HomeMy WebLinkAbout03-0133 BUREAU OF 'rND'rVTDUAL TAXES '"""
BEPT. ~'e0601 AND '
HARR]'SBURO, PA 171Z6-0601 TAXPAYER RESPONSE ACN 021q5568
REV-IS~S Ell AFP C09-00) /
TYPE OF ACCOUNT
EST. OF WALTER CAIN [] SAVINGS
S.S. NO. 189-16-9051 [] CHECKTNG
DATE OF DEATH 07-17-2002 [] TRUST
, COUNTY CUMBERLAND [] CERTTF.
REHTT PAYHENT AND FERNS TO:
CANDY CAIN REGISTER OF WILLS
15 W CHURCH RD CUMBERLAND CO COURT HOUSE
NECHANICSBURG PA 17055 CARLISLE· PA 17015
NAYPOZNT BANK has provided the Department with the information l:Lsted below which has been used in
calculating the potantial tax due. Their records indicate that at the death of the above decedent, you ware a joint owner/beneficiary of
this account, if you faa1 this information is incorrect, please obtain written correction fi*om the financial institution, attach a copy
to this fora end return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
o* Pennsylvania. Uuastions amy be answered by ceiling £~17J
COMPLETE PART 1 BELOW N ~ # SEE REVERSE SIDE FOR FILING AND PAYMENT XNSTRUCTZONS
Account No. 801000~q9 Data 09-10-1999 TO insure proper credit to your account, two
Established (z~ copies of this notice must accompany your
payment to the Register of Nills. Make check
Account Balance 5 · 8~8. O0 payable to: "Register of Hills, Agent".
Percent Taxable X 50.000
NOTE: ~f tax payments ara made within three
Amount Sub,act to Tax Z· 9Zq. O0 c~) months of the decedant's date of death,
Tax Rate X .15 you may deduct a 5Z discount of the tax due.
Any inheritance tax due mill become delinquent
Potential Tax Due q~8.60 nine (9) months after the date of death.
PART TAXPAYER RESPONSE
A. ~ The above information and tax due is correct.
1. You may choose to remit payment to the Register of Nills with two copies of this notice to obtain
CHECK e discount or avoid interest, or you may check box "A" and return this notice to the Register
E ONE q Nills and an official assessment will be issued by the PA Department of Revenue.
BLOCK J 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 dacadent's representative.
C. ~The above information is~_~ncorract and/or debts end deductions were paid by you.
Il You must complete PART L~ and/or PART ~ below.
PART If you indicate a different tax rata· please state your
ralatlonship ~o decedent:
TAX RETURN - COMPUTATION OI~NT/TRUST ACCOUNTS
L/NE 1. Da~e Established 1
2. Accoun~ Balance 2~
3. Percen~ Taxable 3~
q. Amoun~ SubSec~ ~o Tax
S. Debts and Deductions S - ~~, II
6. Amoun* Taxable 6 ~ ~ ~
7. Tax R.*. 7 X -- ~,,~-~
8. Tax Due 8
PART DEBTS AND DEDUCTIONS CLAZMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
~'-~~ ~fl ~ ~b t~-~ I ~U~ / ~ ~ ~F ~I ~
TOTAL (Enter on L/nj 5 of Tax Computation)
Under penalties of perjury, I declare ~ha~ the facts ~ have reported above are ~e, corr~c~ and
~XPAYER SIGNATURE TELEPHONE NUMaER DATE
GENERAL INFORHATION
1. FAILURE TO RESPOND NILL RESULT IN AN OFFICIAL TAX ASSESSHENT aith applicable interest based on information
subeitted by the financial institution.
Z. Inheritance tax becomes delinquent nine months after the decedent's date of death.
3. A joint account is taxable even though the decedent's name ams added as a matter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to
death ara fulZy taxable as transfers.
5. Accounts established jointly betl~een husband and mira more than one year prior to death are not taxable.
6. Accounts held by a decedent "in trust for" another or others ara taxable fully.
REPORTING INSTRUCTIONS PART ! - TAXPAYER RESPONSE
1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an
in bZock "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit thee with your check for the amount of
tax to the Register of #iIIs of the county indicated. The PA Department of Revenue will issue an officJaI assessment
(Form REV-154B EX) upon receipt of the return from the Register of Rills.
2. BLOCK S - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the dacadent's representative, place an "X" in block "B" of Part I of the "Taxpayer Response" section. Sign one
copy and return to the PA Oapartaent of Revenue, Bureau of Individual Taxes, Dept 28060L, Harrisburg, PA 17128-0601 in the
envelope provided.
3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and 3
according to the instructions below. Sign two capias and submit them with your check for the amount of tax payable to the Register
of Nills of the county indicated. The PA Department of Revenue will issue an official assessment (Fore REV-1548 EX) upon receipt
of the return from the Register of Hills.
TAX RETURN - PART 2 - TAX CONPUTATION
LiNE
1. Enter the date the account originalty was established or titted in the manner existing at date of death.
NOTE: For a decedent dying after 1Z/Il/BI: Accounts which the decedent put in joint names within one (1) year of death are
taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of
the account or the number of accounts held.
If a double asterisk (ex) appears before your first name in the address portion of this notice, the $3,000 exclusion
already has been deducted from the account balance as reported by the financial institution.
2. Enter the total balance of the account including interest accrued to the date of death.
3. The percent of tho account that is taxable for each survivor is determined as follows:
A. The percent taxable for joint assets established more than one year prior to the decedent's death:
1 DIVIDED BY TOTAL NUNBER OF DIVIDED BY TOTAL NUHBER OF X LO0 = PERCENT TAXABLE
JOINT O#NERS SURVIVING JOINT OWNERS
Example: A joint asset registered in the name of the decedent and two other persons.
! DIVIDED BY 3 (JOINT OHNERS) DIVIDED BY Z (SURVIVORS) = .167 X LO0 = 16.TZ (TAXABLE FOR EACH SURVIVOR)
B. The percent taxable for assets created within one year of the dacedent's death or accounts owned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
1 DIVIDED BY TOTAL NUNBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE
OWNERS OR TRUST BENEFICIARIES
Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by
the decedent.
I DIVIDED BY 2 (SURVIVORS) = .50 X 100 = SOZ (TAXABLE FOR EACH SURVIVOR)
4. The amount subject to tax (line 4) is determined by multiplying the account balance (line Z) by the percent taxable (line
5. Enter the total of the debts and deductions listed in Part 3.
6. The amount taxable (Line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line
7. Enter the appropriate tax rate (line 7) as determined below.
i Date of Death ~ SpOuse Lineal Sibling ' ColleteraZ
07/01/9fi to 12/S1/9fi iX 6X 15Z
01/01/95 to 06/30/00 OX 6X 1SX
07/01/00 to present OX 4.SX~ 12X
NThe tax rate imposed on the net value of transfers from a deceased child taenty-one years of age or younger at
death to or ~or tho use of a natural parent, an adoptive parent, or a stepparant of the child is OZ.
Tho lineal class of heirs includes grandparents, parents, children, and Lineal descendents. "Children" includes natural children
whether or not they have been adopted by others, adopted children and stop children. "Lineal descendents" includes al1 children of the
natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants
and step-descendants. "Siblings" ara defined as individuals who have at least one parent in common with the decedent, whether by blood
or adoption. The "Collateral" class of hairs includes al1 other beneficiaries.
CLAIHED DEDUCTIONS - PART $ - DEBTS AND DEDUCTIONS CLAIHED
ALlowable debts and deductions are determined as follows:
A. You legally are responsible for payment, Or the estate subject to administration by a personal representative is insufficient
to pay the deductible items.
B.' You actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 l/Z" x 11". Proof of
payment may be requested by the PA Department of Revenue.
4*5-306 2- P~¢k ' ~'" ~'
1
2
3
4
5
7
9
14
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COHHONREALTH OF PENNSYLVANIA ~ 03 13~
DEPARTHENT OF REVENUE ~
BUREAU OF INDIVIDUAL TAXES ZNFORHATZON NOTZCE FZLE NO. 21 -
DEPT. 280601 AND
HARRISDUR~*, PA l?lZB-060~ TAXPAYER RESPONSE ACN OZlq5567
,Ev-~,s Ex *Fp ~,-oo) DATE 10-16-2002
TYPE OF ACCOUNT
EST. OF HALTER CAIN [] SAVTNGS
S.S. NO. 189-16-9051 [] CHECKZNG
DATE OF DEATH 07-17-2002 [] TRUST
· ~ COUNTY CUMBERLAND [] CERTTF
RENTT PAYHENT AND FORHS TO:
CANDY CAIN REGISTER OF HILLS
15 H CHURCH RD CUHBERLAND CO COURT HOUSE
MECHANICSBURG PA 17055 ~ . CARLISLE, PA 1701S
NAYPO/NT BANK has provided the Dopartesnt with the information listed beloa which has been used in
calculating tho potential tax due. Their records indicate that at the death of the above decadent, you ears a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from tho financial institution, attach a copy
to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Quest Jolts may be ansaered by calling (7[7) 787-85Z7.
COMPLETE PART 1 BELOH # ~ ~ SEE REVERSE SZDE FOR FZLZNG AND PAYHENT ZNSTRUCTZONS
Accoun~ No. 908~8610 Da~e 0~-0~-1995 TO insure proper credit to your account,
Es*abllshed (z) copies o; thls notice must accompany your
payment to the Register o~ Hills. Hake check
Accoun~ Balance ~ ~ 5~. O~ payable to: "Register of ~ills, Agent".
Pe~cen* Taxable X 5 0 . 0 0 0
NOTE: ~; ~x pay;ents are ;ade ~lthin three
Amoun~ Sub~ec~ ~o T~x ~,271.5~ (~) months o~ the decedent's date o~ death,
Tax Ra*. X .15 ~.u may deduct a 5Z discount of the tax due.
Any inheritance tax due ~Jll become delinquent
Po~en~ial Tax Due 6~0.7~ nine (9) mon~s after ~e date of death.
PART TAXPAYER RESPONSE
I. ~ The above information and tax due is correct.
1. You may choose to remit payment to the Register of Hills .ith t.o copies of this notice to ob~in
CHECK ~ a discount or avoid interest, or you may check box "A" and return this notice to ~e Register of
ONE ~ius and an official assessment ~Jll be issued by the PA Depar~ent of Revenue.
BLOCK ~ s. ~ The above asset has been or ~][[ be reported and tax paid ~Jth the Pennsylvania [nher[tance Tax return
ONLY tu be filed by the decedent's representative.
C. ~The above information is incorrect and/o~ebts and deductions ~ere paid by you.
~ ' You must complete PART ~ and/or PART ~ below.
PART Zf you ind$ca~e a differen~ ~ax ra~e, please s~a~e your
relationship ~o decedent:
TAX RETURN - COHPUTATZON OF TAX ON JOZNT/TRUST ACCOUNTS
LZNE 1. Da~. Es*ablished 1 ~--q ~ ~
2. Accoun~ Balance 2 /~, ~ ~ ~
3. Percen~ TaxabZe 3 X ~
S. Debts ~d Deduc*ions S - ~// ~1 ~ ~
8. Tax Due 8
PART DEBTS AND DEDUCTZONS CLAZHE~
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on cin~ 5 of Ta~ Cn~pu~a~ion) $ ,~J~, ~
Under p~al~Aes of perjury, Z declare ~ha~ the facts Z have reported above are true, correc~ and
TAXPAYER SIGNATURE TELEPHONE NUHBER DATE
GENERAL INFORHATION
1. FA/LURE TO RESPOND #/LL RESULT IN AN OFF/C/AL TAX ASSESSNENT aith applicable interest based on information
submitted by the Financial institution.
2. Inheritance tax becomes delinquent nine months after the decedent's date of death.
3. A joint account is taxable even though the decedent's name was added as a matter of convenience.
4. Accounts (including those held betaeen husband and Hire) which the decedent put in joint names within one year prior to
death are fully taxable as transfers.
S. Accounts established jointly between husband and aifa more than one year prior to death are not taxable.
6. Accounts held by a decedent "in trust for" another or others are taxable Fully.
REPORTING INSTRUCTIONS - PART I - TAXPAYER RESPONSE
1. BLOCK A - If the information and computation in the notice are correct and deductions are net being claimed, place an
in block "A" of Pert 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check ~or the aeeunt of
tax to the Register of Hills of the county indicated. The PA Department of Revenue ail1 issue an official assessment
(Fore REV-154& EX) upon receipt of the return from the Register of Wills.
Z. BLOCK B - If the asset specified on this notice has been or ail1 be reported and tax paid aith the Pennsylvania Inheritance
Tax Return filed by the decedent's representative, place an "X" in block "B" of Part I of the "Taxpayer Response" section. Sign one
copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Oept Z80601, Harrisburg, PA 171Z8-0601 in the
envelope provided.
3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and
according to the instructions below. Sign tag copies and submit thee mith your check for the amount of tax payable to the Register
of Wills of the county indicated. The PA Department of Revenue ail1 issue an official assessment (Form REV-1548 EX) upon receipt
of the return free the Register of Wills.
TAX RETURN - PART Z - TAX CONPUTATION
LINE
1. Enter the date the account originally ams established or titled in the manner existing at date of death.
NOTE: For a decedent dying after 1Z/II/BI: Accounts ehich the decedent put in joint names within one (1) year of death are
taxable fully as transfers. Hoaever, there is an exclusion not to exceed $3,000 per transferee regardless of the value of
the account or the number of accounts held.
If a double asterisk (.w) appears before your first name in the address portion of this notice, the $3,000 exclusion
already has been deducted from the account balance as reported by the financial institution.
Z. Enter the total balance of the account including interest accrued to the date of death.
3. The percent of the account that is taxable for each survivor is determined as folloas:
A. The percent taxable for joint assets established more than one year prior to the decedant's death:
I DIVIDED BY TOTAL NUNBER OF DIVIDED BY TOTAL NUNBER OF X lOO = PERCENT TAXABLE
JOINT OWNERS SURVIVING JOINT ONNERS
Example: A joint asset registered in the name of the decedent and taG other persons.
I DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 = 16.7Z (TAXABLE FOR EACH SURVIVOR)
B. The percent taxable for assets created within one year of the decedent's death or accounts Gonad by the decedent but held
in trust For another individual(s) (trust beneficiaries):
1 DIVIDED BY TOTAL NUNBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE
OWNERS OR TRUST BENEFICIARIES
Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by
the decedent.
I DIVIDED BY Z (SURVIVORS) = .50 X log = SOZ (TAXABLE FOR EACH SURVIVOR)
4. The amount subject to tax (Line 4} is determined by multiplying the account balance (Line 2) by the percent taxable (Line 3).
5. Enter the total of the debts and deductions listed in Part 3.
6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (Line
7. Enter the appropriate tax rate (line 7) as determined below.
Da~e of Oeaih ~ Spouse ~ Lineal Sibling Collateral
07/01/9q ~o 12/$1/9q SX 6Z 15Z
01/01/95 ~o 06/$0/00 OX 6X 15Z
07/01/00 ~o presen~ OX ~.$X~ 12X 15Z
The tax rata imposed on the net value of transfers fro ~ ...... J -~;'~ * .... ~y-one years -; age nr younger at
death to er for the usa of e nature! parent, an adoptive parent, or a stepparent of the child is OZ.
The Lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children
ahather or not they have been adopted by others, adopted children and stap children. "Lineal descendents" includes all children of the
natural parents and their descendents, ahether or not they have been adopted by others, adopted descendents and their descendants
and step-descendants. "Siblings" ars defined as individuals she have at Least one parent in common aith the decedent, whether by blood
or adoption. The "Collateral" class of heirs includes all other beneficiaries.
CLAIHED DEDUCTIONS PART $ - DEBTS AND DEDUCTIONS CLAIHED
Alloaabla debts and deductions are determined as Follows:
A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient
to pay the deductible items.
B. You actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 l/Z" x 11". Proof of
payment may be requested by the PA Departaent of Revenue.
CONNON~EALTH OF PENNSYLVANIA
BUREAU OF ZNDTVTDUAL TAXES DEPARTNENT OF REVENUE ~ ~._~
INHERITANCE TAX DIVISION
DEPT. ZBOGD1
HARRISBURG, PA 171:>8-0601 NOTICE OF IHHERITAHCE TAX
APPRAZSEHENT. ALLO#ANCE OR DZSALLONANCE
OF DEDUCTTON~, AND ASSESSHENT OF TAX ON
JOTNTLY HELD OR TRUST ASSETS REV-IS48 EX AFP (OI-OS)
Re,?;~ ~ , , :_'::~ATE 06-05-Z005
R£'~i:i~.~' , ~ : i!~ ESTATE OF CAIN HALTER
-' DATE OF DEATH 07-17-2002
FILE NUMBER o.~/-~),~-/~,.~
.~C~qUNTY CUMBERLAND
CANDY CAIN '03 JUN-2 All .5~N/DC 189-16-9051
15 ~/ CHURCH RD ACN 02145567
Amoun'l: R,,m ].'l:~:ed [
HECHANTCSBURG PA 17055~r;, :
I
Cumb~, ~ ............. PA
HAKE CHECK PAYABLE AND REHIT PAYNENT TO:
REGISTER OF ~/ILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THXS LINE ~ RETAIN LO#ER PORTION FOR YOUR RECORDS
REV-IS48 EX AFP (01-03)
NOTICE OF INHERITANCE TAX APPRAISENENT~ ALLOWANCE OR DISALLO#ANCE OF
DEDUCTIONS~ AND ASSESSMENT OF TAX ON dOINTLY HELD OR TRUST ASSETS
DATE 06-05-2005
ESTATE OF CAIN HALTER DATE OF DEATH 07-17-2002 COUNTY CUMBERLAND
FILE NO. S.S/D.C. NO. 189-16-9051 ACN 02145567
TAX RETURN HAS: (X) ACCEPTED AS FILED ¢ ) CHANGED
dOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: HAYPOINT BANK ACCOUNT NO. 90848610
TYPE OF ACCOUNT: ( ) SAVINGS (~ CHECKING ( ) TRUST ¢ ) TIME CERTIFICATE
DATE ESTABLISHED 04-04-1995
Account Balance 10,205.00 NOTE: TO INSURE PROPER CREDIT TO
PePcent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax 5,101.50 UPPER PORTION OF THIS NOTICE
Debts and Deductions - 5,117.06 NTTH YOUR TAX PAYMENT TO THE
Taxable Amount .00 REGISTER OF HILLS AT THE
Tax Rate ~ .45 ABOVE ADDRESS. HAKE CHECK
Tax Due .00 OR HONEY ORDER PAYABLE TO:
"REGISTER OF HILLS, AGENT."
TAX CREDITS:
PAYHENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
TOTAL TAX CREDIT I .00
BALANCE OF TAX DUEI .00
INTEREST AND PEN. I .00
TOTAL DUE ] .00
ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADD/TZONAL INTEREST. ~
ZF TOTAL DUE 1S LESS THAN $1, NO PAYHENT 1S RE~U/RED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND.
SEE REVERSE S/DE OF THIS FORH FOR /NSTRUCTIONS. )
PURPOSE OF
NOTICE: To fulfill the requirements of Sect[on Z140 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (71 P.S.
Sect[an 9140).
PAYMENT: ne[ach the top port[on of this Not[ca and submit with your payment to the Register of Rills printed on the
reverse side.
-- Make check or money order payable to: REGISTER OF RILLS, AGENT.
REFUND (CR): A refund of a tax credit, mhich was not requested on the tax return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Off[ca of
the Rag[star of Rills, any of the 13 Revenue District Offices or by calling the special Z4-hour ansear[ng service
far fores ordering: 1-800-361-Z050; services for taxpayers with special hearing and or speaking needs:
1-800-447-3020 (TT only).
OBJECTIONS: Any party in interest not satisfied m[th the appraisement, allowance, or d[salloeance of deductions or assessment
of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of race[pt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals) nept. 181021, Harrisburg, PA 171Z8-10Z1, OR
--electing to have the eat[ar determined at the audit of the account of the personal representative, OR
--appeal to the Orphans' Court
ADMTN-
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Xndiv[dual Taxes, ATTN: Post Assessment Review Un[t, DEPT. 180601, Harrisburg, PA 17118-0601
Phone [717) 787-6505. See page 5 of the booklet "Tnstruct[ons for Inheritance Tax Return for e Res[dent
Decedent" (REV-1501) for an explanation of administratively correctable errors.
DISCOUNT: l'f any tax due is paid within three (33 calendar months after the decedant's death, a five percent [SZ)
discount of the tax paid is alloeed.
PENALTY: The 1S7- tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation
penalty [s appealable [n the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day
from the date of death, to the data of payment. Taxes which became delinquent before January 1, 1981
bear interest at the rate of six [67-) percent per annum calculated at a daily rate of .000164.
All taxes which became delinquent on ur after January l, 1981 emil bear interest at a rate eh[ch will vary from
calendar year to caIendar year with that rate announced by the PA Department of Revenue. The applicable
interest rates for 1982 through 2003 are:
Interest naiiy Interest naiiy Interest Daily
Year Rate Factor Year Rate Factor Yeast Rate Factor
1982 207. . 000548 1987 91 . 000247 1999 72 . 000192
1983 16Z .000438 1988-1991 llZ .000301 ZOO0 8Z .O00Zl9
1984 11Z . 000301 1992 9Z . 000147 Z001 9Z . O00147
1985 132 .000356 1993-1994 72 .000192 Z00Z 61 .000164
1986 107. .000274 1995-1998 97. .000247 Z003 SZ .000137
--/nterast is calculated as follows:
/NTEREST = BALANCE OF TAX UNPAZD X NUI~BER OF DAYS DELZNQUENT X DAZLY ZNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. ~f payment is made after the interest computation date shown on the
Notice, additional interest must ba calculated.
COHHONWEALTH OF PENNSYLVANZA
BUREAU OF INDIVIDUAL TAXES DEPARTHENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX
APPRAZSEHENT, ALLONANCE OR DZSALLONAHCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOZNTL¥ HELD OR TRUST ASSETS *EV-ZS4S EX AFP (01-OS)
RUC,~}~'~;_~. ~/i i~L cf DATE 06-0:5-200:5
F~.~ji~.~ ~' ,i~ ~ i3 ESTATE OF CAIN WALTER
DATE OF DEATH 07-17-2002
FILE NUHBER
~OUNTY CUHBERLAND
CANDY CAIN '0~ JUN -2 ~dl :I$SN/DC 189-16-9051
15 W CHURCH RD ACN OZZR5568
A~ount
HECHANICSBURG PA 170,~{~l~J~,rk.' . : :~
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA Z701S
CUT ALONG THIS LINE ~'* RETAIN LOWER PORTION FOR YOUR RECORDS '~
REV-1548 EX AFP (01-03)
NOTZCE OF ZNHERZTANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 06-05-Z00~
ESTATE OF CAIN WALTER DATE OF DEATH 07-17-2002 COUNTY CUHBERLAND
FILE NO. S.S/D.C. NO. 189-16-9051 ACN 021~5568
TAX RETURN WAS: eX) ACCEPTED AS FILED ¢ ) CHANGED
JOINT OR TRUST ASSET XNFORNATXON
FINANCIAL INSTITUTION: WAYPOINT BANK ACCOUNT NO. 80100055~9
TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIHE CERTIFICATE
DATE ESTABLISHED 09-10-1999
Account Balance 5,8~8.00 NOTE: TO INSURE PROPER CREDIT TO
Percen~ Taxable X 0.500 YOUR ACCOUNT, SUBHTT THE
Amount Subject ~o Tax z,gzq.00 UPPER PORTION OF THIS NOTICE
Deb*s and Deductions - $,Z00.11 WITH YOUR TAX PAYHENT TO THE
Taxable Amount .00 REGISTER OF WILLS AT THE
Tax Ra'ce }( .~5 ABOVE ADDRESS. HAKE CHECK
Tax Due .00 OR HONEY ORDER PAYABLE TO=
"REGISTER OF WILLS, AGENT."
TAX CREDTTS:
PAYHENT RECEIPT DISCOUNT (+)
DATE NUHBER INTEREST/PEN PAID (-) AHOUNT PAID
TOTAL TAX CREDIT I .00
BALANCE OF TAX DUEJ .00
INTEREST AND PEN. .00
TOTAL DUE .00
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~
XF TOTAL DUE XS LESS THAN $1, NO PAYNENT ZS RE~U~RED.
XF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS. )
PURPOSE OF
NOTICE: To fulfill the rmquireaants of Sect[on 1160 of the Inharitmnca and Estate Tax Act, Act 13 of ZOO0. (71 P.S.
Section 9160).
PAYNENT: Detach the top portion of this Notice and submit with your payment to the Register of Rills printed on the
reverse side.
-- Hake check or money order payable to: REGISTER OF RILLS, ASENT.
REFUND (CR): A refund of a tax credit, which was not requested on tho tax return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications ara availabla at the Office of
the Register of Hills, any of the Z$ Revenue District Offices or by calling the special lB-hour answering service
for fores ordering: 1-BO0-361-ZOSO; services for taxpayars with special hearing and or speaking needs:
1-B00-647-3010 (TT only),
OBJECTIONS: Any party in interest not satisfied with tha appraisement, allowance, or disallowance of deductions or assessment
of tax (including discount or interest) as shown on this Notice say object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. ZBIOZ1, Harrisburg, PA 17118-1021, OR
--elmcting to have the matter determined at the audit of the account of the personal representative, OR
--appeal to the Orphans' Court
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errors discovarad on this assessment should be addressed in writing to: PA Department of Rmvenua,
Bureau of Individual Taxes, ATTN: Past Assessment Review Unit, DEPT. 180601, Harrisburg, PA 17118-0601
Phone (717) 787-6505. Soo page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1SOI) for an explanation of administratlvaly correctable errors.
DISCOUNT: If any tax due is paid within three (3) calendar months after tha dacedent's death, a five percent
discount of the tax paid is allowed.
PENALTY: The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the soma manner and in the tho same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and Dna (1) day
from the date of death, to the date of payment. Taxes which became delinquent before January l, 1981
bear interest at the rate of six (61) percent par annum calculated at a daily rate of .000166.
All taxes which became delinquent on or after January l, 19BI will bear interest at a rate which will vary from
calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable
interest rates for 1982 through 2003 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Yeast Rate Factor
1982 lOX . O 00568 1987 97. .000267 1999 77. .000192
1983 16Z .000638 1988-1991 111 .000301 ZOOO 8Z .OOOZ19
1986 111 .000301 1991 91 .000267 ZOOX 91 . OO 0167
1985 137- .000356 1993-1996 71 . O00xgz ZOOZ 6Z .000166
1986 IOZ .000276 1995-1998 97. .000167 2003 57- .000137
--Xnterest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (IS) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must ba calculated.
OOMMO,*EA:HOE REV'1500
~%~_~t~ DE:28O6O~ INHERITANCE TAX RETURN
~~ HARRISBU~ PA~X28-0601 RESIDENT DECEDENT :~:,:~
DECEDENTS NAME mLAST FIRST AND MIDDLE )N;TIAL, SOCIAL SECURITY NUMBER
DATE OF DEATd CJM BD-YEAR) , DATE OF BRT~ ~MM-D~-YE~R, I THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
.
ilFAPPUCABLE) SURVIVING SPODSE S NA~,IE (LAS7 FIRST AND M~DDLE iNITI4D
~ SOCIAL SECUR,'TY NUMBER
~ 10ri~imal Re[urn ~ 3 Remainder Re~urn
~ 5 Federal Estate Tax Retb'n Requi~ed
~ 9 Litigation Proceeds Rece,vea ~ 10 SpousalPove~y~red ......... h e,ee =~19' a ~'5 ~ 1! Electio~otaxunde¢Sec 9113A) ~ ~ sc-o
THIS SECTION MUST BE COMPLETED. ALL OO~k~kSPONDENCE AND O~FIDE~TIAL T~ INFORMATION SHOULB
C DIREO~E~ TO:
'( ~: ~ ( ~ I ~ COMPLETE MAIUNGADDRESS
TELEPHONE NUMBER
2 Stocks and Bonds (Schedule B) ,2) ¢ ~
3 Closely Held Corporation Padnership or Sole-Propne'orship (3) ~.
16 An'ount of Line14 taxable at lineaJ ra[e ~ ~' ~- x 0 g~'~- (16) ~ i ~, (~'
19 Tax Due (19) ~/,% 0¢
> > BE SURE TO ANSWER ALL QUESTIONS OH RE~K ~ATH < ~
Decedent's Complete Address:
ISTREET ADDRESS
Tax Payments and Credits:
1. Tax Due (Page 1 Line 192 (12
2 Credits/Payments
A Spousal Poverty Credit
B. Prior Payments
C Discount Total Credits ( A + B + C ) (2)
3. interest/Penalty if applicable
D. Interest (7~' ~/,-.)/IP~[2), ~7/ ~2,
E PenaLty Total Interest/Penalty ( D + E ) (3)
4. if Line 2 is greater than Line l +Line3 enterthedffeence. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (42
5 If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (52
A. Enter the interest on the tax due (SA)
B. Enter the total of Line 5 + 5A This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1 Did decedent make a transfer and: Yes No
a retain the use or income of the properly transferred:
b. retain the right to designate who shall use the properly transferred o s income:
c retain a reversionary interest or
d receive the promise for Life of either payments, benefits or care?
2. if death occurred after December 12 1982, did decedent transfer property within one year of death
without receiving adequate consideration?
3 Did decedent own an "in trust for" or payable upan death bank account or security at his or her death?
4. Did decedent own an Ir, dividual RetirementAccount annuity or other non-probate property which
contains a beneficiary designation?
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Upderpena ese perjjry Idec!arethatl~avee×aminedth~sreturn ncudcgao3oqlpancngssnedulesands[a'emep; sldt3thehes ofrlli, kso,'lle,!~earldSe e isue corec!apdcc /plete
eeclaration of preparer other than the persona! represer/tatlve s 3ased on all cformatlor' of ,'¢h~ch preparer 'as ar'}
SIGNAT4LfCLE~OF PERSO,~, RESPONSIB,LE F~R FILIN.C-4~qJRN' DATE - ~'~ ~ /'
ADDRESS
SIGNATURE ~F PREPARER OTHER THAN REPRESENTATIVE ' DATE
ADDRESS
For dates of death on or after July 1. 1994 and before January , 1995, the tax ra e imposed on the net value of transfers to or for the use o the surviving spouse is 3 o
[72 P.S §9/16 (a)(1 12
For dates of death on or after January 1, 1995. the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S §9116 (a) (1 12 (ii)
The statute el?es not exempt a transfer to a surviving spouse from tax and the statutory requirements for disclosure of assets and filing a tax return are still applicable even
the surviving spouse is the only beneficiary
For dates of death on or after July 1,2000:
The tax rate imposed on the net value of transfers from a deceased child twenty one years of age or younger at death to or for the use of a natural parent an adoptive paten
or a stepparent of the child is 0% [72 P.S §9116(a)(1.222
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 45%, except as noted in 72 P.S §91~6(1.22
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S §9116(a)(1.32]. A sibling is defined, under Section 9102 as a
individual who has at least one parent in common with the decedent, whether by blood or adoption,
.~ SCHEDULE I
CO~,',',~'~,',E^~TH CF ~E~'~SYL~DEBTS OF DECEDENT,
~E~'OE~T;~C~ MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
Include unreimbursed medical expenses.
[TSM
NUMBER DESCRIPT'.ON ~MOUNT
TOTAL (Also enter on line 10. Recapitulation) $
(If more space is needed, insert additional sheets of the same s~ze)
SCHEDULE F
COMMONWEALTNOFPENNS¥ V^N'A JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT FILE NUMBER
ESTATE OF
mf an asset ~s made joint ~thin one year of the decedent's date of death, ~ must be reposed on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RE~T[ONSHIP TO OECEDENT
JL)IN I LT -L2 VW'4: L~ ~-mJPERTY: % OF DATE OF DEATH
LETTER DATE DESCRIPTION OF PROPERTY
ITEM FOR JOINT MADE [nclube name of financial institution and bank account number or sinilar identifying ~umber Attach DATE OF DEATH DECD'S VALUE OF
VALUE OF ASSET INTEREST DECEDENTS INTEREST
4LIMBER TENANT JOINT deed for jointly held real estate
TOTAL (Also enter on line 6, Recapitulation) $ ~:
lACK Mechanicsburg Office
GAUGHEN Old Schoolhouse Lane
Mechanicsburg, PA 17055
REALTORE R 697-4673
(717) 697-0822 FAX
November 5, 2004
Ms Candy Cain
15 Church Road
Mechaxxicsburg, PA 17055
Dear Candy,
This letter is in response to your request for a real estate market amalysis dating back to
July-August, 2002 on your home at 15 Church Road, Mechanicsburg. Using past
comparable two (2) bedroom, 850-1100 square foot home sales in this area, mad in that
timeframe, it looks like a reasonable market value for your home would have been
between $68,000 and $70,000.
Remember, your home has 960 sq ft of living space, over a 2 car garage and basement
area on a small 0.05 acre tot. I have enclosed raulti-list information on the comparable
homes I used for the analysis.
This analysis has not been performed in accordm~ce with the Uniform Standards of
Professional Appraisal Practice which requires valuers to act as unbiased, disinterested
third parties with impartiality, objectivity and independence and without accommodation
of personal interest. It is not to be construed as an appraisal and may not be used as such
for any purpose.
If you have questions, please call me.
S%ly
REALTOR®
Independentl~ O~ned And Operated By NRT Incorporated
www.igr corn
THIS DEED,
MADE THE day ~ in the year of our
Lord two thousand one ( 01
BETWEEN WALTER L. CAIN, single man, Grantor and
WALTER L. CAIN, single man and CANDACE R. CAIN, single woman,
as Joint Tenants with the Right of Survivorship, Grantees:
WITNESSETH, that in consideration of One and 00/100 ($1.00)
Dollars, in hand paid, the receipt whereof is hereby acknowledged,
the said grantor does hereby grant and convey to the said grantees,
ALL THAT CERTAIN lot of ground situate in the Township of
Silver Spring, County of Cumberland,~and State of Pennsylvania,
bounded and described as follows, to wit:
BEGINNING at a point on the line of property now or formerly
of Fred Conner and wife, said point being seventy-eight (78) feet
in a Northerly direction from the Northern curb line of the
TrUndle Road; thence Northwardly along the line of property now
or formerly of Fred L. Conner and wife, sixty-three (63) feet ten
(10) inches to a point on the Southern berm line of the Church
Road; thence Eastwardly along the Southern bern line of the
Church Road, thirty-eight (38) feet eight (8) inches, more or
less, to a point on the line of property now or formerly of Amos
Baker and wife; thence Southwardly along the line of said
property now or formerly of Amos Baker and wife, fifty-three (53)
feet, more or ]ess, to a point; thence Westwardly along the line
of property now or formerly of Jesse S. Eckert, thirty-seven (37)
feet six (6) inches to a point, the place of BEGINNING.
SUBJECT, HOWEVER, to the restrictions and conditions contained
in Record Book C, Volume 11, Page 273, so far as said
restrictions and conditions pertain to this lot of ground.
TOGETHER with the water line right-of-way over lands now or
formerly of Jesse S. Eckert and Ruth Eckert, his wife, described
in Record Book B, Volume 15, Page 366.
BEING THE SAME PRE[~IISES which C. Philip Nusbaum and Sharcn
Nusbaum, his wife, by their deed dated June 24, 199], and
recorded July 1, 1991, i~! Record Book "E", volume 35, Page 768~
in the Of~/ice o[ the R~corder of Deeds [~n and for Cumberland
County, Pennsylvania, granted and conveyed unto Walter L. Cain,
single man, Grantor hereir:.
T~{IS IS A CONVEYA/~CE FROM FATHER TO FATHER A/~D DAUGHTER .~2~D IS
THEREFORE EXES?T FROM A~NY AND ALL REAL ESTATE TRANSFER TAXES.
~d the said grantor hereby covenants and agrees that he will
warrant specially the property hereby conveyed.
IN WITNESS WHEREOF, said grantor has hereunto met his hand and
seal the day and year first above written.
signed, Sealed and Delivered ~u~ ~-
in the t~re~eIlc¢ of Walter L. Cain
COUNTY OF
On this, the t~'~ day of/~~/~ , 2001, befo~re me,
the undersign(id officer, per¢o~ally appeared Walter L. Cain known
to ~e (or satisfactorily pro~e~ to be the person whose name is
subocribed to the within inst~ment, and acknowledged that he
executed same for the purposes therein contained.
IN WITNESS WKEREOF, I hereunto set my~and and of~i~l~sea!.
~ Stepha~m E ':,m~r, NO~
I Hampd~',: ' ~mberla~Cou~
LMy co,,,,, pireS July 28. 2001
[ Notarial
: -., .. ~, .~,, h ' ..... ~ Sie~an!e E, Witmer, Nota~ Publtc
~ Hm~pdenTwp.. Cumberland Coun~
~ My C,~mmlssion Expires July 2~. 2001
I do hereby certify that the precise ,residence and complete Dost
office address of the within grantee is: (~.~ .~6~ ~6~__
A entI for
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE REV-11 62 EX(11-96)
BUREAU OF INDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM' INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 004734
CAIN CANDY
15 W CHURCH ROAD
MECHANICSBURG, PA 17055
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
........ fold
101 $357,53
ESTATE INFORMATION: SSN: 189-16-9031
FILE NUMBER: 2103-01 33
DECEDENT NAME: CAIN WALTER
DATE OF PAYMENT: 12/14/2004
POSTMARK DATE: 12/14/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 07/17/2002
TOTAL AMOUNT PAID: $357.53
REMARKS:
CHECK//1047
INITIALS. CCP
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INOIVIOlfi(;~j~~~I" :
INHERITANCE TAX DIVISIDtl-.;---,;,
PO BOX 280601 t,.;~...
HARRISBURG PA 17lZ8-060l'"
,_,..."""r- c,r
"-i-1'\ ~ "I-
,', ,.I.... -'
I:;,
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR OISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
2005 Jf\iJ 2 '. fl,:1 B: I 8
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
01-25-2005
CAIN SR
07-17-2002
21 03-0133
CUMBERLAND
101
C'l !=PV r~i..
-'-' ,,\ ~.
ORr:ll!\r:~
CANDACEc~;"eAt N
650 LOSH RD
SHERMANSDALE PA 17090
Amount Ra..itied
*
REV-lS47 EXAFP C12-D4J
WALTER
L
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HDUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
n-Ii :rA~-Ex--AFP--rll"'--6!rNIlft'cE-oF-i:NHER-ifAN-cE-"Ax-A-pjlRAisEitE'Nt~--A[rO"QAFrc"E-D'Ir------------- - ---
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF CAIN SR WALTER L FILE NO. 21 03-0133 ACN 101 DATE 01-25-2005
TAX RETURN WAS: [X I ACCEPTED AS FILED
I CMANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate {Schedule AJ
2. Stocks and Bonds (Schedule BJ
3. Closely Held stock/Partnership Interest (Schedule C)
4. Hortgages/Notes Receivable (Schedule DJ
S. Cash/Bank Deposits/Misc. Personal Property (Schedule EJ
6. Jointly Owned Property (Schedule fJ
7. Transfers (Schedule G)
8. Total Assets
III
(21
(31
(41
(51
(61
(71
.00
.00
.00
.00
.00
35,000.00
.00
(BI
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
.00
[91
1101
28.000.00
(111
1121
1131
1141
NOTE: If an assessment was issued previously, lines
reflect figures that include the total of ALL
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. AMount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
35,000.00
?8.000 00
7,000.00
.00
7,000.00
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
.00 X 00 =
7,000.00 X 045 =
.00 X 12 =
.00 X 15 =
1191=
.00
315.00
.00
.00
315.00
,., AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-I
12-14-2004 CD004734 23.23- 357.53
TOTAL TAX CREDIT 334.30
BALANCE OF TAX DUE 19.30CR
INTEREST AND PEN. .00
TOTAL DUE 19.30CR
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, ND PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT"" (CRJ, YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIDNS.I ~\'--
'If.
BUREAU OF INDIVIOUA~Ct~iCTi
INHERITANCE TAX DIVISION .- - - -""
PO BOX 280601 -
HARRISBURG PA 17128-0601 - -
_-. I ~~
. .,'.:
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*'
REV-16D1 EX AFP (03-05
zons /'lAY 16 PI 2: 45
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
04-25-2005
CAIN SR
07-17-2002
21 03-0133
CUMBERLAND
101
AIIount R_l tt..,
WALTER
L
C' FR'I (!C
l~ ,1\ vI
ORPHAN'S CO 'AT
CANDACE gl~:igj C). PA
650 lOSH RD
SHERMANSDAlE PA 7090
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WIllS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credi to your account, submit the upper portion of this for. with your t.x pay..nt.
CUT ALONG THIS lINE _~ RETAIN lOWER PORTION FOR YOUR RECORDS ...
................................ ...............................................................................
REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT KKK
ESTATE OF CAIN SR Al TER l FILE NO.21 03-0133 ACN 101 DATE 04-25-2005
THIS STATEMENT IS PROVIDED TO AIl1 ISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOll
IS A SUHHARY OF THE PRINCIPAL TA' DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF lAST ASSESSMENT OR RECORD ADJUSTMENT: 01-25-2005
PRINCIPAL TAX DUE: 315.00
PAYMENTS (TAX CREDITS):
PAYMENT
DATE
12-14-2004
04-11-2005
RECEIPT
NUMBER
CD00473l
REFUND
DISCOUNT (+)
INTEREST/PEN PAID (-)
23.23-
.00
AMOUNT PAID
357.53
19.30-
~
TOTAL TAX CREDIT
BALANCE OF TAX DUE
. IF PAID AFTER THIS DATE, SE REVERSE
SIDE FOR CALCULATION OF ADD TIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN . ,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED A A "CREDIT" ICRI,
YOU HAY BE DUE A REfUND. SE REVERSE SIDE OF THIS fDRK fOR INSTRUCTIONS. I
TOTAL DUE
315.00
.00
.00
.00
INTEREST AND PEN.