HomeMy WebLinkAbout01-19-11COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 013915
HALBLEIB DAVID G
1252 REBERT DRIVE
MECHANICSBURG, PA 17055-9714
fold
ESTATE INFORMATION: SSN: ~~8-~6-4300
FILE NUMBER: 211 1-0085
DECEDENT NAME: PENNINGTON BLANCHE E
DATE OF PAYMENT: 01 / 1 9/201 1
POSTMARK DATE: 01 /1 8/201 1
couNTY: CUMBERLAND
DATE OF DEATH: 1 1 /05/2010
REMARKS:
CHECK# 3214
SEAL
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
10174126 ~ 5409.05
TOTAL AMOUNT PAID:
INITIALS: CJ
REV-1762 EX(11-96)
5409.05
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE _
BUREAU OF INDIVIDUAL TAXES AND FILE ND. 21'-~I` ~~
PO BOX 280601 `, 1,~-~-F~
HARRISBURG PA n12B-0601 __ ' !~~ AYER RESPONSE ACN 10174126
- ~'~~ DATE 12-27-2010
REV-1543 E% AFP (Od-IB]
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DAVID G HALBLEIB
1252 REBERT DR
MECHANICSBURG PA 17055-9714
TYPE OF ACCOUNT
EST. OF BLANCHE E PENNINGTON ^ snvlNGs
SSN 178-16-4300 ® CHECKING
DATE OF DEATH 11-05-2010 ^ TRUST
COUNTY CUMBERLAND ^ CERTIF.
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
PNC BANK NA provided the Departwent 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 Soint 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. 5140049159 Date 03-05-2007 To ensure proper credit to the account, two
Established copies of this notice ^ust accompany
9 1 4.2 9 payment to the Register of Wills. Make check
Account Balance $ 91 , payable to "Register of Wills, Agent".
Percent Taxable X 16.667
NOTE: If tax payments are made within three
Amount Subject to Tax $ 15, 319.35 months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Arty Inheritance Tax due will become delinquent
Potential Tax Due g 689.37 nine months after the date of death.
PART TAXPAYER RESPONSE
~ FAILLE' TO rrESP~~D w~LL;.,RES
.1 H, AH OFFICIAL, A5S£,851'iEHT.
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
C 0 N E ~ Wills and an official assessment will be issued by the PA Departwent of Revenue.
B L 0 C K B. ^ The above asset has been or will be reported and tax Oaid 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: "~~ ~
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS p,D
{
LINE 1.
Date Established
1
~ 1
rrir'i n..+ r`~ ~ „~
2.
Account Balance
2
• 2 _,lx yr
'
3. Percent Taxable 3 X ~ I 3 f "' r~~""
4.
Amount Subject to Tax
4
4 <,~:..,,~ .~. ,: w
'
5. Debts and Deductions 5 ~`~a ,5. ,
~""~ ~' '~ - "'' '
6. Amount Taxable 6 $ • b " ~~ "
7. Tax Rate 7 _ ~'
8. Tax Due 8 $ /~
•'f~ •~~ ~ g~ `''~~ ," , ;` -
PART DEBTS AND DEDUCTIONS CLAIMED
^3
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
/ ~ ,pc ~ NN ~ - G. rcaD ~ E
- a. 010 D prL t,8 E
(DIAL ctnter on a ne s or lax Computation) s ti~ 7 5 i•~
Under penalties of perjury, I declare that the facts I have reported abo~lve are true, c/orrect and
co late to the e t of my knowledge and belief. HOME C I~ ) ~ ~(~ 3
c
WORK C ) ~ f4~~
T DAVCD ~`iCAIA TIIDC TCI CDtJn AIC AIIIMIICD TATC
ca~~i aaa~a~ta ~afz~
8 Market Ptaza Way (717) 697-4696
Mechanicsburg, PA 17055 www.malpezzifuneralhome.com
Jeremy J. Shartzer, FD Michael J. Malpezzi, Owner, FD Kyle C, Knipe, FD
November 22, 2010
David Halbleib
1252 Rebert Drive
Mechanicsburg, PA ] 7055
The Funeral Service for Blanche E. Pennington
We sincerely appreciate the confide,~ce you have placed in us and will continu e to assist you in every
way we can. Please feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITF.MIZ.L'•D STA`t'EMENT Ot~ "1'IIE SERVICES. FACtL.CI'IES, AU TOMOTIVE EQUIPMEN'T',
AND MERCHANDISF, THAT YOU SELECT£1? WHEN R~tAKTNC, TH}> FUNER:~L ARRANGEMF,NTS.
I. PROFESSIONAL SERVICES:
Services of Funeral DirectorlStaff $4,625 AO
FUNERAL HOME SERVICI'r L'.r#Aftt_at;S 54,625.00
SELECTED MERCHANDISE:
Stainless Steel Casket $4.180.00
Sentinel Vault ;+1,425.00
Butterfly Register Package $95,00
THE COST OF OUR SERVICES, Et~t11P-l~lE.Ri`I', ,A}til) M13ERCHA!till1SE
THAT YOU HAVE SELECTED 510,325.00
AT THE TIME FUTII;RAL ARRANGEsMENTS ~~'ERE h1AI?L, 411: ADV:INCI~I:i Ci;RTA1N P,AYMENI'S TO
OTHERS AS AN ACCOMMODATION. 3-~s1I; Fi )l. LOWING IS ,;ti . ~C'C-.`I,~ITI?~'G ~'OR `I3 ~IOSE CitARGES.
CASH ADVANCES:
Cemetery Equipment $165.00
Certified Death Certificates 530.00
Newspaper Notices -Patriot 5 357,97
i-:-ergylMass t7fitenng $200.~c1
Flowers $159,00
TOTAL CASH AI)VA!ti(:Eti AYt) SPEC#Ai:. C;lIAI2t;l::,~ $911.9'
CONTRACT' PRICE $11,23697
HISTORY:
11/10/2010 Pre-Need Guarantee $1,804,00
11/]5/2010 Forethought $3,850.85
TOTAI, A AIUU ~!'t' i)L L 558?. i 2
OL = V E GARDEN 1 4 7 1
6520 Carlisle Pike
Mechanicsburg, PA 17055-5251
Check 1f :59851
Tables 10:10:400
Nena S
16:29 11/11/2010 Gst 13
Transaction #:102076821
~ID # 7752 37~ Ca9 ~3;:3~1f3
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(OFFER ExPIRES Nov 18, 2010)
Card Number Auth Code
xxxxxxxxxxxx 6031 746998
halbleib /david g Visa
Ch~ak ,~lrnoun-t 113 _ 14
Gra-tui ~ty 19 _ 37
Tortal 132.51
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Ca ember agrees to pay total in
accordance with agreement governing
use of such card.
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