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HomeMy WebLinkAbout05-20-11BUREAU OF INDIVIDUAL TAXES _ PO BOX 280601 - HARRISBURG PA 17128-0601 " '~ .. REV ;1543.E%AFP (08-Ofl~.. PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE --~ AND FILE N0. 21"1 ~`~ 1 - TAXPAYER RESPONSE ACN 11126325 ,~ DATE 04-19-2011 ..,~ _~ ~ ~, ~ cr LOIS J PAXTON 1117 E POWDERHORN RD MECHANICSBURG PA 17050-2003 EST. OF PAUL L PAXTON SSN 209-12-6987 DATE OF DEATH 11-18-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. BELCO COMMUNITY 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, yqu 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 (717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0008678070 Date 03-06-2008 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance $ , 528 • 29 payable to "Register of Wills, Agent". Percent Taxable X 16. 7 NOTE: If tau payments are made within three Amount Subject to Tax $ 1 ~ 9 • 42 months of the decedent's date of death, ~( deduct a 5 percent discount on the tax due. Tax Rate Any Inheritance Tax due will become delinquent Potential TaX Due ~` 288 • 21 nine months after the date of death. PART TAXPAYER RESPONSE R~SI~OND WILD R°E~SU~ ~,eIN AN~OFFICIAL~ TAX SS~SSMENT FAILURE ~ 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. ONE C BLOC K B. ~ The above asset has been or will be reported and tax Daid with the Pennsylvania Inheritance Tax return O 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, pleaC s~ tote ~ ~ OFFICIAL USE ~ONL~ ;~ AAF relationship to decedent: PA DEPARTfi4ENT OF REVENUE TAX RE TURN - 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 b $ 6 7. Tax Rate 7 X ~ 7 8. Tax Due 8 $ 8 PART nerF pern PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported a/b~ove are true, correct antd' complete to the bed of my knowledge and belief. HOME C ( ~~ ) ~~( ~ ~}Y y7 ~ ~~ ~ o'~I-G~ - r~~"l"J ~/ WORK C ) -~L / TAXPAYER S GNATURE TELEPHONE NUMBER DATE IUTAL ~en~er un amine ~ -•• PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 `~~"~j ~~ Po BOX 280601 ~ `= TAXPAYER RESPONSE ACN 11126323 HARRISBURG PA 17128-0601 `" L ~ DATE 04-19-2011 REV-Y 503.E%:AFP <.OB-08> ,_.j `~ ~ i ~ ~., !~ (' _ -- LOIS J PAXTON 1117 E POWDERHORN RD MECHANICSBURG PA 17050-2003 EST. OF PAUL L PAXTON SSN 209-12-6987 DATE OF DEATH 11-18-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. BELCO COMMUNITY 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 point 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. 0008678070 Date 03-06-2008 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance $ , 2 1 9 . O payable to "Register of Wills, Agent". Percent Taxable X 1 .667 NOTE: If tax payments are made within three Amount Subject to Tax y~` 6 • 52 months of the decedent's date of death, Tax Rate X 15 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due $` 80 • 8 nine months after the date of death. PART TAXPAYER RESPONSE FAILURES TO R~S~'ON.D WILL~~RE~ULY~ Ik A1i~OFFICI~AL~~AX 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 BLOC 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. omplete PART 2~ and/or PART 3LJ below. PART If indicating a different tax rate, pleas state ~' ~FICiAL J1SE OAiLY \~ AAF relationship to decedent: n,-~ S 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 c 6. Amount Taxable 6 `~ 6 7. Tax Rate 7 X ~ 7 8. Tax Due 8 $ ( ~ 8 PART DEBTS AND DEDUCTIONS CLAIMED nerG aern PAYEE DESCRIPTION AMOUNT PAID IUTAL ltnCer vn ~i „e Under penalties of perjury, I declare that the facts I have reported above are tru[e~, correct and complete to the bes f my knowledge and belief . HOME C~ ~ ~ ) ~ -1 ~ - o y ~ y WORK C ) ~S-// -I -- TA PAY R S NATURE TELEPHONE NUMBER DA E PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 _ ~~/ ~~~ PD eox zao6ol ~~~ ~' ;~- TAXPAYER RESPONSE ACN 11126327 HARRISBURG PA 17128-0601 ,~ DATE 04-19-2011 REtl-1543 E% AFP (08.08) - •-'J ._ ~ ~~ }} J ~ ~ l ~. '"'.~-1 LOIS J PAXTON 1117 E POWDERHORN RD MECHANICSBURG PA 17050-2003 219.6 TYPE OF ACCOUNT ^ savlNGs © CHECKING ^ TRUST ^ CERTIF. BE LCO COMMUNITY 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 I BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0008678070 Date 03-06-2008 J To ensure proper credit to the account, two Established ~ copies of this notice must accompany Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART 0 CHECK ONE [ BLOCK ONLY EST. OF PAUL L PAXTON SSN 209-12-6987 DATE OF DEATH 11-18-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 7 NOTE: If tax paynents are wade within three months of the decedent's date of death, deduct a 5 percent discount on the tax due. ~- Any Inheritance Tax due will become delinquent nine wonths after the date of death. TAX AYER RESPONSE FAILURE TO RESPON WIL1. RESULTr\I~1 At~ OFFICTAL 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 Wills and an official assessment will be issued by the PA Department of Revenue. B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the estate representative. C. ~ The above inforwa ion is incorrect and/or debts and deductions were paid. Complete PART ^2 and/or PART 3^ below. PART If indicating a different pgle~e state tax r~~ OFFICIAL USE' ONLY U AAFx relationship to decedent: . PA DEPARTMENT OF REVENUE ON JOINT/TRUST ACCOUNTS PAD TAX RE TURN - COMPUTATION OF TAX 1 LINE 1. Date Established 1 $ 2 2. Account Balance 2 ~~ X 3 3. Percent Taxable 3 $ 4 4. Amount Subject to Tax 4 S 5. Debts and Deductions 5 ~` 6 6. Amount Taxable 6 X 7 7. Tax Rate 7 $ ~ 8 8. Tax Due 8 ~ PART DEBTS AND DEDUCTIONS CLAIMED nerG aeTn PAYEE DESCRIPTION AMOUNT PAID payment to the Re91ster of Wills. Make check 7 8 4. 6 9 payable to "Register of Wills, Agent". 1,4bf~.14 X IUTAL ltn[er vn L1)IC ~ ~~~r..~ -• Under penalties of perjury, I declare that the facts I have reported anbove are~-7t rue, corrrect ~a/nd complete to the best of mY knowledge and belief . HOME C ` ~ ~ ) 1~ ~ ~` ~ `I ~ T sv T PAYER S NATURE ~ TELEPHONE NUMBER DA E 1 Il ELCO COMMUNITY CREDIT UNION 5/19/11 To Whom It May Concern: This letter is to affirm the balances in Paul L. Paxton's account with Belco as of November 18, 2010. Lois J Paxton was the spouse of Paul L. Paxton and was also listed as joint owner on the account. The balances were as follows: Savings- $3,215.18 Checking- $8,784.69 Money Market- $11,528.29 Please contact us at 717-232-3526 should you have any further questions. Thank you in advance, Lauren M. Hale Belco Community Credit Union ; Illi,~ll.^ 12, (:`r ,il', !f I'-1 LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. l=ee for this certificate, b6.00 P 16806187_ Certification Number This is to certify tsult the information here given is correctly copied Ir1,m an origi(al Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office lur permanent filing. 0`' NOV ~111a010 Local Registrar ~~~ Date issued c 3LV 1lrzdos COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS PRINT IN CERTIFICATE OF DEATH UNENr ;K INK (See Instructions and examples on reverse) STATE FILE NUMBER 1. Name d Decedera (FaY, midda, IaaL sultan) 2. Sex 3. Sanw Seawny Nwlber 1. Date of Deam (M«KA, day, year) Paul L. Paxton Male 209 - 12 - 6987 November 18, 2010 5. Age (Lest Birmdry) !Milo 1 yen t1Mer 1 S. Date d BMIr Moan, de , 7. (' and skk « alsriuy Se. Plea d Deem (Check Froepikl: Omer: Montle Dry, Mws Mahe 85 • Se tember 4, 1925 Barnitz, Yre. P PA ^ (rowed ^ ER ~ ornpalied ^ DDA ®Narsug Nana ^ Rest ^omer ~ speedy • Bb. County d Oeam &. Clry, Bond, Twp. d Deem Sd. FaaNry Name (n nil krMdbn, ttwe sheet em danhert 9. Was Deaden! d Inepenb Odpin4 ®No ^ Vey 10. Race: Amman Milan, Bock White, etc. (gyeE,epadycaan, (SPa`"~ white Cumberland Upper Allen Twp. /~fE~,//~-/-{' ~/~~~~ Mexben, PUerlo Rlarl, wc.) paad's Usual ~ d work done moll d Ne. Do not stele ~ It 12. Wes Deaden! ever in the 13. DeadeM'a Educatbn (Spedly oNy higlrew grade comWwed) 11. Madw Sklus: Marred, News Marad, Wbowed, Dlvarad (SPedM 15. Sumwng Spouse (lf wile, give maxian name) . landwwak ~idd1Nitl16w U.S. Arrrred Forest Elementary ~ Secorrdary 1o-12) 12 Coaege l1 d a 5+) 5 Married Lois J. Bates Chemistry Teacher Education ®vee ^Na D.~.a.~raMwlg"ma..tstr.w,dtr~mwn•mb•=a~i 1e D°n°da^''a Penns lvania °~M°e:d°~f Upper Allen no. ®vea, Decedent Lwxl r Trw y . 100 Mt . Allen Drive "~" Reeiana 'Ta's'ek TowneNPe Cumberland "d ^ ~ "`"Oxnpin Mechanicsburg, PA 17055 nb.coady GrylBoro Acn,ImMa d 19. Momefa Name IFkw, mbda, rreben sumrre) iS. Fatlwr'e Name (~. nkdde• ~• °~) Martha E. Garman Morris M. Paxton 20b. MlamrKa MaWp Addax (Sh«L aY I bwn, wek, dp ails) 2a. adanant's Noma (type I Prkn) 100 Mt. Allen Drive, Laurel 412, Mechanicsburg, PA 17055 Lois B. Paxton 21h Dak d DNpanla (Moral, dY. Y~ 2tc. Plea d DNpaniar (Name d cemetery. aemNay a Dorn pka) lid. LoWion Katy 1 town. akk, rip ads) 21a. Mwhod d DMpanbn ^ Crnrelwi ^ Darhal ® Bold ^ Rerr,ovwkanskte YYUCrmuskrl«DorotlonAuNOded November 23, 2010 Woodlawm Memorial Gardens Lower Paxton Twp. ,PA 17109 ^ Otlkr • Wyk, M Medical t3erMrrlr I Corarrr ^ Yes ^ No 22a d F la edkq u audrl 220. IJarre NunOer 220. Name Mrd Addrw d FedMy ~ FD 013 340 L Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070 CapMa IWa oily rArn 23e. To me bew d my knowledge, dean! aawred w nr iMk, aM end place soled. Isgreare end tltle) 230. lkeae NumOer 23c. Dak Signed IMmU, day, Year) ptryeltlen k nal evslahle w Ike d deem b asdy aw d desm. 21. Trre d Da/am /~ Q 25. oak Prabreced Dead ((may , mY. Y•n1 w~ro 21Prmaa r d aa~d~ W Parwb ~~.Q / /C C,J ~ ~ - ~ b '~ M. CAUSE OF DEATkI (SN Inawctbna and rsanrpNs) r Approdmek iMenral: Item 27. Pad I: Eder nr gpsO.fdM®oM - dleeeses, Irjrke, a mnpkadar -art dkWly Bawd dr dMm. DO NDT eder IetnYrwl e,eraa audl ri ardkc anew, i Oael b DaeM reapketay crew, «wMdcWr Ydietlon welaul alaaYq the aYndaj/. Uw ady one era on sec0~iyr. ~ ~~sEp1~ Raw ,~{f , ~~. ~JICJ~if-~ r ~.. arldYOn r~asdang b ~M) -~ e. 7( ~_- i Dab (or as a aaeprna d): , SadrdWYAw andtlnw,MmY, b. i ka3b k Ihe~~Y~ ~~ a Dab (ar as a cawePrrlce dl: i E~~d~,eaea~a nYav y~kd ma c, rtlW aw c, r isenM rasuWq In daaN) L"Sr. r ~-- Due b (« tl a wrrgana dB r d. r 30x. \VUU vl Aulopey Soh. Wsro Autopsy FM6nge 31. Mortar d Deem 92e. Dsk d InhaY (MOdh, deY, roar) 32b. Daxsba Now khaY Oocuned Perfamed7 Aveaehb Pdor b Eanplesdr ~"'° ^ ~~ 28. was Case Referred ro Aledk;el Examiner I Camar rot a Reason Other than Cremelbn or Donelbn? ^Yaa ^No I: beer doer .. 29. Did Tdkca Use CanwGKe b Dmm7 but nil raedtlrrp M dw rawfedykg sae 9w•n M Pan I. ^ Yes ^ ProWdy ~ ^ No [Unknown /~ ~ ~ , C' ' .!~ / \ 29. II Female: ./~ "" rent wiUIM Pest Year ^ Nd re ~~~ C ~j4 p g ^ Pregnenl et nme d earn ^ Nil pregred, da We9renl wimM /2 deyE ~ ~ ddaam ~. .~, 1 year ^ Nil pregred, 0d pregnarK 43 days b etas deem ^ lAYugwn N prepwd wimM the P•n Yer 32c. Rae d IMaY: Hare. Fsrm, Shan, Fxnay. Oria BuYMIg, wc. (SOacilY) d Caw d Dewh7 32e. INury et Work? 321. n Trerreporktlon InpaY (SpedM 32q. Loatbn d In~wy (Shen. illy I own, oak) ,.,r ^ M.ddem ^ Pealing InvewlpeGa 32d. tea d ky,ry ^ Yes 1 d No ^ Yes ^ No ^ Yes ^ NO ^ Ddun / DWrelor ^ Psetsrgx ^Padmhien TT^ Sukbe ^ CalAd Nd a owemkrwd M. Omer • SP•~Y~' a3a Cntleer l~ aN ore) 33e. end tale a . CaNM^9 wrrskk^ 1 cennMng aa. d deem wlMn rwnrr plryelcWl has W~~ deatlr and caglakd nom 23) ^ \~~ . To tlrnMdmy klrswkdga, deem aaurrM dwksM ewr(p and nrerwrer as skbd___________~___________________ - - _ 33d. Date slQwa m, ~a/y,,n~.r) Rorrorerekq srW artllyMW PhY~kn IPMskian ban takN Outlr and arlNykq b aw a deinQ ~-~'1 ~1 ~ ~~-~ G ~ ~ / ~/ ' To tlr baldmy knowNOP,asem oeeumdndre tkre,dak, srW pka,snd sus totM eawye)snd murnsra skkd..______________ VV • Atedkal EESmYw 1 Corona On dra UsW d sramhWlar aM I a MwWgetlon. M my Wider, MeM oared w tlM tkM, dW, sod pkoa, aM Mr k tM aae•(U soil msn a ^ 3,. Name Ad«eas n Person CanMakak _ Caw d nem zn~TYD ~I Praa 39. Date Eke l , dr. Yeed ~js7 h C GL/ ' d'CJ 3s. tkglwrefe nwaadd ~ L ~~ I / I oZ I ~ I ~ I // ~G 1 rl/d /Y! ~- ~!/-Gilt ~~ C'-K~r2~ 4S pkpanion P.rmk No. nS X12 21 2 ~ ~c.~,.' ~ a o Z . ~ ~ Q ~ ~ viaEn ~ ¢¢ ~yo° ~o j ~ F ti 2 ti ~~~~ M o -~ ti ~~. ... .. '#~ ~~~ O -' ~~~ ~LG a~ ~ ,- -; ~o oA".c y~ U ~~~ ~