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Home My WebLink About01-14-11PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AN D Po Box zao6ol TAXPAYER RESPONSE HARRISBURG PA 17128-0601 REY-1543 EX AFP (OB-08) FILE N0. 21 - ~ ~ - ~~~ ACN 10147078 DATE 08-25-2010 YVONNE J CAPAZO 187 ASHFORD DR ENOLA PA 17025 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 SgUARE 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 call 1717) 787-5327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 103003372 Date 04-09-2002 To ensure proper credit to the account, two Established copies of this notice must accompany 4 ~ 787.74 payment to the Register of Wills. Make check Account Balance $ payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax ~` 797.97 months of the decedent's date of death, Tax Rate X ~ lrj 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. P~T TAXPAYER RESPONSE 1 ~ ~\ ~ ~~ ~ ~` A. ^ The above information and tax due is correct. ,_ Remit payment to the Register of Wills with two copies of this notice to ain ---•~ ~] C H E C K a discount or avoid interest, or check box "A" and return this notice to ~gister of^µ ~~~~~~ ONE Mulls and an official assessment will be issued by the PA Department of Rg~. vy~ , '. •-~ __~_~C7 B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsvlvan~ ~h~tance Tax return _-~ ONLY to be filed by the estate representative. ~_~, ~ ~ ,C' :_~:~ C. dThe above informs ion is incorrect and/or debts and deductions were paid. ~ -'' ~..~~~~ Complete PART ~ and/or PART ~ below. -,~~^;--~ ,, -r ~.. 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 \ ,,\\\ \ \~p p 4. Amount Subject to Tax 4 $ \ ,\\\\ \\,~ p 5. Debts and Deductions 5 - \ \ \ \\\. \ \\\ '•~ 0 6. Amount Taxable 6 +~ ~ \ \\~~~ \\ 7. Tax Rate 7 X ~~~ ~\ \ ~~ 8. Tax Due 8 ~` ~ \ \\~ . ~ ~ ~ ~ ~:. PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID 4 D a0l0 ; ; ~ -- ~vrn~ ~r=n~cr- vn Lane 7 ~T IaX GOmpULaLlOn) $ Under penalties of perjury, I declare that the facts I have reported above are true, correUct and co plete to the best of my knowledge and belief. HOME CTl~ ~ ~!(QO'S~Z y WORK ('7!'1 ) N(o0- s77 ~ ! ~ 11 T PAYER GNATUR TELEPHONE NUMBER ATE ~~~~~~ ~./~11 L........ E....~.r~.~ ~ 100 MOUNT ALLEN DRIVE, MECHANICSBURG, PA 17055 VONNIE CAPAZO 187 ASHLAND DRIVE ENOLA, PA 17025 Form PB-01 RESIDENT # UNIT STMT. DATE 80705 258 W 09/30/2010 RESIDENT S Mrs. RUTH M. CAPAZO TOTAL AMOUNT DUE $0.00 DATE DUE 10/31/2010 S DATE DESCRIPTION RATE Days/ Units - _ -------_ CHARGES CREDITS _. BALANCE Balance Forward 5,760.62 09/20/2010 PAYMENT RECEIVED -THANK YOU! ! ! 5,760.62 0.00 ~,. n :~ ~. ~, ,. 1 A~ ~~ ~ ~{ .... "7 1 Lr. ~ Y1 jM1~ . _.. . • ~ ~ ~ ... .. .. , , , ~ ( V J ! 1 . J ^^~-^ .... .+y ~'..y a ~~ rr ('~5 ~.lJ ~ ....F...) r,~ ~ ~~ ~~ ~ r .....+ ~ ~ i+~ ~w~+~ RESIDENT # CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 8o7os o.oo o.oo o.oo o.oo o.oo so.oo RESIDENT NAME Mrs. RUTH M. CAPAZO iw~'r~~" Please make check payable to Messiah Village. A 1 % finance charge may be assessed on accounts for which payment has trot been received by the due date. Thank you! If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. Thank You! ^ j,. •. i t„~ t•• ~;,~ ;'~•t {S S~t~Sj, ~ S '• } ., ~- -,~ C`'~~r ,a-y rte' ~.+=. ~~ . -~- r'• C 0.-5 ~ ,._ C.. v f~~~ ,i n ~ ~ w..` ..~ ~ ~`,~ ~/~~ ~ ~ ` _...- ~~ ~ ~ \ J ~i /~ V ` "' G o ~q G .,.~.._. .- ..J ~ :~= G ~~h~ Y ~ ~ O o ~ z" ~ ID V ~' ^ Q ~ ~ N'~ ~ W ;y:;~ , ~; „ ,.~ y:,~ }, ~ .iR' f `-- ~~ <:fx ~~;M ~: 1 t~.~ ~,~ M~ xxxM.o. h i 8j . ~{ , .~ ~ h.? . ..:f~ ` : y 2 ~": ..:max; 4 4 ~M~'