HomeMy WebLinkAbout03-1071CONNONNEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
BURPAU OF INDIVIDUAL TAXES
DEP~'. Z80601
HARRISBURg, PA 17128-0601
J ZNFORHATI'ON NOTICE
AND
TAXPAYER RESPONSE
REV-I~¢$ EX &FP (09-00)
RONALD M BELL
902 DREXEL HILLS BLVD
NEW CUMBERLAND PA 17070 ~
DATE 11-27-2005
TYPE OF ACCOUNT
EST. OF JEAN BELL [] SAVINGS
S.S. NO. ZOq-Ol-q$87 [] CHECKING
DA?~. OF D~ATH 09-Z5-ZO0~ ~ TRUST
COUNTY CUHBERLAND ~ CERTZF.
REHZT PAYHENT AND FORH~ TO:
REGISTER OF ~ILLS
OUH~ERLAND 00 OOURT HOUSE
OARLISLE, PA I701S
HEHBERS leT FCU has provided the Department with the informatien listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this 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 Coaeonasalth
of Pennsylvania. Questions may be answered by calling (717) ?87-8527.
COMPLETE PART I BELOH ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Accoun~ No. qlq19-O~
Date 09-1 O- 198~ To insure proper credit to your account, t.o
Established (z) copies of this notice must accompany your
Account Balance q, 00[. 53 payment to the Register of Nilis. Hake check
payable to: "Register of Hills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments ara made within three
Amount SubSect to Tax 2,000.77 cs) months of the dscedent's date of death,
Tax Rata X .0~5 you may deduct a SZ discount of the tax due.
Any inheritance tax due will become delinquent
Potential Tax Due 90.03 nine (9) months after the date of death.
PART TAXPAYER RESPONSE
A. ~hm above information and tax due is correct.
/'-"~1. You may choose to remit payment to the Register of Hills with two copies of this notice to obtain
E CHECK -~ a discount or avoid interest, or you may check box "A' and return this notice to tho Register of
ONE Hilts and an official assessment mill 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 dacedent's representative.
C. []The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART []and/or PART [] halco.
PART If you indicate a different tax rate, please state your
[] relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established
2. Account Balance
$. Percent Taxable
q. Amount Subject to Tax
S. Debts and Deductions
6. Amount Taxable
7. Tax Rata
8. Tax Due
PART
DATE PAID
DEBTS AND DEDUCTIONS CLAZMEn
PAYEE
TOTAL (Enter on Line $ of Tax Computation)
DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
(_,>_.. pZete to the best of ay knowledge and belief.
~ORK ( ) I'~ _..-,~- ~-.,
T~XI~AYER SIGNATURE TELEPHONE NUMBER
GENERAL INFORMATION
1. FA/LURE TO RESPOND #ILL RESULT ZN AN OFFICIAL TAX ASSESSNENT aith applicable interest based on information
submitted 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 decsdent's name ams added as a matter of convenience.
4. Accounts (including those held bstaaan husband and ails) ahich the decedent put in joint names within one year prior to
death arm fully taxable as transfers.
5. Accounts established jointly bstmaan husband and mile more than Dna year prior to death ara not taxable.
6. Accounts held by a decedent "in trust for" another or others ars taxable fully.
REPORTING INSTRUCTIONS - PART ! - TAXPAYER RESPONSE
1. BLOCK A - If the information and computation in the notice arm correct and deductions are not being claimed, place an "X"
in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them aith your check for the amount of
tax to the Register of Wills of tho county indicated. The PA Department of Revenue will issue an official assessment
(Form REV-1548 EX) upon receipt of the return from the Register of Wills.
Z. BLOCK B - If the asset specified on this notice has been or wi1! ba reported and tax paid with 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, Dapt Z80601, Harrisburg, PA 171ZB-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 5
according to the instructions belom. Sign two copies and submit them aith your check for the amount of tax payable to the Register
of WiIls of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-I54B EX) upon receipt
of the return from the Register of Wills.
TAX RETURN - PART 2 - TAX COMPUTATION
LINE
1. Enter the date the account originally was mstablishad or titled in the manner existing at date of death.
NOTE: For a decedent dying after 1Z/II/BI: Accounts which the decedent put in joint names within Dna (1) year of death arm
taxable fully as transfers. However, there is an exclusion not to exceed $3)000 par transferee regardless of the value of
the account or the number of accounts held.
If a double asterisk lax) appears balers 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 follows:
A. The percent taxable for joint assets established more than Dna year prior to the dacedent's death:
I DIVIDED BY TOTAL NUNBER OF DIVIDED BY TOTAL NUNBER OF X 100 = PERCENT TAXABLE
JOINT ONNERS SURVIVING JOINT ONNERS
Example: A joint asset registered in the name of the decedent and two other persons.
I DIVIDED BY 3 (JOINT ONNERS) DIVIDED BY Z (SURVIVORS) = .167 X lO0 16.TZ (TAXABLE FOR EACH SURVIVOR)
B.Tho percent taxable for assets created within Dna year of the decedent's death or accounts owned by tho decedent but held
in trust for another individual(s) (trust beneficiaries):
I DIVIDED BY TOTAL NUNBER OF SURVIVING JOINT X 100 PERCENT TAXABLE
OWNERS OR TRUST BENEFICIARIES
Example: Joint account registered in the name o~ the decedent and two other persons and established within one year of death by
the decedent.
1 DIVIDED BY Z (SURVIVORS) = .50 X 100 - 50X (TAXABLE FOR EACH SURVIVOR)
The amount subject to tax (line 4) is determined by multiplying the account balance (line Z) by the percent taxable (line 3).
5. Enter the total of the debts and deductions listed in Part 3.
6. The amount taxable (1ina 6) is determined by subtracting the debts and deductions (1ina 5) from tho amount subject to tax (line 4).
7. Enter the appropriate tax rate (line 7) as determined below.
Da~e of Death I Spouse I Lineal Sibling I Collateral
07/01/9~ ~o 12/$1/9~
01/01/95 ~o 06/50/00 OX 6Z
07/01/00 ~o presen~ OX
xThe tax rate imposed on the net value of transfers from a deceased y one years age younger at
death to or for the usa of a natural 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
whether or not they have been adopted by others) adopted children and step children. "Lineal descendants" 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" are defined as individuals oho have at least one parent in common with the decedent) whether by blood
or adoption. The "Collateral" class of heirs includes al1 other beneficiaries.
CLAIMED DEDUCTIONS - PART 5 - DEIiTS AND DEDUCTIONS CLAIMED
Alloaable debts and deductions ara 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. [f additional space is needed, use plain paper 8 l/Z" x 11". Proof of
payment may be requested by the PA Department of Revenue.
Ronald M. Bell
Diane R. Bell
902 Drexel Hills Blvd.
New Cumberland, PA 17070
C~ v,.,ktr c- rt.C ~ ~ O
U.3
CO.
Ho~SE,
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
NO.
REV-1162 EX(11-96)
CD 003389
BELL RONALD M
902 DREXEL HILLS BLVD
NEW CUMBERLAND, PA
17070
........ fold
ESTATE INFORMATION: SSN: 204-01-4387
FILE NUMBER: 2103- 1071
DECEDENT NAME: BELL JEAN
DATE OF PAYMENT: 1 2/30/2003
POSTMARK DATE: 1 2/29/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 09/15/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
03144242 ~90.03
'REMARKS: RONALD BELL
TOTAL AMOUNT PAID:
990.03
SEAL
CHECK# 443
INITIALS: VZ
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
CONHONMEALTH OF PENNSYLVANIA
DEr~TMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
REV-15~i$ EX AFP (09-00)
RONALD M BELL
90Z DREXEL HILLS BLVD ~
MEN CUHBERLAND PA 17070
ZNFORHATZON NOTZCE
AND
TAXPAYER RESPONSE
FILE NO./O
ACH 0:51qqZq$
DATE 11-27-200:5
TYPE OF ACCOUNT
JEAN BELL I--ISAVINgS
EST.
OF
S.S. NO. 20q-Ol-q$87 E~CHECKING
DATE OF DEATH 09-15-2005 [~]TRUST
COUNTY CUMBERLAND I~CERTZF.
REMIT PAYMENT AND FORMS TO:
REGISTER OF MILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 1701:5
MEMBERS 1ST FCU has provided the Department with the information listed below which has been used in
calculating tho potential tax duo. Their records indicate that at tho death of tho above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. guastJon~ amy be answered by calling (717) 787-83Z7.
COMPLETE PART ! BELOW # # x SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. qlql9-11 Oat. 09-10-198q
Established
Account Balance 5q:5.:56
Percent Taxable X 50.000
Amount Subjec~ to Tax 271.68
Tax Rate X
Potential Tax Due 12.25
To insure proper credit to your account, two
(Z} copies of this notice must accompany your
payment to the Register of Hills. Make check
payable to: "Register of Hills, Agent".
NOTE: If tax payments are made within three
($) months of the dscadant's data of death,
you may deduct a 5g discount of the tax due.
Any inheritance tax due wi11 become delinquent
nine (9) months after the date of death.
PART TAXPAYER RESPONSE
A. ~Tha above information and tax due is correct.
~-~1
. You may choose to remit payment to the Register of gills with two copies of this notice to obtain
CHECK
ONE
BLOCK
ONLY
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Hills and an officio! assessment will be issued by the PA Department of Revenue.
B. E~ The above asset has been or ~i1! be reported and tax paid with the Pennsylvania Inheritance Tax return
to be fi[ed by the docedent's representative.
C. ~ The above information is incorrect and/or debts and deductions were paid by you. You must comp[ate PART [] and/or PART [] be[ow.
PART Zf you indicate a different tax rata, please s~ate your
relationship ~o decedent:
TAX RETURN -COMPUTATZON OF TAX ON JOZNT/TRUST ACCOUNTS
LZNE 1. Date Established I
2. Account Balance 2
3. Percent TaxabZe $ ~
q. Amount Subject to Tax q
S. Debts and Deductions $ -
6. Amount Taxable 6
7. Tax Rata 7 ~
8. Tax Due 8
PART
DATE PAID
DE~ITS AND DEDUCTZONS CLAIMED
PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on Line $ of Tax Computation)
Under penalties of perjury, Z declare that the facts Z have reported above ara true, correct and
T/~x~omplate to the best of .y knowledge and
.~,u ~R ~ TELEPHONE NUMBER DATE
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT ZN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information
submitted by the financial institution.
Z. Inheritance tax becomes delinquent nine months after the decadent'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 end mile) ahich the decedent put in joint names within one year prior to
death are fully taxable as transfers.
5. Accounts established jointly between husband and aJfe 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 [ - TAXPAYER RESPONSE
BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X"'
in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit thee with your check for the amount
tax to the Register of Nilis of the county indicated. The PA Department of Revenue will issue an official assessment
(Fore REV-15qB EX) upon receipt of the return from the Register of Hills.
Z. BLOCK B - 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 decadent'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, Bert lB0601, Harrisburg, PA 171Z&-0601 in the
envelope provided.
5. 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 two copies and submit them with your check for the amount of tax payable to the Register
of Hills of the county indicated. The PA Department of Revenue will issue an official assessment (Fora REV-ZBq8 EX) upon receipt
of the return from the Register of
TAX RETURN - PART Z TAX COMPUTATION
LINE
1. Enter the date the account originally was established or titled in the manner existing at data of death.
NOTE: For a decedent dying after 1Z/II/el: 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 (xa) appears before your first name in the address portion of this notice, the $5,000 exclusion
already has been deducted from the account balance as reported by the financial institution.
Enter the total balance of the account including interest accrued to the data of death.
The percent of the 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 dacedent's death:
I DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE
JOINT ONNERS SURVIVING JO/NT OHNERS
Example: A joint asset registered in the name of the decedent and two other persons.
I DIVIDED BY 5 (JOINT OHNERS) 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 owned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
I DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 PERCENT TAXABLE
OWNERS DR 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 100 S0Z (TAXABLE FOR EACH SURVIVOR)
The amount subject to tax (line fi) is determined by multiplying the account balance (line Z) by the percent taxable (line
5. Enter the total of the debts and deductions 11stad in Part 5.
6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line S) free the amount subject to tax (line
7. Enter the appropriate tax rate (line 7) as determined below.
De~e of Death I Spouse I Lineal Sibling Collateral
07/01/9q ~o 12/$1/9q I SZ 6Z 15X
01/01/95 ~o 06/50/00I OX 6g 15X
07/01/00 ~o presen~ OX q.SX~ 12Z 15X
xThe tax rata imposed on the net value of transfers from a duuuasad child twenty-one years of age or younger at
death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is
The lineal class of he[rs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children
whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all 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 mhd have at least one parent in common with the decedent, whether by blood
or adoption. The "Collateral" class of heirs includes al1 other beneficiaries.
CLAIMED DEDUCTIONS - PART 5 DEBTS AND DEDUCTIONS CLAIMED
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 Turnish proof of payment.
C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper B l/Z" x 11". Proof of
payment may ba requested by tho PA Department of Revenue.
Ronald M. Bell
Diane R. Bell
90~ Drexel Hills Blvd.
New Cumberland, PA 17070
~E_C~i~ ¥ i ~ oC.- u3 'LC_L $
toA.. 17o~
I,,,tll,,,lll:,,,,,Ih,lh.tl,,,ll,lh,,,,,lh,,lll
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
NO.
REV-1162 EX(11-96)
CD 0O3390
BELL RONALD M
902 DREXEL HILLS BLVD
NEW CUMBERLAND, PA
17070
ESTATE INFORMATION: SSN: 204-01-4387
FILE NUMBER: 2103- 1071
DECEDENT NAME: BELL JEAN
DATE OF PAYMENT: 12/30/2003
POSTMARK DATE: 1 2/29/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 09/15/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
03144243 $12.23
TOTAL AMOUNT PAID:
$12.23
REMARKS: RONALD BELL
SEAL
CHECK#442
INITIALS: VZ
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF ZNDZVZDUAL TAXES
XNHERXTANCE TAX DZVTSXON
DEPT. 28n601
HARRTSBURG, PA 17128-0601
COHHONHEALTH OF PENNSYLVANZA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAXSEHENT. ALLOHANCE OR DZSALLOHANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-1548 EX AFP (Ol-OS)
RONALD H BELL
902 DREXEL HILLS BLVD
NEH CUHBERLAND
R~CF~:~?!~:. .i 2~DATE 05-08-200q
~L! ~"~ :i;~ ESTATE OF BELL
- DATE OF DEATH 09-15-2005
FXLE NUHDER
COUNTY
'0~ H~R-5 P3:,~N/DC
ACN
21 05-1071
CUHBERLAND
20~-01-~587
Amoun~ Rem/~md
JEAN
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF HILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAXN LOHER PORTION FOR YOUR RECORDS *"~
REV-1548 EX AFP (01-03)
NOTICE OF INHERITANCE TAX APPRAXSEHENT, ALLOHANCE OR DXSALLOHANCE OF
DEDUCTIONS, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 05-08-200~
ESTATE OF BELL JEAN DATE OF DEATH 09-15-2005 COUNTY CUHBERLAND
FILE NO. 21 05-1071 S.S/D.C. NO. 20q-01-~587 ACN O$1q~2qZ
TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET XNFORHATZON
FINANCIAL INSTITUTION: HEHBERS IST FCU ACCOUNT NO. ~1q19-0~
TYPE OF ACCOUNT= (~ SAVINGS ( ) CHECKING ( ) TRUST ( ) TIHE CERTIFICATE
DATE ESTABLISHED 09-10-198~
Accoun~ Balance
Percen~ Taxable ~ 0.500
Amoun~ Sub~ec* to Tax 2,000.77
Debts and Deduc~1ons - .00
Taxable Amoun~ Z,000.77
Tax Ra~e ~ .~5
Tax Due 90.05
TAX CREDZTS:
~,001.55 NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBHIT THE
UPPER PORTION OF THIS NOTICE
H/TH YOUR TAX PAYHENT TO THE
REGISTER OF HILLS AT THE
ABOVE ADDRESS. HAKE CHECK
OR HONEY ORDER PAYABLE TO:
"REGISTER OF HILLS, AGENT."
PAYHENT RECEIPT DISCOUNT (+)
DATE NUHBER INTEREST/PEN PAID (-) AHOUNT PAID
12-29-2005 CD005589 .00 90.05
TOTAL TAX CREDZT
BALANCE OF TAX DUE
XNTEREST AND PEN.
TOTAL DUE
ZF PAID AFTER THXS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL TNTEREST. ~
( 'rF TOTAL DUE TS LESS THAN $1, NO PAYNENT TS REI~U/RED.
ZF TOTAL DUE TS REFLECTED AS A "CREDTT' (CR), YOU NAY BE DUE A REFUND.
SEE REVERSE STDE OF THIS FORN FOR TNSTRUCTZONS. )
90.05
.00
.00
.00
BUREAU OF TNDZVZDUAL TAXES
INHERITANCE TAX DTVZSTON
DEPT. 280601
HARRTSBURG, PA 171Z8-0601
COMMONgEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF XNHERXTANCE TAX
APPRAZSEHENT, ALLO#ANCE OR DZSALLO#ANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
DATE 03-08-200q
ESTATE OF BELL
DATE OF DEATH 09-15-2003
RONALD N BELL
902 DREXEL HILLS BLVD
NEg CUMBERLAND PA 170~D1~[~ ' ~-:,~;~
FILE NUMBER
.A OUNTY
-5 P3 " SN/DC
ACN
21 03-1071
CUMBERLAND
20q-01-~387
031~2R3
Amoun~ RemiC:ted
REV-1548 EX AFP ¢01-g5}
JEAN
MAKE CMECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF gILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE
REV-1548 EX AFP (01-03)
RETAIN LOgER PORTION FOR YOUR RECORDS
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOgANCE OR DZSALLOgANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON dOZNTLY HELD OR TRUST ASSETS
DATE 03-08-200q
ESTATE OF BELL dEAN
DATE OF DEATH 09-15-2003 COUNTY CUMBERLAND
FILE NO. 21 03-1071 S.S/D.C. NO. 20q-Ol-q387 ACN O$1qqZq$
TAX RETURN gAS: CX) ACCEPTED AS FILED C ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. qlqI9-11
TYPE OF ACCOUNT: ( ) SAVINGS C ~ CHECKING C ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 09-I0-198q
Account Balance 5q3.36
Percent Taxable X 0.500
Amount Subject to Tax 271.68
Debts and Deductions - .00
Taxable Amount 271.68
Tax Rate X .~5
Tax Due 12.Z3
NOTE:
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID
12-29-2003 CD003390 . O0 12.23
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
gITH YOUR TAX PAYMENT TO THE
REGISTER OF gILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF gILLS, AGENT."
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATZON OF ADDITIONAL INTEREST. a
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
12.23
.00
.00
.00