Loading...
HomeMy WebLinkAbout12-17-10COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: TAYLOR MARY 1 144 STONE CK DR HUMMELSTOWN, PA 17036 -------- fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: SSN: 109-18-7752 FILE NUMBER: 2110-1236 DECEDENT NAME: BAGGERS LOUIS C DATE OF PAYMENT: 1 2/ 1 7/2010 POSTMARK DATE: 1 2/ 1 5/2010 COUNTY: CUMBERLAND DATE OF DEATH: 1 1 / 19/2010 ACN ASSESSMENT CONTROL NUMBER AMOUNT 10168632 ,129.17 10168633 ,~ 536.39 10168634 ~ ~; 262.67 10168635 ~ ~; 128.68 10168636 ~; 275.01 10168637 ~ $338.52 10168638 ~ $256,18 TOTAL AMOUNT PAID: REMARKS: CHECK# 51 1 SEAL INITIALS: DB S 1, 926.62 RECEIVED BY: GLENDA EARNER STR,ASBAUGH REGISTER OF WILLS REV-1162 EX(11-96) NO. CD 013798 REGISTER OF WILLS BUREAU OF INDIVIfDIJAiL' ~1~(ES'`1; ~~', ~ ,.=?( PO BOX 280601 ~ ~ ~ '-'' ~~ HARRISBURG PA 171,28'=gC01~ _~ +' ^ _ ' k t°' , REV-1543 EX AFP (08-08) ACN 10168632 DATE 12-03-2010 ~~ ~ Q ~~C j 7 ~~ ~~~ ~ 6 G~~~~ ~~ 4RPHA~4'S ~t~URT CI~~P~.!C'~ ~~ , PA, MARY S TAYLOR 1144 STONE CREEK DR HUMMELSTOWN PA 17036 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST F C U 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 ]oint 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 C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 3157-47 Date 11-09-1954 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 6 ~ 047.29 payment to the Register o1= Wil.ls. Make check payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject t0 TaX ~` 3 ~ 023.65 months of the decedent's elate of death, Tax Rate ~( , 0(f5 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due $ 136.06 nine months after the date of death. PART TAXPAYER RESPONSE ~ FAILURE TD RESPL~ND 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 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. 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 incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3~ below. PART If indicating a different tax rate, please state OFFICIAL USE ONLY ~ AAF' relationship to decedent: 2 PA DEPARTMENT OF REVENUE \\~` ....\~ TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established 1 1 2. Account Balance 2 $ 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ Cf 5. Debts and Deductions 5 5 ~~~ 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 7 8. Tax Due 8 +~' $ PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID PENNSYL~/ANIA INHERITANCE TAX INFORMATION NOTICE AND TAXPAYER RESPONSE EST. OF LOUIS C BAGGERS SSN 109-18-7752 DATE OF DEATH 11-19-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 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 C ~~) ° ~l'~" ~C'' ~ ~~ l~ TAXPAYER SIGNATUR TELEPH NUMBER 1 ~ ~-lr' DATE TOTAL CEnter on Line 5 of Tax Computation) ~ BUREAU OF INDIVIDUAL TAXES PO BOX 2806D1 __ HARRISBURG PA 17128-06'01- - ~.. ,,;~•~ PENNSYL4/ANIA INHERITANCE TAX INFORMATION NOTICE AND TAXPAYER RESPONSE FILE N0. 21 - ~L ~~ ~~ ~ ~:~~~ ACN 10168633 DATE 12-03-2010 ~'~1I ~ ~~C 17 a~ !4~ ~ 6 C~E~C n~ Q~~J~C~~ CU~~ ~~~~ ~~ , PA MARY S TAYLOR 1144 STONE CREEK DR HUMMELSTOWN PA 17036 EST. OF LOUIS C BAGGERS SSN 109-18-7752 DATE OF DEATH 11-14-2010 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 F CU 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 PAYMENT INSTRUCTIONS Account No. 3157-52 Date 07-24-2002 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance 25, 094. $5 payment to the Register oi` Wil.ls. 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 $ 12, 547.43 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 $ 564.63 nine months after the date of death. PART TAXPAYER RESPONSE ~ FAiLD~2E TO~~~RESPOh1D WILL RESULT IN AN fFFICIAL 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 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 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 intorma ion is incorrect and/or debts and deductions were paid. Complete PART l-~ and/or PART 3~ below. ~~~~ PART If indicating a different tax rate, please state OFFICIAL USE ONLY ~ Ali relationship to decedent: D PA DEPARTMENT DF REVENUE TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established 1 1 2. Account Balance 2 $ z 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ C} 5. Debts and Deductions 5 - 5 6. Amount Taxable 6 $ 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 complete to t e best of my knowled a and belief. '7/~)~~~~.-~:~ `~ ~, ~~ HOME C ~ , j ~,, r;°, ~.~~- y- , ~ - ~-~-~ ~-- „~.-~~ : WORK C j(,h~' ) _ ' TAXPAYER SIGNATURE ~' TELEPHONE NUMBER DAT TOTAL CEnter on Line 5 of Tax Computation) 5 BUREAU OF INDIVIDUAL TAXE& PO BOX 280601 y"~~ ~•.. HARRISBURG PA 17128-0601 "" WR~wl~43~~ AFP~~Qg~08) PENNSYLVANIA INHERITANCE TAX INFORMATION NOTIt:E .AND TAXPAYER RESPONSE FILE NO. 21 ~~~ _~~,,~. ACN 10168634 DATE 12-03-2010 ~~~o ~~~ ~ ~ a~ ~o: ~t ~ ORPHA RAC fit- T ~ViViC7~~~~~ ~~~1 ~~. , PA MARY S TAYLOR 1144 STONE CREEK DR HUMMELSTOWN PA 17036 EST. OF LOUIS C BAGGERS SSN 109-18-7752 DATE OF DEATH 11-19-2010 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 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 C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 3157-54 Date 08-26-2002 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 12, 288.74 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to Tax ~` 6, 144.37 NOTE: 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 ~- 276.50 Any Inheritance Tax due will become delinquent nine months after the date of death. PART TAXPAYER RESPONSE 0 FA~LI'1R~~TO DESPOND W°I'LL RESULT IN AN OFFICIAL TAX ASSESSMENT A. ~f71 The above information and tax due is correct. `'LI 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 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 incorrect 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: OFFICI,~L USA OI+~iY [~ AAF, PA DEPARTMENT OF REVENUE \ TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established 1 1 2. Account Balance 2 $ 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ 4 ~~~ 5. Debts and Deductions 5 - 5 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 7 8. Tax Due g $ 8 PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE iIFSCRTPTTnu ...~...._ _ _ __ 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 C`~ <> > ~-~~G>-- ~-~~> 1 TAXPAYER SIGNA URE TELEPHONE NUMBER DAT BUREAU OF INDIVIDUAL TAXES PO BOX 280601 ~ -- HARRISBURG PA 17128-O~OI `i~, ~~ ^"~ 4. ~i R~•Y 1543 `~QX ~1FP;(08-08) PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE AND TAXPAYER RESPONSE F I L E N O. 21 ~- 1 ~.~ - ~ ~~ ACN 10168635 DATE 12-03-2010 dF~}o ~~ c ~ 7 are ~a. ~~ ~~ Ct~RK ~F ~-~AN S ~.C3l~RT CU?E~~ ti'~J ~~. , PA. MARY S TAYLOR 1144 STONE CREEK DR HUMMELSTOWN PA 17036 EST. OF LOUIS C BAGGERS SSN 109-18-7752 DATE OF DEATH 11-19-2010 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 F CU 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 C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 3157-56 Date 10-12-1999 To ensure proper credit to they account, two Established copies of this notice must accompany Account Balance $ 6 ~ 020.42 Payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to Tax $ 3 ~ 010.21 NOTE: 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 $ 135.46 Any Inheritance Tax due will become delinquent nine months after the date of death. PART TAXPAYER RESPONSE FAILUR(~ TQ RESP,O~ID WILL ~ESI~LT iN AN OFFICIAL TAX ASSESSMENT: A. 1 R'The above information and tax due is correct. LJ 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 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 incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3~ below. PART If indicating a different tax rate, please state relationship to decedent: ~FFICiAL USE OhU:Y ~ AA,F TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PA DEPARTMENT OF REVENUE \~ PAD LINE 1. Date Established 1- 1 2. Account Balance 2 $ 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ ~ 5. Debts and Deductions 5 - 5 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 7 8. Tax Due g $ 8 PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE ilF~f'RTPTTf1A1 ..._...._ _ _ __ 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. TAXPAYER SIGNATURE ,. ( ~ ~~ ~C~ TELEPHONE NUMBER DATE BUREAU OF INDIVIDUAL TAXES PO BOX 280601 __ HARRISBURG PA 17~~28r06p1'" ' - ..J :- _. ~ .- ~~ ~ .,qEd ;'~~343~ E*D( AFP (08-OB) ~i~ ~C~ 17 Ah 10~ ~~~ pG1.ERK ~~F QRI"~""~~~5(lE.~t(~~L~R i~ MARY GU~~~~,~"OR"~,, PA, 1144 STONE CREEK DR HUMMELSTOWN PA 17036 PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE AND FILE N0. 21 _ TAXPAYER RESPONSE ACN 101686'36` u~~ DATE 12-03-2010 EST. OF LOUIS C BAGGERS SSN 109-18-7752 DATE OF DEATH 11-19-2010 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 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 C717) 787-8127 with question.. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 3157-60 Date 05-04-2006 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 12, 866.43 payment to the Register of Wills. Make check payable to Register of Wills, Agent". Percent Taxable )( 50.000 Amount Subject to Tax NOTE: If tax payments are made within three $ 6,433.22 months of the decedent's date of death, Tax Rate )( .045 deduct a 5 percent discount on the tax due. Potential Tax Due $ 289.49 Any Inheritance Tax due will become delinquent nine months after the date of death. PART TAXPAYER RESPONSE 0 FAIL Tfi RESPI~M~°~,Mi~LL ~2ESU1.T IN AN L~FFICIAL TAX ASSESSMENT A. I VThe above information and tax due is correct. L~ 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 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 incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART ~ below. PART If indicating a different tax rate, please state a relationship to decedent: Ci~~~CIAL USE Oh~LY ~ AAF TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PA DEPARTMENT OF REVENUE PAD LINE 1. Date Established 1 1 -° ~~ 2. Account Balance 2 $ 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ 4 5. Debts and Deductions 5 - 5 6. Amount Taxable 6 $ ~ 7. Tax Rate 7 X 7 8. Tax Due g $ ~ PART DEBTS AND DEDUCTIONS CLAIMED a DATE PAID PAYEE T1FCf RTpTrnu _.._...__ _ 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 ( ~ i~ ~ 5~~."~'~3 ~ ~, ~j'h ~~'~{ ' t. ~~~. ~ C-irj ~ /~'~ WO R K C PLA,~ . ~ ~ ~ - l L~ TAXPAYER S GNATURE TELEPHONE NUMBER DATE PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES. , AND F I L E NO. 21 ~ ~ (; - ~ Z ~~, Po Box 2so6o1 ~- ~ TAXPAYER RESPONSE ACN HARRISBURG PA ln2s-o6ol '_ 10168637 _. ~ ,,;,, REV 1543"EX`AFP (OB-08) ~`{~-~ ~~~ ~~~ '~'~ }} DATE 12-03-2010 ~~~0 ~E~ t 7 A~ i~= 4b CLERK G~ C}RPNA!`J'S v~~~~T CUNl~FP~N~ ~~ , PA MARY S TAYLOR 1144 STONE CREEK DR HUMMELSTOWN PA 17036 EST. OF LOUIS C BAGGERS SSN 109-18-7752 DATE OF DEATH 11-19-2010 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 F CU 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) 787-827 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 3157 - 72 Date 11 - 09 -1954 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 15,837.16 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable )( 50.000 Amount Subject to Tax $ 7, 918.58 NOTE: 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 $ 356.34 Any Inheritance Tax due will become delinquent nine months after the date of death. PART TAXPAYER RESPONSE FAiLUR,~~~Tt~°~~tESPO1+iD° WILL RESULT IN AN OFFICIAL TAX ASSESSMENT A• ~~j/rhe above information and tax due is correct. uu 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 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. PART If indicating a different tax rate, please state a 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 Deductions 5 - 6. Amount Taxable 6 $ 7. Tax Rate ~ X 8. Tax Due g $ OFFICIAL USA ONLI~~~° ~~°AAF PA DEPARTMENT OF REVENUE PAD 1 .~ > 2 3 ' 4 5 6 7 r r-)c i DATE PAID C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART ~ below. PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) $ Under penalties of perjury, I declare that the facts I have reported a ve are true, correct and complete to the best of my knowledge and belief. -~' ~~ ~- HOME C ~ 7 ~ rD ~v~~ ~ j' ~~ -~ ~ ~ WORK C~-~N TAXPAYER SIGNATURE ~ - ~ /G' TELEPHONE NUMBER DATE rtnn~Y~VANIA INHERITANCE TAX INFORMATION NOTICE .-~, - cr~~~, Bug1~-~ oF.-;~N~{YI~tWf'{TAx~s" AND F I L E PO BOX 280'6pl ~. , ~„ HARRI„~S~.pQ~"~P~i~=,~28-.~~~I TAXPAYER RESPONSE ACN l REV-1543 EX AFP (08-OB) DA T E ~o ~ ~ o~c ~ ~ ~M 14~ ~~~R~~ ~~~~~ 4RP1~~S ~ ~~ . PA. cu~~~~- MARY S TAYLOR 1144 STONE CREEK DR HUMMELSTOWN PA 17036 EST. OF LOUIS C BAGGERS SSN 109-18-7752 DATE OF DEATH 11-19-2010 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 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 (7l 7) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 3157-75 Date 11-09-1954 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 11 , 985.12 payment to the Register of Wills. Make check Percent Taxable payable to "Register of Wills, Agent". X 50.000 Amount Subject to Tax $ 5, 992 . 5b NOTE: If tax payments are made within three Tax Rate months of the decedent's date of death, X . 0 4 5 deduct a 5 percent discount on the tax due. Potential Tax Due $ 269 . b7 Any Inheritance Tax due will. become delinquent nine months after the date of (ieath. PART TAXPAYER RESPONSE FAiLUR~.TO RESPOND 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 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 u below. DADT TF n.d{ ..~: -- -•~--..~.~~~y a u~r~eren~ tax rate, please state a relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 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 0 NO. 21 _ ! L -I Z~4; 10168b38 12-03-2010 1 2 3 X 4 5 - 6 $ 7 X 8 DATE PAID PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) S 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 ( ~/ } ~~~ ~~' ~ ~ ~:. TAXPAYER SIGNATURES -- ! . ~ ~ TELEPHONE NU DATE I PAL OFFICIAL USE DNLY [~ AAF PA DEPARTMENT DF REVENUE 1 _ 2 3 4 5 b 7 ~;`±``a `,~. ~ .. "~`` ,.,~ ~.,. ~~ ~ ~ ~>>~ ~ ' \ ,. '`til (~`"`^ a ~, `t ±~a rn ~ 3 ~ ., :~=~ fJ ~ ~ .• r "`` ~' ~;- ;-.:. .~ 3, ,j q..:. _ »~ i~;i•i ~i~ ;jj+t •t`S `~,~} ~~~~~ ~~ ~ _~j ~. .~~ , ~. ~~.: ~_ ~ ~ 1 ..rw ~~ www ~1.n+ M riM A~w~ o~ ~o r r ~n y~ O O ~ ~'+ p n m m~ r~~ `~~ -~~ Q i r O ~ G o~ 9~r~'~ C ~G ~~ ~ Z = ~ ~o ° ~~ 9 a