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Home My WebLink About01-19-11BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 - ~~•-~~ PO BOX 280601 I TAXPAYER RESPONSE ACN 10147079 HARRISBURG PA 17128-0601 DATE 08-25-2010 REV-1543 E% AFP (OB-OA) ~L i ~_i~l ~fl. ~~lfj~ [~~ l ~~~d ! 9 W~~i ~ I' W TRUDY CAPAZO C~~~~ ~~ 187 ASHFORD DR ORPF;,~Pv~S CDURT ENOLA PA 1,~'~I_.';~P'J~) (~~, P~; EST. OF RUTH M CAPAZO SSN 300-38-4033 DATE OF DEATH 07-08-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. ORRSTOWN BANK 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 tali C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 103003372 Date 04-09-2002 To ensure prover credit to the account, two Established copies of this notice ^ust accompany payment to the Register of Wills. Make check Account Balance $ 4 ~ 787 • 74 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax y~` 797 • 97 months of the decedent's date of death, Tax Rate ~( • lj deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due $ 119 • 70 nine months after the date of death. PART TAXPAYER RESPONSE 0 FAILURE ?0 RESPOND MILL 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 a discount or avoid interest, or check box "A" and return this notice to the Register of C H E C K Wills 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 revresentative. 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 OFFICIAL USE ONLY ~ AA>= PA DEPARTMENT t3F REVENUE PAD 1 2 3 4 5 6 8 , 8 PART nArc owrn PAYFF DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID ....._~•O-O 1 ~ 7 Z rr..r.. .. i ; G of Tar Cemoutatl0n) & 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 1~1 ) 5~ 0 - ~~ l~ WORK ( ) ~ II /l-t, ~ ~~ TELEPHONE NUMBER DAT TAXPAYER SI NATU E Forth PB-01 ~ ~ . ~~~~~ 100 MOUNT ALLEN DRIVE, MECHANICSBURG, PA 17055 RESIDENT # UNIT STMT. DATE 80705 258 W 09/30/2010 RESIDENTS ~ Mrs. RUTH M. CApAZO VON\IE CAPAZO 187 ASHLAND D~~` E TOTAL AMOUNT DUE X0.00 E\OLA, PA 1702 DATE DUE 10/31/2010 S ___ __ ._ Daysi CHARGES CREDITS BALANCE - RATE ;, Units ~ 5,760.62 _- DESCRIPTION DATE Balance Forward 5,760.62 0.00 09/20/2010 PAYMENT RECEIVED - TANK YOU!!! OVER 90 OVER 120 TOTAL AMOUNT DUE OVER 30 OVER 60 Q.00 ~Q.Of RESIDENT # CURRENT 0.00 Q.QQ 0.00 0.00 Forth PB-0, 80705 MA RESIDENT NAME Mrs. RUTH P~• CAPAZO Please make check payable to vlessiah Village. tment has not been received by the due date. Thank you'. A 1% finance charge ma}° be assessed on accounts for which pa} concerns about your bill, please address them directly to Fiscal Services at 790-8220. Thank You! .~..,,,, ha~~e anv questions or 'f i . 1 ~i ~.+L:' ~- t ~~ L: t . ,1'.:.'1 ,~ i a r f a~ ,ai$:F~ d~ ~~ , J }~~ Or~~' t~. ~~: s~ ~; fw : ,~~ ~:.; ~ ,; k:• ts, f o ~', t~. :1` ~^ /AO~ ~~ y J 1 _ 3 ~ .. ~ ~ ~ O ~ ~" i.i p• ~ Sg ~ { ~ ~ ~ ;` `3 ~ ~_'~ ~. - .~ 00 N ~^ Ga ~ b o0 ~L~ Q ._ ~ ~ a pro ~; w -~