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Home My WebLink About09-30-11COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 015020 MIDGLEY ANN F 263 W SOUTH STREET CARLISLE, PA 17013 ------- fold ESTATE INFORMATION: SSN: 297-14-5377 FILE NUMBER: 21 1 1-1000 DECEDENT NAME: FARRELL JAMES K DATE OF PAYMENT: 09/30/2011 POSTMARK DATE: 09/29/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 07/01 /201 1 ACN ASSESSMENT AMOUNT CONTROL NUMBER 11148497 ~ 5179.75 TOTAL AMOUNT PAID: 5179.75 REMARKS: CHECK#1355 INITIALS: DB SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS -~ PENNSYLVANIA INHERITANCE TAX ~' INFORMATION NOTICE } BUREAU OF INDIVIDUAL T,~X,E$ ~ FILE N0. 21 -" ~ ~ (;~~ Po Box 260601 ~@17t1S~/~/~18 AND ACN 11148497 HARRISBURG PA 17128-06U1 DEPARTMENTOF'RE ENUE TAX P AY E R R E S P O N S E DATE 07-19-2011 REV-.1543 EX AFF~~5-11) - TYPE OF ACCOUNT ~~`~ ~ ' EST. OF JAMES K FARRELL ^ savlNGs SSN 297-14-5377 ^ CHECKING ~ ~~ '~'_` DATE OF DEATH 07-01-2011 ^ TRUST ~~!',_i, ` _~ ~~ ""it COUNTY CUMBERLAND ~ CERTIF. /, iI ~-~+~k, ~^ REMIT PAYMENT AND FDRMS T0: ANN MIDGLEY REGISTER OF WILLS 263 W SOUTH STREET 1 COURTHOUSE SQUARE CARLISLE PA 17013 CARLISLE PA 17013 MEMBERS 1ST F CU provided the department with the information below, which was used it calculating the inheritance tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you are the Spouse of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe 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. Please call 717-7R7-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 319710-46 Date 03-29-2010 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 25 ~ 227.60 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 16.667 Amount Subject to Tax $ 4 X 204.6$ NOTE: If tax payments are made within three months of the decedent's date of death, Tax Rate X .045 deduct a 5 percent discount on the tax due. Potential Tax Due Any inheritance tax due will become delinquent 189.21 nine months after the date of death. PART TAXPAYER RESPONSE 'I^ FAILURE TO RESPOND WILL 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 C H E C K a discount or avoid interest, or return this notice to the Register of Wills and 0 N E an official assessment will be issued by the PA Department of Revenue. B L 0 C K ~ B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return 0 N L Y filed by the estate representative. C. ^ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART ~ and/or PART ~ below. Y AKI r.r inaicacing a oitterent tax rate, please state relationship to decedent: TAX RETURN - CALCULATION LINE I. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to T'ax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS 2 3 X 4 5 - 6 7 X 8 $ PAD 1 2 3 4 5 6 7 8 OFFICIAL USE ONLY ^ AAF PA DEPARTMENT OF REVENUE YAKI DEBTS AND DEDUCTIONS CLAIMED DATE PAI PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) g Under penalties of perjury, I declarefthat,the facts I reported above are t ue, cgrre>r and ,"1 complete t the best of y kno 1 ge nd elief. fi~~'"'/'(~ U ~- HOME C' ) 6~. ~ V t I ~ WORK C ) TAXPAYER SIGNATURE TELEPHONE NUMBER D E ~~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EXI11-96) N0. CD 015021 MIDGLEY ANN F 263 W SOUTH STREET CARLISLE, PA 17013 -------- fold ACN ASSESSMENT AMOUNT CONTROL NUMBER ESTATE INFORMATION: Ssrv: 297-i4-5377 FILE NUMBER: 211 1-1000 DECEDENT NAME: FARRELL JAMES K DATE OF PAYMENT: 09/30/201 1 POSTMARK DATE: 09/29/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 07/01 /201 1 REMARKS: 11148495 ~ 5115.12 TOTAL AMOUNT PAID: 5115.12 CHECK#1356 INITIALS: DB SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS /_1 BUREAU OF INDIVIDUAL TAXES"' PD BDX 280601 '..,(% ,... R~~~lvania HARRISBURG PA 17P29-b6B1 I _ DEPAR MEN~~OF REVENUE I ~ - REV-1543{X AFP (D5 -111 PENNSYLVANIA INHERITANCE T INFORMATION NOTICE AND TAXPAYER RESPONSE F I L E N 0. 21 `~ ~- ~~~ ACN 11148495 DATE 07-19-2011 ,. a ) ' . t L. ~;,';. n u 1; ! 'if ANN MIDGLEY 263 W SOUTH STREET CARLISLE PA 17013 EST. OF JAMES K FARRELL SSN 297-14-5377 DATE OF DEATH 07-01-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS TD: REGISTER OF WILLS 1 COURTHOUSE SgUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. MEMBERS 1 ST FCU provided the department with the information below, which was used in calculating the inheritance tax c'ue. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If y0U are the SpoUSe Of the deceased and any amount other than zero is reflected below on the Potential lax Due line, note no tax may be due, but you must notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe the information is incorrect, please obtain written correction from the financial institution, at~ach a copy to this form and return it tc the above address. vlease cal 717-7A7-A327 wfth nuestisns. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 319710-42 Date 03-31-2009 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 16, 155.57 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 16.667 Amount Subject to Tax ~` 2, 692.65 NOTE: If tax payments are made within three months of the decedent's date of death, Tax Rate X .045 deduct a 5 percent discount on the tax due. Potential Tax Due $ 121.17 Any inheritance tax due will become delinquent nine months after the date of death. PART TAXPAYER RESPONSE 1^ FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT A. IVI The above information and tax due is correct. LJ Remit payment to the Register of Wills with two copies of this notice to obtain C C H E C K a discount or avoid interest, or return this notice to the Register of Wills and 0 N E ~ an official assessment will be issued by the PA Department of Revenue. B L 0 C K B. ~ The above asset has been or will be reported and tax 0 N L Y paid with the Pennsylvania inheritance tax return 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 L__I below. PART If indicating a different tax rate, please state relationship to decedent: ~ OFFICIAL USE ONLY ~ AAF TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PA DEPARTMENT OF REVENUE PAD LINE 1. Date Established 1 I 2. Account Balance 2 $ Z 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ 4 5. Debts and Deductions 5 - 5 6. Amount Taxable 6 $ 6 7. Tax Rate ~ X 7 8. Tax Due g $ 8 PART DEBTS AND DEDUCTIONS CLAIMED DATE AID PAYEE ~~. el DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) g Under penalties of perjury, I declare that the facts I reported above are true, corr ct and mplete to th est f m k owledge and belief. '~ i HOME C ~ ) J ~' WORK C ) AXPAYER SIGNATURE TELEPHO E UMBER TE