:.;::4c'/: • ~.' ' :f% `~•Y ~C. ~::..'v: - jf%r%"`'~:y!~~,'~. :><~/.,!l~"•1 i6 rsu:. y4</: f %:f:•:~~~~:~.~_',::. ~,1°.'~~ ~?r '~.w,l~ ;; ~;, r~er'~ .. .. . C/? 5. Debts and Deductions 5 '' ~`' .~ ``~'`~:`~}~:~:f:' fr•,rr ~• t~~`..,f. ~" 4~a:~ •.•r~,frr. {.,<:n,:.r5' '„i r':i~:... '<~i<c'r;ff.::r, ic';a!`;.~f! : y~.:;:~i •%r....l~:r#v~ f,l;,s,%`, y~~~fry~Try~?:,lkr/Y i% .:f/~r}% :.:.ffho`.~. t f' f '':; ` .,h.; ; !~'..ht %irf ~~ #i~7i'%r!':%:' f% :#f#~.:~ '~y'~l..,f.~/. ~.~' l ~a :~~il 6. Amount Taxable 6 $ ~~y,, r ~~~,"`.~s!,..~..:, r:: „~.::ul~,`:a;!::...;,:~>r .~.,.:f' :~1..4'f 4, r.`~~0'g.4 'kY': r //p :~~F;+'y?f;,~ it~/.. 1. '~'4'F2 i?.F%'F ,~i6.: l X •, :k~i.%:' >'~ s . sdy.4yGf. s<% d:.: ':f';'~,~.'``,'r~./•;,,3Gilr y :ff ,,,y4~1`' :'mi'l Sf~'''~rf: 7 r.~:~;!; ,:.yj4.y,f~'•/r~l:f!``~. ~~ .»•5'..s::<;or',y.;~>.f'`F::~'ll„%`'>;•s.`. •i. ;'X~ I";/E'f.~`! 7. Tax Rate f~ `•:r: ~f'7:,'ik:~'•k .ffr¢f'~f` l `~!: •rlflu•:y ~{i;/~rfi~r Jrv:,:4,' .cL.%' i ~ •rt ~"•;;1~' <:G'/•/x,,: $ 1:~.fr..,/':,,yr; ~' fr/., s%rf l i f!.fZ:f,.;! •%` /9f;fl':"fr p` ` t%%'%•??.moo":%.':~~ lfrFS.:}'`l`~ rjr~~•54~:'! ~'~~•'k%7,:,~~Y,r•,;'v%:~4'+'`~yf.~':: ~^'%{ ;:~ :'~a:"~':rf4:':,;'gl'''..r,S~fl<, 8. Tax Due .Fy%~~~.,f„~.~~'.f~~.~1..,_„ t.,,':> r...,~~f:> ::~`::;;:.;.,,.`•,. fl.:,:,,::,s:;;r~:<: PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, corOrect and lete to t bes o kn dge and belief. HOME C7~? )~ ! d ~'~ ~~ WORK C -- ) • ~/.• ©! D XPAYE SIGNATURE TELEPHONE NUMBER DATE TOTAL CEnter on Line 5 of Tax Computation) s