HomeMy WebLinkAbout04-1001 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 004588
LESA WILSON
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
........ fold
101 $1,999.07
ESTATE INFORMATION: SSN: 192-34-6921
FILE NUMBER: 2104- 1001
DECEDENT NAME: CLOUSE IRENE M
DATE OF PAYMENT: 11/05/2004
POSTMARK DATE: 11/05/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 12/10/2003
TOTAL AMOUNT PAID: $1,999.07
REMARKS' CLOUSE
CHECK//4544
INITIALS: CCP
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COHNONHEALTU OF PENNSYLVANIA ~
DEPARTHENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES TNFORHATTON NOTICE FILE NO. 21 ~0~- I00~
DEPT. ZSO60l AND
HARRISBURG, PA 171Z8-060! TAXPAYER RESPONSE ACN 0q105358
REV-lS43 EX AFP (Og-OO) DATE 02-16-2004
TYPE OF ACCOUNT
£$T. OF MARY C HUTZELL [] SAVINGS
5.5. NO. 192-34-6921 [] CHECKTNG
DATE OF DEATH 12-10-2003 [] TRUST
COUNTY CUMBERLAND [] CERTZF.
REH/T PAYMENT AND FORHS TO:
IRENE M CLOUSE REGISTER OF WILLS
276 SLED DR CUMBERLAND CO COURT HOUSE
SHERNANSDALE PA 17090 CARLISLE, PA 17013
BANK OF LANDZSBURG has provided the Department with fha information listed bales 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 [nharitanca Tax Laos of the Commonwealth
o~ Perinsylvania. Questions may be ansearad by call,ne (717) 767-6327.
COHPLETE PART I BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYHENT INSTRUCTIONS
Account No. 700011578 Data 12-17-2001 To insure proper credit to your account, two
Established cz) copies of this notice must accompany your
Account Balance 70,611.30 payment to the Register of Hills. Hake check
payabla to: 'Rsgistar of Hills, Agent".
Percent Taxable X 16.667
Amount SubSact to Tax 11,768.79 NOTE: If tax payments ara made within three
($) months of the decsdent's date of dsath~
Tax Rate X .045 you may deduct a 5Z discount of the tax due.
Any inharitanca tax due will become delinquent
Potential Tax Due 529.60 nine (9) months after the date of
PART TAXPAYER RESPONSE
A. ~ The above information and tax dua is correct.
l. You say choose to remit payment to the Register of Hills with two copies of this notice ta obtain
CHECK ~ a discount or avoid interest, or you may check box "A" and return this notice to the Register of
ONE Nills and an official assessment will be issued by the PA Department of Revenue.
BLOCK B. [] The above asset has been or ~il! be reported and tax paid with the Pennsylvania ~nheritance Tax return
ONLY to be filed by the decedent's representative.
C. ~he above information is incorrect and/or debts and deductions were paid by you.
You must complete PART [] and/or PART ~ below.
PART Zf you indicate a different tax rate~ please state your
relationship to decedent:
TAX RETURN - COHPUTATZON OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Data Established 1
2. Account Balance 2.
$. Percent Taxable $
~. Amount Subject to Tax
$. Debts and Deductions
6. Amount Taxable 6
7. Tax Rata 7
8. Tax Due 8
PART DEBTS AND DEDUCTIONS CLAZM;n
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on L/ne $ of Tax Computation)
Under penalties of per5ury~ Z declare that the facts I have reported abovur~,,trua~.r,o~,re;;~-Jand
coop,ate to the best of~ kno.ledge and bal,ef. HO"E (7/~) 6~1'/~,~)- ~__~///~/~ .
TAXPAYER SIGNATURE TELEPHONE NUMBER
COMMONREALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES ZNFORMATZON NOTZCE FZLE NO. 21
DEFT. 280601 AND
HARRISBURg, PA 17128-0601 TAXPAYER RESPONSE ACN 0q105556
.., REV-ZSaSEXAFPCOg-OO) DATE 02-16-gOOq
TYPE OF ACCOUNT
EST. OF MARY C HUTZELL []SAVZNaS
S.S. NO. 19Z-3q-69Z1 []CHECKZNg
DAT£ OF DEATH 12-10-2003 E~TRUST
COUNTY CUMBERLAND []CERTXF,
REMZT PAYMENT AND FORMS TO:
IRENE M CLOUSE REGISTER OF WILLS
276 SLED DR CUMBERLAND CO COURT HOUSE
SHERMANSDALE PA 17090 CARLISLE· PA 17013
BANK OF LANDZSBURG has provided the Department with the information llsted below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you ware 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 Tnheritance Tax Laws of the Commonwealth
of Pennsylvania. guestions may be answerea by calling (71/) 787-&SZ7.
COMPLETE PART ! BELOW x x x SEE REVERSE SZDE FOR FZLZNG AND PAYMENT ZNSTRUCTZONS
Account No. 068q98q38 Data [2-[7-2001 TO insure proper credit to your account, two
Establ/shad cz) copies of this notice must accompany your
payment to the Register of Rills. Make check
Account Balance 37,065. q3 payable to: "Register of Rills, Agent".
Percent Taxable X 16. 667
Amount SubSect to Tax 5 · 3q~. 35 NOTE: If tax payments are made within three
(:5) months of the decedent's date of death,
Tax Rate X . 0~5 you may deduct a 5Z discount of the tax due.
Any inheritance tax due ail1 become delinquent
Potent/a/ Tax Due ?qO. 50 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 Rills with two copies of this notice to obtain
CHECK -~ a discount or avoid interest, or you may check box "*" and return this notice to the Register of
ONE Nllls and an official assessment will be issued by the PA Department of Revenue.
BLOCK J S. [] The above asset has been or will be reported and tax paid with the Pennsylvania Tnheritance Tax return
ONLY to be filed by the decedent's representative.
C. ~/The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART [] and/or PART [] below.
PART Tf yOU /nd/cate a different tax rate· please state your
relat/onsh/p to decedent:
TAX RETURN - COMPUTATZON OF TAX ON JOZNT/TRUST ACCOUNTS
L~NE 1. Date EstebZ/shed 1
2. Account Balance 2
~. Percent Taxable $
q. Amount Subject to Tax
S. Debts and Deductions
6. Amount Taxable 6
7. Tax Rate 7
8. Tax Due 8.
PART DEBTS AND DEDUCTZONS CLA]:H~I
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on L/ne 5 of Tax C~---_-~:dtat/on)
Under panalt/as of perjury· ]~ declare that the facts Z have reported above arej:rue·.c~e~c:~and
/TAXPAYER
SIGNATURE TELEPHONE NUMBER
1. 'L~(""""'.r_-';r""'::-- ("
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
RECORD ADJUSTMENT
JOINTLY HELD OR TRUST ASSETS
REV-1604 EX AFP (03-05)
..., .~
,
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DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
10-14-2005
HUTZElL
12-10-2003
21 04-1001
CUMBERLAND
192-34-6921
04105358
Amount Remitted
MARY
C
~ . : ,
IRENE ~ CLOUSE
C/O DAVID C MILLER JR
1100 SPRING GDN DR A
MIDDLETOWN PA 17057
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE
--+ RETAIN LOWER PORTION FOR YOUR RECORDS
+-
------------------------------------------------------------------------------------------------------------------------------------------------------------------
REV-1604 EX AFP (03-05)
-- INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS __
DATE 10-14-2005
ESTATE OF HUTZELL
MARY
C DATE OF DEATH 12-10-2003
COUNTY
CUMBERLAND
FILE NO. 21 04-1001
ADJUSTMENT BASED ON:
S.S/D.C. NO. 192-34-6921
ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
ACN
04105358
FINANCIAL INSTITUTION: BANK OF LANDISBURG
ACCOUNT NO. 700011578
TYPE OF ACCOUNT: () SAVINGS () CHECKING () TRUST (X) TIME CERTIFICATE
DATE ESTABLISHED 12-17-2001
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
70,611.30
0.166
11,768.79
1,262.88
10,505.91
.45
472.76
NOTE: TO INSURE PROPER CREDIT TO YOUR
ACCOUNT, SUBMIT THE UPPER PORTION
OF THIS NOTICE WITH YOUR TAX
PAYMENT TO THE REGISTER OF WILLS
AT THE ADDRESS SHOWN ABOVE.
MAKE CHECK OR MONEY ORDER PAYABLE
TO: "REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
11-05-2004 CD005552 2.91- 475.67
TOTAL TAX CREDIT 472.76
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE on
· IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
llEV-1470 EX (6-88)
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG PA 17128-0601
DECEDENT'S NAME
FILE NUMBER
REVIEWED BY
MARY C HUTZELL
SCOTT ELLISON
ACN
ITEM
SCHEDULE NO.
EXPLANATION OF CHANGES
DEDUCTIONS IN THE AMOUNT OF $1,262.88 HAVE BEEN APPROVED.
ROW
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COMMONHEALTH OF PENNSYLVANZA ~
DEPARTHENT OF REVENUE
BUREAU OF ZNDZVZDUAL TAXES ZNFORMATZON NOTZCE FZLE NO. 21
DEPT. Z80601 AND
HARRISBURG, PA 17128-0601 TAXPAYER RESPONSE ACN 0q105559
REV-I~dSEX&FP(Og-OO) DATE OZ-16-ZOOq
TYPE OF ACCOUNT
EST. OF MARY C HUTZELL [] SAV1.NOS
S.S. NO. 19Z-Sq-6921 [] CHECK1.NG
DATE OF DEATH 12-10-2005 [] TRUST
COUNTY CUMBERLAND j~-JCERT1.F.
REM1.T PAYMENT AND FORMS TO:
LESA D NZLSON REGZSTER OF NZLLS
502 NOUNTAZN VIEN RD CUMBERLAND CO COURT HOUSE
SHERMANSDALE PA 17090 CARLISLE, PA 17015
BANK OF LANDTSBUR$ has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you ware a joint owner/beneficiary of
this account. Zf 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 CoamonweaIth
of Pennsyivania. ~uestions may be answered i~y calli.g (7i7) 7&7-&SA7.
COMPLETE PART :1 DELON x x ~ SEE REVERSE Si:DE FOR FZLZNG AND PAYMENT ZNSTRUCTZONS
Account No. 700011578 Date 12-17-2001 TO insure proper credit to your account, two
Established (z) copies of this notice must accompany your
Account Balance 7 O, 611.50 payment to the Regis/ar of Hills. Make check
payable to: "Register of Hills, Agent".
Percent Taxable X 16.6 6 7
Amount Subject to Tax 11,768.79 MOTE: If tax payments ara made within three
C5) months of the dacedent's data of death,
Tax Rata X . 12 you may deduct a AZ discount of the tax due.
Any inheritance tax due ~i11 become delinquent
Potent/al Tax Due 1 · 412 · 25 nine (9) months after the date of death.
PART TAXPAYER RESPONSE
I'
A. [] The above information and tax duo is correct.
1. You may choose to remit payment to the Register of Mills with two copies of this notice to obtain
CHECK -~ a discount or avoid interest, or you may check box "A" and return this notice to the Register of
ONE Hills and an official assessment will be issued by the PA Department of Revenue.
BLOCK J B. [] The above asset has been or will bm reported and tax paid with the Pennsylvania Znheritance Tax return
ONLY to be filed by the decedent's representative.
C. ~/The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART [] and/or PART [] below.
PART Tf you /nd/cate a different ~ax rata, p/ease state your
relationship to decadent:
TAX RETURN - COMPUTATTON OF TAX ON JOTNT/TRUST ACCOUNTS
LTNE 1. Data Established 1
2. Account Balance 2
5. Percent Taxable
q. Amount Subject to Tax
5. Debts end Deduct/ohs
6. Amount Taxable 6
7. Tax Rate 7
8. Tax Due 8
PART DEBTS AND DEDUCTTONS CLAZH~I
DATE PATD PAYEE DESCRIPTTON AMOUNT PATD
TOTAL (Enter on L/ne 5 of Tax Co~5-:dtation) $
Under penalt/e~T~.~~ perjury, Z declare that the facts 1' have reported above ar~L.;I;rue·~_cj~qr~c_!gand
compZmte ~~h , kno.ledge and bel,ef. "OHE ~/7
SZGNAT~ - TELEPHONE NUH~ER
CONNON#EALTH OF PENNSYLVANTA ~
DEPARTNENT OF REVENUE
DUREAU OF ZNDZVZDUAL TAXES ZNFORMATZON NOTZCE FILE NO. 21
DEPT. 280601 AND
HARR[SBURg, PA 17128-0601 TAXPAYER RESPONSE ACN 04105557
REV-~43 EX *FP CO~-.O) DATE 02-16-2004
TYPE OF ACCOUNT
EST. OF MARY C HUTZELL [] SAVTN$S
S.S. NO. 192-34-6921 [] CHECKTMg
DATE OF DEATH 12-10-2003 [] TRUST
COUNTY CUMBERLAND [] CERTTF.
REMTT PAYMENT AND FORMS TO:
LESA D WILSON REGISTER OF k/ILLS
502 MOUNTAIN VIE9/ RD CUMBERLAND CO COURT HOUSE
SHERMANSDALE PA 17090 CARLISLE, PA 17013
BANK OF LANDZSBURg has provided the Department mith the information listed belam mhich has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you mere a joint owner/beneficiary
this account. If you feel this information is incorrect, please obtain mritten correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance mith the Inheritance Tax Lams of the Coamonmaalth
COMPLETE PART ! BELOW x x x SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 068498438 Date 12-17-2001 TO insure proper credit to your account, ted
Established (g3 copies of this notice must accompany your
Account Balance 32,065.43 payment to tho Register of gills. Make check
payable to: "Register of NiZls, Agent"'.
Percent Taxable X 16.667
Amount Subject to Tax ~, 344.55 NOTE: If tax Payments ars made mithJn three
(~) months of the dacedant's date of death,
Tax Rata X . 12 you may deduct a 52 discount of tho tax due.
Any inheritance tax due mill become delinquent
Potentia! Tax Due 641.32 nine (9) months after the date of death.
PART
~] TAXPAYER RESPONSE
A. ~Thm above information and tax duo is correct.
1. You may choose to remit payment to the Register of NJ~ls mJth tad copies of this notice to obtain
E CHECK ~ a discount or avoid interest, or you may check box "A" and return this notice to the Register of
ONE Mitts and an officJa! assessment mi!! be issued by tho PA Department of Revenue.
BLOCK s. [] The above asset has been or mi!! be reported and tax paid mith the PsnnsyXvania ~nhsritanca Tax return
ONLY to be fiZsd by the decedent's representative.
C. ~The above information is incorrect and/or debts and deductions mere paid by you.
You must complete PART ~ and/or PART ~ balom.
PART Zf you indicate a different tax rate) please state your
[ ~] relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOiNT/TRUST ACCOUNTS
LINE [. Date Established
2. Account Balance 2
$. Percent Taxable
q. Amount Subject ~o Tax
5. Debts and Deductions
6. Amount Taxable 6
7. Tax Rate 7
8. Tax Due B..
PART DEBTS AND DEDUCTIONS CLAZME~
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on Line $ of Tax Computation)
Under p~elties of perjury, T decZare that the facts have reported above
~ORK (
~A~R -S T~ATURE - -
TELEPHONE NUHBER
Attorney at Lau,
INFORMATION NOTICE and TAXPAYER RESPONSE
File #: 21 ACN: 04105358
Estate: Estate of Mary C. Hutzell SSN: 192-34-6921
Date of County: Cumberland
Death: 12-10-2003
The decedent, Mary C. Hutzell, held assets in two joint accounts at the time of her death. Both
accounts were created on 12-17-2001, more than one year before the date of death. The first account
was a savings account, #068498438. The attached Rev. Form 1543 indicates a balance for tax
purposes of $32,065.43. The account was taxable to two individuals, the decedent's mother, Irene
M. Clouse, and the decedent's sister Lesa D. Wilson. Each individual was accessed tax on the basis
of a one-sixth (1/6th) share of the account, or $ 5,344.35.
The second account was a Certificate of Deposit, #700011578, also created on 12-17-2001, more
than one year before the date of death. The account had a balance 03570,611.30, which was taxable
to two individuals, the decedent's mother, Irene M. Clouse, and the decedent's sister, Lesa D.
Wilson. Each individual was accessed tax on the basis of a one-sixth (1/6th) share of the account,
or $11,768.79.
The taxes due from both individuals involved are indicated in the chart below.
Total Assets: Taxable Share of Assets:
Account # 068498438 $ 32,065.43 Account Values: $102,676.73
Account # 700011578 $ 70,611.30 Percent Taxable: x 16.667%
TOTAL: $102,676.73 Subtotal: $17,113.14 Irene
$17,113.14 Lesa
Deductions: TOTAL: $34,226.28
Westminster Cemetary Memorial $ 2,992.00
Hoffman-Roth Fun. Home Funeral $ 4,736.00
Chapel Pointe Nursing Home Care $ 2,267.10
$ 9,995.10
Total Assets: $34,226.28
Total Deductions: $ 9,995.10
Taxable Amount: $24,231.18
Irene Clouse: $24,231.18 x 50% = $12,115.59 x 4.5% tax = $ 545.20
Lesa Wilson $24,231.18 x 50% = $12,115.59 x 12% tax = $1,453.87
TAX DUE: $1,999.07
1846 Bonnie Blue Lane · Middletown, PA 17057 * Phone: 717-329-8533 · Fax: 717-939-2798 · E-mail: DavidCMillerLaw(a,aol.com
1159 Newville Road Phone (717) 249-2029
Carlisle, Pennsylvania 17013-1777 FAX (717) 249-9365
September 21, 2004
To Whom It May Concern:
This is to verify that Mr. Richard Hutzell paid $2992.00 for a bronze memorial
for Mary "Molly" Hutzell. This account is paid in full.
If you have any questions or concerns, please feel free to contact the office.
Sincerely,
Fonda Taylor ~
14176-239
Name Mary E, Hutzell
Residence 273 West Ridge St., Carlisle, PA 17013-
Place of death Chapel Pointe at Carlisle
Date of dea'th December 10, 2003
Wife/Husband Married Richard M. Hutzell
Born September 26, 1942 61 2 14
Occupation Receptionist Medical Insurance
Social Security # ~'~34-9781
Birthplace Linglestown, PA
Father Dale A. Clouse
Mother Irene M. McQuay Clouse
Viewing Friday, December 12, 2003 from 6:00 PM to 8:00 PM
Viewing Place Hoffman-Roth Funeral Home, Inc.
Services Hoffman-Roth Funeral Home, Inc.
Service time 8:00 PM Date 12/12/2003
Interment Westminster Memorial Gardens, Carlisle, PA
SECTION Garden Benedidl[~'~ 98A GRAVE
Cremation Yorktowne Cremation Service 1211312003
Clergy Rev. Charles Kish
Informant Richard M. Hutzell Husband
Address 273 West Ridge St. Carlisle, PA 17013-
Phone (717)249-4077
Surviving:
Richard M. Hutzell of Carlisle, PA
Marc C. Hutzell Of Silver Spring, MD
Travis B. Hutzell of Des Moines, IA
Lesa D. Wilson of Shermans Dale, PA
Townes H. Hutzell of Des Moines, IA
Irene M. Clouse of Shermans Dale, PA
Grandchildren 1 Great Grand 0 Great Great 0
Enlisted / /
Discharged / /
Service ft
CREMATION PACKAGE # 1
2975.00
Casket Kinsey Casket Yorktowne 725.00
Vault Marbelon Universal Urn Wilbert 300.00
Urn Unity Biodegrable Urn
Clothing Wearing Apparel 81.00
Etc. 0.00
0.00
TOTAL
Grave Opening 4081.00
Newspaper Notice 580.00
Newspaper Notice 0o00
Airfare 0.00
Clergy 0.00
Certified Copies 0.00
Flowers 20.00
Hairdresser 0.00
Other 30.00
25.00
~ TOTAL CASH ADVANCES
Additional Items 655.00
0.00
0.00
TOTAL ADDITIONAL ITEMS ~
0.00
GRAND TOTAL 4736.00
Glenda Farner Strasb ugh
Register of Wills &
Clerk of Orphans' Co
Marjorie A. Wevod u
First Deputy
Kirk S. Sohonage, E q.
Solicitor
One Courthouse Square
Carlisle, P A 17013
Phone: (717) 240-6345
Fax: (717)240-7797
OFFICES OF
Regist r of Wills and Clerk ofthe Orphans' Court
County of Cumberland
TO:
Diane McCain
COMPANY:
Dept of Rev
FAX NUMBER:
717-772-0412
REo
Corrected Inher Tax ceipt
FACSIMILE TRANSMITTAL SHEET
FROM:
Roger Kelly
PHONE:
717-240-6347
DATE:
May 26, 2005
TOTAL NO. OF PAGES INCLUDING COVER:
2
o URGENT
o FOR RE JEW 0 PLEASE COMMENT 0 PLEASE REPLY
o PLEASE RECYCLE
ATTORNEY DAVID ILLER CONTACTED OUR OFFICE REGARDING A
MISSING INHER TA RECEIPT. OUR OFFICE ISSUED AN INVOICE IN ERROR,
LISTING "IRENE M. LOUSE" AS DECEDENT IN FILE # 21-04-1001. THE
ACTUAL DECEDEN WAS MARY C HUTZELL. A CORRECTED RECEIPT IS
ATTACHED. HOPE ULLY, THIS WILL HELP TO RESOLVE THE SITUATION.
ROGER KELLY, SEC ND DEPUTY.
TRANSMISSION VERIFICATION REPORT
TIME OS/25/2005 22:41
NAME
FAX
TEL
DATE. TIME OS/25 22:41
FAX NO. /NAME 917177720412
DURATION 00:00:29
PAGE(S) 02
RESULT [J(
MODE STANDARD
ECM
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(' '-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 004588
LESA WILSON
DUPLICATE
nun fold
ESTATE INFORMATION:
SSN:
192-34-6921
FILE NUMBER:
2104- 001
HUTZE,-L MARY C
11/05 2004
11/05/2004
CUMB RLAND
12/10 2003
DECEDENT NAME:
DATE OF PAYMENT:
POSTMARK DATE:
COUNTY:
DATE OF DEATH:
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,999.07
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$1,999.07
REMARKS: CLOUSE
CHECK# 4544
SEAL
INITIALS: CCP
RECEIVED BY:
~ ~<:::.~,,~'-\ <<:.'i:l
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REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
Situation Report
s\ LI,,\~..s.
Caller: David Miller Attorney 329-8533
Asking if we have a estate for Mary Hutzell. I could not find any under that name. He
then asked me to ch ck under Clouse. We discovered that we created an estate in the
name of the taxpaye , not the decedent.
David asked me to c ntact Diane McClain at the Dept of Rev. Phone 787-6505, fax 772-
04 I 2 and provide he with a receipt for the tax payment that we credited under Clouse
instead of Hutzell.
All Dept of Rev she ts are correctly listing Mary Hutzell wi correct SSN.
BUREAU OF INDIVIDUAL '":iAXf:S
INHERITANCE TAX DIVISION. -' .
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
--
IRENE M CLOUSE
C/O DAVID MIllER JR
1100 SPRING DR STE A
MIDDLETOWN PA 17057
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
REV-1607 EX AFP (03-05)
r:,'"
10-17-2005
HUTZEll
12-10-2003
21 04-1001
CUMBERLAND
04105356
MARY
C
[
Allount Rellitted
J
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
CUT ALONG THIS lINE
NOTE, To ;n.ur. prop.r er.d;' '0 your .eeoun', ....;. 'ho "PPor por"on of 'h.. foro .;th Your 'ox P.,.....
REGISTER OF WIllS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
REV-1607 EX AFP (03-05)
---------------------------------------------------------------------------
-+
ESTATE OF HUTZEll MARY C FILE NO.21 04-1001 ACN 04105356 DATE 10-17-2005
THIS STATEHEHT IS PROVIDED TO ADVISE OF THE CURRENT STATUs OF THE STATED ACH IH THE HARED ESTATE. SNO.. BELOW
IS A S"",ART OF THE PRIHCIPAL TAX DUE, APPLlCATIOR OF ALL PAYHEHIS, THE CURRENT BALAHCE, AHO, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
*** INHERITANCE TAX STATEMENT OF ACCOUNT *__
RETAIN lOWER PORTION FOR YOUR RECORDS
+-
DATE OF lAST ASSESSMENT OR RECORD ADJUSTMENT: 01-17-2005
PAYMENTS (TAX CREDITS):
PRINCIPAL TAX DUE, 240.50
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
11-05-2004 CD005552 1.48- 241.98
TOTAL TAX CREDIT 240.50
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
if IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO 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 INSTRUCTIONS. J
BUREAU OF INDIVIDUAl:,::TAXES-,
INHERITANCE TAX DIVISION-
PO BOX Z80601
HARRISBURG PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
REV-1607 EX AFP (03-05)
LESA .0 WILSON
C/O DAVID C MILLER JR
1100 SRING GDN DR A
MIDDLETOWN PA 17057
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
10-17-2005
HUTZElL
12-10-2003
21 04-1001
CUMBERLAND
04105359
MARY
C
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
CUT ALONG THIS LINE
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
-+
RETAIN LOWER PORTION FOR YOUR RECORDS
+-
REV-1607 EX AFP (03-05)
---------------------------------------------------------------------------
*** INHERITANCE TAX STATEMENT OF ACCOUNT ...
ESTATE OF HUTZElL MARY C FILE NO.21 04-1001 ACN 04105359 DATE 10-17-2005
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-17-2005
PRINCIPAL TAX DUE: 1,412.25
PAYMENTS (TAX CREDITS):
INT
AT
REV
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
11-05-2004 CD005552 .00 636.15
EREST IS CHARGED THROUGH 11-01-2005 TOTAL TAX CREDIT 636.15
THE RATES APPLICABLE AS OUTLINED ON THE
ERSE SIDE OF THIS FORM.* BALANCE OF TAX DUE 776.10
INTEREST AND PEN. 45.91
!Ii IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 822.01
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
C IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCRJ,
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J
(>~
BUREAU OF INDIVIDUAL[T~Si{;:
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
REV-1607 EX AFP (03-05)
"'.""1'.""
~ "<~': :::: 0
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
10-17-2005
HUTZELL
12-10-2003
21 04-1001
CUMBERLAND
04105358
MARY
C
IRENErM.CLOUSE
C/O DAVID C MILLER JR
1100 SPRING GDN DR A
MIDDLETOWN PA 17057
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
CUT ALONG THIS LINE
NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent.
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
-+
RETAIN LOWER PORTION FOR YOUR RECORDS
+-
REV-1607 EX AFP (03-05)
---------------------------------------------------------------------------
*** INHERITANCE TAX STATEMENT OF ACCOUNT ...
ESTATE OF HUTZElL MARY C FILE NO.21 04-1001 ACN 04105358 DATE 10-17-2005
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 10-13-2005
PRINCIPAL TAX DUE: 472.76
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
11-05-2004 CD005552 2.91- 475.67
TOTAL TAX CREDIT 472.76
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
ill IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO 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 INSTRUCTIONS. J
C^~
BUREAU OF INDIVIDUAL l'AX'(:r-r-
INHERITANCE TAX DIVISION .
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
REV-1607 EX AFP (03-05)
~t'...,,....
"~ ,,",
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
10-17-2005
HUTZEl L
12-10-2003
21 04-1001
CUMBERLAND
04105357
MARY
C
LESA ~-WILSON
C/O DAVID MILLER JR
1100 SPRING DR STE A
MIDDLETOWN PA 17057
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE
-+
RETAIN LOWER PORTION FOR YOUR RECORDS
+-
REV-1607 EX AFP (03-05)
---------------------------------------------------------------------------
*** INHERITANCE TAX STATEMENT OF ACCOUNT ...
ESTATE OF HUTZElL MARY C FILE NO.21 04-1001 ACN 04105357 DATE 10-17-2005
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYMENTS. THE CURRENT BALANCE. AND. IF APPLICABLE.
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-17-2005
PRINCIPAL TAX DUE: 641.32
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
11-05-2004 CD005552 3.95- 645.27
TOTAL TAX CREDIT 641.32
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
If IF PAID AFTER THIS DATE. SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1.
NO 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 INSTRUCTIONS. J
elfV'
COMMONWEALTH 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 006013
LESA WILSON
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold ---------- --------
101 I $822.01
ESTATE INFORMATION: SSN: 192-34-6921 I
FILE NUMBER: 2104-1001 I
DECEDENT NAME: HUTZELL MARY C I
DA TE OF PAYMENT: 11/18/2005 I
POSTMARK DATE: 11/17/2005 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 12/10/2003 I
I
TOTAL AMOUNT PAID: $822.01
REMARKS:
LESA D WILSON
CHECK# 4737
INITIALS: RSK
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
,
REGISTER OF WILLS
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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
REV-1607 EX AFP (03-05)
LESA D WILSON
C/O DAVID C MILLER JR
1100 SRING GDN DR A
MIDDLETOWN PA 17057
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
10-17-2005
HUTZEL L
12-10-2003
21 04-1001
CUMBERLAND
04105359
MARY
C
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE
-+
RETAIN LOWER PORTION FOR YOUR RECORDS
+-
REV-1607 EX AFP (03-05)
---------------------------------------------------------------------------
*** INHERITANCE TAX STATEMENT OF ACCOUNT ...
ESTATE OF HUTZELL
MARY
C FILE NO.21 04-1001
ACN 04105359 DATE 10-17-2005
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-17-2005
PRINCIPAL TAX DUE: 1,412.25
PAYMENTS (TAX CREDITS):
INT
AT
REV
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
11-05-2004 CD005552 .00 636.15
EREST IS CHARGED THROUGH 11-01-2005 TOTAL TAX CREDIT 636.15
THE RATES APPLICABLE AS OUTLINED ON THE
ERSE SIDE OF THIS FORM.* BALANCE OF TAX DUE 776.10
INTEREST AND PEN. 45.91
If IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 822.01
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
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BUREAU OF INDIVIDUAL"TAX-ES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
REV-1607 EX AFP (03-05)
"'''',-
i:3 i'i, t: (~8
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
01-03-2006
HUTZElL
12-10-2003
21 04-1001
CUMBERLAND
04105359
MARY
C
,I~'l
r\:-,r-
LESA i_T"-J)wi t.:S{)N
r'i :' ,
C/O DAVID C MILLER JR
1100 SRING GDN DR A
MIDDLETOWN PA 17057
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE
-+
RETAIN LOWER PORTION FOR YOUR RECORDS
+-
REV-1607 EX AFP (03-05)
---------------------------------------------------------------------------
*** INHERITANCE TAX STATEMENT OF ACCOUNT *__
ESTATE OF HUTZElL MARY C FILE NO.21 04-1001 ACN 04105359 DATE 01-03-2006
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-17-2005
PRINCIPAL TAX DUE: 1,412.25
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
11-05-2004 CD005552 .00 636.15
11-17-2005 CD006013 45.91- 822.01
12-30-2005 """', WRITEOFF .00 1. 70
TOTAL TAX CREDIT 1,412.25
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
!Ii IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
RK
BUREAU OF INDIVIDUAL 'TA)(~S- ,-
INHERITANCE TAX DIVISION '
PO BOX Z80601
HARRISBURG PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
~~--'.c- . INHERITANCE TAX
STATEMENT OF ACCOUNT
REV-1607 EX AFP (03-05)
':' 1
....1 :
: I '=:: :3:.i
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
01-03-2006
HUTZEL L
12-10-2003
21 04-1001
CUMBERLAND
04105359
MARY
C
LESA D WILSON
C/O DAVID C MILLER JR
1100 SRING GDN DR A
MIDDLETOWN PA 11051
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 11013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE
-+
RETAIN LOWER PORTION FOR YOUR RECORDS
+-
---------------------------------------------------------------------------
REV-1607 EX AFP (03-05)
*** INHERITANCE TAX STATEMENT OF ACCOUNT ...
ESTATE OF HUTZELL MARY C FILE NO.21 04-1001 ACN 04105359 DATE 01-03-2006
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 09-02-2005
PRINCIPAL TAX DUE: 1,412.25
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
11-05-2004 CD005552 .00 636.15
11-17-2005 CD006013 45.91- 822.01
12-30-2005 WRITE OFF .00 1. 70
TOTAL TAX CREDIT 1.412.25
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
If IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl,
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. l
RA