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Home My WebLink About04-1047O00O 170~3 U.S. POSTAGE PAIO CAMp HILL PA NOV AMOUNT CORHONBEALTH OF PEHNSYLVABZA DEPARTMENT OF REVEHUE BUREAU OF INDIVIDUAL TAXED DEPT. ZB0601 '04 16 DORIS NCKOWN ~., 62 OLD FEDERAL RD ** i , CAMP HILL PA 17011-~~- :, ZNFORHATZON NOTICE AND TAXPAYER RESPONSE FZCE NO. I Oq oqq ACN 0qlqZ5Z9 DATE 10-ZT-200q TYPE OF ACCOUNT EST. OF MARIE E ROSTECK r~SAVZNGS S.S. NO. 157-26-2665 [] CHECKZNS DATE OF DEATH 06-29-200~ [] TRUST 2 CppNT¥ CUMBERLAND [] CERTZF. REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUNBERLAND CO COURT HOUSE CARLISLE, PA 17015 CTTZZENS BANK OF PA has provided the Department with the Information 11sted below which has been used :In CONPLETE PART 1 BELON # K K SEE REVERSE SIDE FOR FILING AND PAYNENT INSTRUCTIONS Account No. 62~108~655 Date 05-21-200~5 Established Account Balance 8 ) 00 5. ~ ~ Percent Taxable X 100. O0 Amount Sub.~ect to Tax 8 · 00~ . q~ Tax Rate X .0~5 Po~mn~1al T~x Due ~60, ~5 ' PART TAXPAYER RESPONSE CHECK ] Wills and an official assessment aill be isled by Ibm PA Dlpar~ent of Revenue. ONE You must co. late PART Izl and/or PART Ism bmto~. PART TAX RETURN - CONPUTATION OF relatio~lsh$p to decedent: ~L~ TAX ON JOINT/TRUST ACCOUNTS LZNE 1. Date Estebltshed 2. Account Balance 3. Percent Taxable q. Amount Subject to Tax $. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due PART DEBTS AND DEDUCTIONS CLA/MED DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on L1ne S of Tax Computation) Under penalties of perjury, Z declare that the facts Z have reported M)ovo ere true, correct and cq~mploto to thtJ~best of my knowledge and boiler. HOME ( ~/~ ) ~ ~- ~/ ~ TAXPAYER SIGNATURE TELEPHONE NUMBER DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT 280601 HARRISBURG, PA 17128 O601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV 1 162 EX(1 1-96) NO. CD 004634 MCKOWN DORIS 62 OLD FEDERAL RD CAMP HILL, PA 17011-2047 ........ fold ESTATE INFORMATION: SSN: 157-26-2665 FILE NUMBER: 2104- 1 047 DECEDENT NAME: ROSTECK MARIE E DATE OF PAYMENT: 1 1 / 1 6/2004 POSTMARK DATE: 11/1 5/2004 COUNTY: CUMBERLAND DATE OF DEATH: 06/29/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04142529 $45.15 TOTAL AMOUNT PAID: $45.15 REMARKS: SEAL CHECK//1504 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COEHONKEALTH OF PENNSYLVANZA DEPARTHENT OF REVENUE BUREAU OF ZNDZVZDUAL TAXES DEPT. 280601 DORIS HCKONN 6Z OLD FEDERAL RD CAMP HILL ZNFORMATZON NOTZCE AND TAXPAYER RESPONSE PA 17011- .~77 ACN 0q142530 DATE 10-27-2004 TYPE OF ACCOUNT EST. OF MARIE E ROSTECK [] SAVTNGS S.S. NO. 157-26-2665 [] CHECKTNG DATE OF DEAT]~ 06-29-2004 [] TRUST COUNTY CUMBERLAND [] CERTTF. RERTT PAYRENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 COMPLETE PART I BELOW # # # SEE REVERSE SZDE FOR FZLZNG AND PAYMENT ZNSTRUCTIONS Account No. 614085748! Data 03-02-ZOOZ Estmblishad Account Balance 7,010.7q Percent Taxable X 100.00 Amour Subject to Tax 7,010.74 Tax Rate X .045 PART TAXPAYER RESPONSE CHECK ONE BLOCK ONLY PART zf you tndtcate e different taffeta, please s~ate your TAX RETURN - COHPUTATZON OF TAX ON JOiNT/TRUST ACCOUNTS LINE 1. Date Established 2. Account Balance $. Percent Taxable q. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due PART DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line S of Tax Computation) $ ~ Under penalties of perjury, I declare that the facts T have reported above are true, correct and TAXPAYER SIGNATURE TELEPHONE NUMBER DATE DORIS MCKONN 6Z OLD FEDERAL RD CAMP HILL PA 17011-Z0q INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. Z! Oq IOq-~ ACN 0qlq2531 DATE 10-27-200~ TYPE 0F ACCOUNT EST.' OF MARIE E ROSTECK I--]SAVINGS S.S, NO. 157-Z6-2665 r~]CHECK/NG DATE OF DEATH 06-29-200~ []TRUST ~ CUN~ERLAND r--lCERTZF. REH~T PAYHENT AND FORHS TO: REGISTER OF MILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 COMPLETE PART 1 BELON # # ~ SEE REVERSE SIDE FOR PILING AND PAYMENT INSTRUCTIONS Account No. 6240994958 Dete 10-09-2002 Established Account Ralance 10,011.51 Percent Taxable X 100.00 Amount Subject to Tax 10,011.51 Tax Rate X .045 Potential Tax Due 450.52 · PART TAXPAYER RESPONSE E ONE -~ Rills andanofficialassessmentwillbeissuedbythePAD.partmentofRev You must complete PART [] and/or [] belom. PART Tf yOU indicate a different tax.rate, please st_~te your [] relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 2. Account Balance 3. Percent Taxab/e · . Amount Subject to Tax 5. Debts end Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Rue PART DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on L1rm $ of Tax Computation) Under penalties of perjury, I declare that the facts T have reported above are true, correct end c~pleta to th~best of .y kno./edge and belief. HONE ( ~/~ ) ~.~-=.~/~ TA SIGNATURE TELEPHONE NUHBER DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENTOFREVENUE BUREAU OFINDIVIDUAL TAXES DEPT280601 HARRISBURG, PA 17128 0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD OO4635 MCKOWN DORIS 62 OLD FEDERAL RD CAMP HILL, PA 17011-2047 ........ f01d ESTATE INFORMATION: SSN: 157-26-2665 FILE NUMBER: 2104- 1047 DECEDENT NAME: ROSTECK MARIE E DATE OF PAYMENT: 11 / 16/2004 POSTMARK DATE: 11/15/2004 COUNTY: CUMBERLAND DATE OF DEATH: 06/29/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04142531 $315.52 TOTAL AMOUNT PAID: $315.52 REMARKS: SEAL CHECK# 1505 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS CONHON#EALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DORIS R MCKOWN 6Z OLD FEDERAL RD CAMP HILL PA 17011 ZNFORHATZON NOTZCE AND TAXPAYER RESPONSE FZLE NO. Zl ACN 0~157~7~ DATE 10-11-Z004 TYPE OF ACCOUNT EST. OF HARTE ROSTECK [] SAVINGS S:S. NO. 157-26-2665 [] CHECKING DATE OF DEATH 06-29-2004 [] TRUST ~qU~TY CUMBERLAND [] CERTZF. REHIT PAYNENT AND FORHS TO.' RESISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 COMPLETE PART 1 BELOW # # # SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 710001Z970 Date 10-19-2001 Established Account Balance 5,004.75 Percent Taxable X 50.000 Amount SubJaet to Tax Z, 502.38 Tax Rata X .25 PotentLal Tix Due 375.36 PART TAXPAYER RESPONSE CHECK ONE BLOCK ONLY You must complete PART r~ and/or PART ~belo.. ]~f you Indicate i d/fferant tax rate; please state your relat/onsh/p to decedent: ~..~21/.~-N · ~-~_ TAX ON JOINT/TRUST ACCOUNTS PART TAX RETURN - COMPUTATION OF LINE 1. Date Established 2. Account Balance 3. Percent Taxable q. Amount Sub~ect to Tax S. Debts Imd Deductions 6. Amount TaxabZa 7. Tax Rate 8. Tax Due DEBTS AND DEDUCTIONS CLAZMED PAYEE DESCRIPTION AMOUNT PAID PART DATE PAID TOTAL (Enter on Line $ of Tax ComPutation) Under panaltJ, aa of perjury, ! declare that the facts ! have reported above ara true, correct and co.lets to the }est of .y knowledge and belief. HOME ( 2/] ) ~ ?-*.2/~ 0 TAXPAYER SIGNATURE TELEPHONE NUMBER DATE 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 1162EX(11 96) NO. CD OO4636 MCKOWN DORIS 62 OLD FEDERAL RD CAMP HILL, PA 17011-2047 fold ESTATE INFORMATION: SSN: 157-26-2665 FILE NUMBER: 2104- 1047 DECEDENT NAME: ROSTECK MARIE E DATE OF PAYMENT: 11 / 16/2004 POSTMARK DATE: 11/15/2004 COUNTY: CUMBERLAND DATE OF DEATH: 06/29/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04137474 $40.83 TOTAL AMOUNT PAID: $40.83 REMARKS: SEAL CHECK# 1503 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COP~ONMEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z~06D! HARRISBURg, PA 171ZS-0601 ZNFORHATZON NOTICE AND TAXPAYER RESPONSE FILE NO. Z! ~ } 0L/~ ACM 0q137q75 DATE 10-11-200q i~. TYPE OF ACCOUNT EST. OF MARIE ROSTECK [] SAVINGS S.S. NO. 157-26-2665 [] CHECKING DA/~ OF DEATH 06-Z9-Z00~ [] TRUST '04 i~,,~ 1 ~ i~CO~NTY CUId~ERLAND [] CERTZ~. REH~T PAYHENT AHD ~ORHS TO: DORIS R NCKOHN REGISTER OF ~ILLS 62 OLD FEDERAL RD [J :~ CUNSERLAND CO COURT HOUSE CAHP HILL PA [70[[ ','~[~F CARLISLE, PA [7015 COMPLETE FART I BELON # # # SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. Z000~9789 Date 06-20-1996 Established Account Bmlanca 9,275.ql Percent Texmble X 50.000 Amount Subject to Tax ~,637.71 Tax Rate X Potential Tax Due 695.66 PART TAXPAYER RESPONSE A. [] The above Information and tax due ts correct. You muse compl,ta PART [] and/or PART [] below. PART If you indlcata a different tax rate~ please s~ata your ~ relationship ~o deceden~: ~A ~ ~ ~ ~ ~ TAX RETURN - COMPUTATION OF LINE 1. Date EstabXish~d 2. Account Balance 3. Percent Taxable q. Amount Subjac~ to Tax $. D~bts and Deductions 6. Amount Taxable 7. Tmx Rate 8. T~x ~e PART DATE PAID TAX ON JOINT/TRUST ACCOUNTS 3 x 7 x ,~ DE~TS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line $ of Tm< Computation} $ _"J ~2~'~'0~} Under penalties o~: perjury, Z declare that thl~ facts Z have reported above mra true, correct ~nd coe)p_ 1eta to tlll/Y~best of my knowledge and bel~,af. HOME ( ~,/7 ) ~7~' 7.,,,~/~'~ .OR , , TAXPAYER SIGNATURE TELEPHONE NUMBER ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENTOFREVENUE BUREAU OFINDIV~DUAL TAXES OEPT. 280601 HARRISBURGr PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV 1162EX(11 96) NO. CD 004637 MCKOWN DORIS 62 OLD FEDERAL RD CAMP HILL, PA 17011-2047 ESTATE INFORMATION: SSN: 157-26-266§ FILE NUMBER: 2104- 1047 DECEDENT NAME: ROSTECK MARIE E DATE OF PAYMENT: 11 / 16/2004 POSTMARK DATE: 11/15/2004 COUNTY: CUMBERLAND DATE OF DEATH: 06/29/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04137475 $38.82 REMARKS: TOTAL AMOUNT PAID: $38.82 SEAL CHECK# 1502 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVlDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 REV-, '62 EX(1 1-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT MCKOWN DORIS 62 OLD FEDERAL RD CAMP Hill, PA 17011-2047 ____n fold ESTATE INFORMATION: SSN: 157-26-2665 FILE NUMBER: 2104-1047 DECEDENT NAME: ROSTECK MARIE E DATE OF PAYMENT: 03/18/2005 POSTMARK DATE: 03/17/2005 COUNTY: CUMBERLAND DATE OF DEATH: 06/29/2004 NO. CD 005090 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04142530 I $100.99 I I I I I I I I TOTAL AMOUNT PAID: $100.99 REMARKS: CHECK# 503 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WillS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV.1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT MCKOWN DORIS 62 OLD FEDERAL RD CAMP HILL, PA 17011-2047 -------- fold ESTATE INFORMATION: SSN: 157-26-2665 FILE NUMBER: 2104-1047 DECEDENT NAME: ROSTECK MARIE E DATE OF PAYMENT: 03/18/2005 POSTMARK DATE: 03/17/2005 COUNTY: CUMBERLAND DATE OF DEATH: 06/29/2004 NO. CD 005086 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04142529 I $135.00 I I I I I I I I TOTAL AMOUNT PAID: $135.00 REMARKS: CHECK# 504 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX( 11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT MCKOWN DORIS 62 OLD FEDERAL RD CAMP Hill, PA 17011-2047 __n~___ told ESTATE INFORMATION: SSN: 157-26-2665 FILE NUMBER: 2104-1047 DECEDENT NAME: ROSTECK MARIE E DATE OF PAYMENT: 03/18/2005 POSTMARK DATE: 03/17/2005 COUNTY: CUMBERLAND DATE OF DEATH: 06/29/2004 NO. CD 005087 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04137475 I $135.00 I I I I I I I I TOTAL AMOUNT PAID: $135.00 REMARKS: CHECK# 501 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WillS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX( 11-96) RECEIVED FROM; PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT KEllY ROBERT B 1532 MCCORMICK DRIVE MECHANICSBURG, PA 17055 -------- fold ESTATE INFORMATION: SSN: 204-40-1097 FILE NUMBER: 2105-0058 DECEDENT NAME: KEllY MARY DATE OF PAYMENT: 03/18/2005 POSTMARK DATE: 03/17/2005 COUNTY; CUMBERLAND DATE OF DEATH: 12/31/2004 NO. CD 005085 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $32,500.00 I I I I I I I I TOTAL AMOUNT PAID: $32,500.00 REMARKS: SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WilLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128.0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT MCKOWN DORIS 62 OLD FEDERAL RD CAMP Hill, PA 17011-2047 n_n fold ESTATE INFORMATION: SSN, 157-26-2665 FILE NUMBER: 2104-1047 DECEDENT NAME: ROSTECK MARIE E DATE OF PAYMENT: 03/18/2005 POSTMARK DATE: 03/17/2005 COUNTY: CUMBERLAND DATE OF DEATH: 06/29/2004 NO. CD 005088 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04137474 I $67.50 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 502 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $67.50 GLENDA FARNER STRASBAUGH REGISTER OF WillS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE B\JREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT MCKOWN DORIS 62 OLD FEDERAL RD CAMP HILL, PA 17011-2047 nn____ fold ESTATE INFORMATION: SSN: 157-26-2665 FILE NUMBER: 2104-1047 DECEDENT NAME: ROSTECK MARIE E DATE OF PAYMENT: 03/18/2005 POSTMARK DATE: 03/17/2005 COUNTY: CUMBERLAND DATE OF DEATH: 06/29/2004 NO. CD 005089 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04142531 I $135.00 I I I I I I I I TOTAL AMOUNT PAID: $135.00 REMARKS: CHECK# 505 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS lJ" ' \' ,-,: ,"",,- ((:~ ~ i",s~~;\l ( "~ _~~.'I< Y \.. 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Cl ~ " 0 ~ ~ ;:. ~ , . 8- . 0 ~ ~ , N i ~ in COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE *' BUREAU OF INDIV~()~~$ INHERITANCE TAX DIVISION"" PO BOX Z80601 . HARRISBURG PA 171Z8-0601" NOTICE OF INHERITANCE TAX APPRAISE"ENT~ ALLOKANCE OR DISALLOKANCE OF DEDUCTION~. AND ASSESS"ENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REY-1548 EX iFP (12-041 ! Cl 'j. I" 4 10 II.... DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSNI'DC ACN 03-21-2005 ROSTECK 06-29-2004 21 04-1047 CUMBERLAND 157-26-2665 04142530 Amount Re..itted MARIE E DORIS CUt\EF'MCKtfwN:) 62 OLD FEDERAL RD CAMP HILL PA 17011-2047 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 ~ RE;;=is4-i-ix--AFP--foi-:03i------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 03-21-2005 ESTATE OF ROSTECK MARIE E DATE OF DEATH 06-29-2004 COUNTY CUMBERLAND FILE NO. 21 04-1047 TAX RETURN WAS: S.S/D.C. NO. 157-26~2665 () ACCEPTED AS FILED (X) CHANGED SEE JOINT OR TRUST ASSET INFORMATION ACN 04142530 ATTACHED NOTICE FINANCIAL INSTITUTION: CITIZENS BANK OF PA ACCOUNT NO. 6140857481 TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ()() TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 03-02-2002 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due 7.010.74 1. 000 7.010.74 4.766.66 2.244.08 .45 100.99 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 ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS. AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) PAYMENT MUST BE MADE BY 03-30-2005~. TOTAL TAX CREDIT .00 BALANCE OF TAX DUE 100.99 INTEREST AND PEN. .00 TOTAL DUE 100.99 . 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 I1A Y BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORI1 FOR INSTRUCTIONS. ) Q S'<-- REV-1<~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 DECEDENTS NAME FILE NUMBER MARIE ROSTECK REVIEWED BY ROBIN GRAFF ACN ITEM SCHEDULE NO. 2104-1047 04142530 EXPLANATION OF CHANGES "IN TRUST FOR" ACCOUNTS ARE FULLY T AXABLEWITH NO $3,000 EXCLUSION ALLOWED, SeE SECTION 2107(C) (7) OF THE INHERITANCE TAX ACT OF 1991. CHANGED TAX RATE FROM 15 PERCENT TO 4.5 PERCENT SINCE A DAUGHTER IS A LINEAL BENEFICIARY. ROW Page 1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE *' BUREAU OF INDIVlQDA:YI'~ INHERITANCE TAX DIVISJ-oN-' PO BOX Z80601 . _ HARRISBURG PA 171Z8-06Dl' ; NOTICE OF INHERITANCE TAX APPRAISE"ENTL ALLOMANCE OR DISALLOMANCE OF DEDUCTION~, AND ASSESS~ OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-15U EX AFP 02-114. 1I: ll5 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 03-21-2005 ROSTECK 06-29-2004 21 04-1047 CUMBERLAND 157-26-2665 04142529 Amount Relli Ued MARIE E DORIS CS~fb~~~o~:~';~riT 62 OLD FEDERALRD ... CAMP HILL PA 17011-2047 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 ~ Rifv:i5~i-E3f-AFP--roi-:03)------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 03-21-2005 ESTATE OF ROSTECK MARIE E DATE OF DEATH 06-29-2004 COUNTY CUMBERLAND FILE NO. 21 04-1047 TAX RETURN WAS: S.S/D.C. NO. 157-26-2665 () ACCEPTED AS FILED (X) CHANGED SEE JOINT OR TRUST ASSET INFORMATION ACN 04142529 ATTACHED NOTICE FINANCIAL INSTITUTION: CITIZENS BANK OF PA ACCOUNT NO. 6241084653 TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ()() TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 05-21-2003 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due 8,003.43 1.000 8,003.43 4,000.00 4,003.43 .45 180.15 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 ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-15-2004 CD004634 .00 45.15 PAYMENT MUST BE MADE BY 03-30-2005~. TOTAL TAX CREDIT 45.15 BALANCE OF TAX DUE 135.00 INTEREST AND PEN. .00 TOTAL DUE 135.00 . IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. · ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. TI' TOTAl DUE IS REFLECTED AS A "CREDIT" ( CR1, YOU HAY BE DUE A REFUND. - -- -..-- ....a.. ",nil TNSTRUCTIONS. 1 < ~ " ~e-r-i17o EX (6-88) * INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDMDUAL TAXES PO Box 280601 HARRISBURG PA 17128-0601 DECEDENrS NAME MARIE ROSTeCK FILE NUMBER REVIEWED BY ROBIN GRAFF ACN 2104-1047 . 04142529 ITEM SCHEDULE NO. EXPLANATION OF CHANGES "IN TRUST FOR" ACCOUNTS ARE FULLY TAXABLE WITH NO $3,000 EXCLUSION ALLOWED, SEE SECTION 2107(C) (7) OF THE INHERITANCE TAX ACT OF 1991. CHANGED TAX RATE FROM 15 PERCENT TO 4.5 PERCENT SINCE A DAUGHTER IS A LINEAL BENEFICIARY. ROW Page 1 BUREAU Of INDIVIDU"'r:~p.rT\ ('ce!!'!=: ('[ INHERITANCE TAX DIVISIDIF_ij); ,,_}_~tj \..d ; '\.JL. Ij: PO lOX 28D601 \ ' HARRISBURG PA 17128-06Gl COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REV-I'a7 EX AFP (D3-05) ?fin;; ,!" ",-"~'''; . ~o P" ,~. 10 ". "";'-'J ;/. . (_ J .. ,.~.. _ DATE ESTATE OF DATE OF DEATH FILE NUDER COUNTY ACN 0'1-18-2005 RoSTECK 06-29-200'1 21 0'1-10'17 CUMBERLAND 0'1137'175 _t _ittlld M~RIE E ne':"", DORIS ~.'tiIcKOWN 62 OLD FEDERAL RD CAMP HILL PA 17011 Ii I PAYMENT TO: MAKE CHECK PAYABLE AND REMIT REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure p~r credit to your account, su~it the upper portion of this fo~ with your t.. paywent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ................................................................................................................ REV-1607 EX AFP (03-05) ~~~ INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF ROSTECK MARIE E FILE NO.21 0'1-10'17 ACN 0'il37'175 DATE ,0'1-18-2005 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACH IH THE HAMED ESTATE. S~ BELOW IS A SUHHARY OF THE PRIHCIPAL TAX DUE, APPLlCATIDH OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APrLlCABLE, A PROUECTED INTEREST FleuRE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 03-21-2005 PRINCIPAL TAX DUE: 173.82 PAYMENTS (TAX CREDITS): ~ PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) I 11-15-200'1 CDoO'l637 .00 38.82 03-17-2005 CDo05087 .00 135.00 , , , I TOTAL TAX CREDIT I 173.82 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE , .00 . IF PAID AFTER THIS DATE, SEE REVERSE , SIDE FOR CALCULATION OF ADDITIONAL INTEREST. I IF TDTAL DUE IS LESS THAN fl, lID PAYHENT IS RElIUIRED. IF TDTAL DUE IS REFLECTED AS A "CREDIT" ICR), YDU HAY BE DUE A REF.-. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) ;'r":""r\nr"\ci' r',CC1,^C (1C BUREAU OF IIIDIVlOUAIUrUBU.J L., ivL 'j DlERlTANCE TAX DIVISION - - ,.. PO lOX !aD6Dl HARRISIUAS PA 171Z1-D601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REV-1607 EX AFP (03-05) ?fin~ i?; 10 DATE ESTATE OF DATE OF DEATH FILE HUIIBER COUNTY ACN 0'1-18-2005 ROSTECK 06-29-200'1 21 0'1-10'17 CUMBERLAND 041'12530 _t R_ittlld ~ARIE E DORIS ~' MCKOWN 62 OLD FEDERAL RD CAMP HILL PA 17011-2047 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 NOTE: To insu.... proper credit to your ~count, .....it the .....-r portion of this for. with your :tax P8YIIWtt. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ................................................................................................................ REV-1607 EX AFP (03-05) ~~~ INHERITANCE TAX STATEMENT OF ACCOUNT... ' ESTATE OF ROSTECK MARIE E FILE NO.21 0'1-10'17 ACN 0'11'12530 DATE :0'1-18-2005 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACH IH THE HAIlED ESTATE. S~ BELOH IS A SUHHARY OF THE PRIHCIPAL TAX DUE, APPLICATIOH OF ALL PAYHENTS, THE CURRENT BALANCE, AIID, IF AP'LlCABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT DR RECORD ADJUSTMENT: 03-21-2005 PRINCIPAL TAX DUE: 100.99 PAYMENTS (TAX CREDITS): ~ PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) , 03-17-2005 CDo05090 .00 100.99 , , , , , TOTAL TAX CREDIT 100.99 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE , .00 . IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION Of ADDITIONAL INTEREST. I IF TOTAL OUE IS LESS THAN tl, lID PAYHENT IS REIIlIIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) _"'~-"""~'''T' (,c".~r BUREAU OF INDIVI......'.._...,: ,"'r' ,r INlERITANCE TAX DIVISI'~-'~'-' '.'--,,~ _.,i . ,--- .~ PDIOX2106Dl --,'-~". .,' HARRISlURI: PA 17128-0601''' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REV-I'.? EX AFP (03-D5) 17011 Ii , MAKE CHECK PAYABLE AND REMIT PAY~NT TO: 04-18-2005 ROSTECK 06-29-2004 21 04-1047 CUMBERLAND 04137474 _t R_lttecl MARIE i , E ?D~5 0: 10 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN C~":"'::". DORIS , 'R MCKOWN 62 OLD FEDERAL RD CAMP HILL PA REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, s~lt the upper portion of this fo~ with your t.x ~t. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ' ................................................................................................................ REV-1607 EX AFP (03-05) ... INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF ROSTECK MARIE E FILE NO.21 04-1047 ACN 04137474 DATE 04-18-2005 THIS STATEllEHT IS PROVIDED TO ADVISE OF THE CURREHT STATUS OF THE STATED ACN IN THE NAMED ESTATE. S BELOW IS A SUNNARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYNENTS, THE CURRENT BALANCE, AND, IF AP ICABLE, A PRDJECTED IHTEREST FIGURE. DATE OF LAST ASSESSMENT DR RECORD ADJUSTMENT: 03-21-2005 PRINCIPAL TAX DUE: 108.33 PAYMENTS (TAX CREDITS): ~ PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-15-2004 CD004636 .00 40.83 03-17-2005 CD005088 .00 67.50 , i , TOTAL TAX CREDIT , 108.33 BALANCE OF TAX DUE .00 INTEREST AND PEN. , .00 TOTAL DUE I .00 . IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITI~L IHTEREST. I IF TOTAL DUE IS LESS THAN $I, ND PAYHENT IS REIIlIIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU ~Y BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I nUY,c'-,r', (,f'nrr- n' BUREAU OF INDIVIDU'L",?i\dSS--,:_~L UI-n",'::, ,Ji INHERITANCE TAX DIVISION PO lOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REV-16i07 EX AFP (03-05) nms r r'~~ fr). lO '.I. DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN -,' DORIS MCKOWN 62 OLD FEDERAL RD CAMP HILL PA 17011-2047 Ii MAKE CHECK PAYABLE AND REMIT PA~ENT 04-18-2005 ROSTECK 06-29-2004 21 04-1047 CUMBERLAND 04142529 --..t _It_ MARIE I E TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your ~ount, sub.it th8 upp.r portion of this fo~ with your ~ax ~~t. CUT ALONG THIS LINE ~ RETAIN LOWER PDRTION FOR YOUR RECORDS ~ ................................................................................................................ REV-1607 EX AFP (03-05) ... INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF ROSTECK MARIE E FILE NO.21 04-1047 ACN 04142529 DATE 04-18-2005 THIS STATEMENT IS PROVIDED TO ADVISE DF THE CURRENT STATUS DF THE STATED ACH IN TNE MAHED ESTATE. S,,*" BELOII IS A SUNHARY OF THE PRINCIPAL TAX DUE, APPLICATIDH OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF AP~LICABLE, A PROJECTED INTEREST FIUURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 03-21-2005 PRINCIPAL TAX DUE: 180.15 PAYMENTS (TAX CREDITS), ~ PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-15-2004 CD004634 .00 45.15 , 03-17-2005 CD005086 .00 135.00 i I , I TOTAL TAX CREDIT 180.15 BALANCE OF TAX DUE .00 INTEREST AND PEN. , .00 , TOTAL DUE .00 . IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATIIIIl OF ADDITIIIIlAL INTEREST. I IF TOTAL DUE IS LESS THAN $1, 11II PAYHENT IS REIIlIIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FDR INSTRUCTIONS. ) BUREAU OF DlDIVIDUlP"n~r) nC:[l(';:: nC INHERITANCE TAX DIYISJiJMt?,:J"""J..T_L. '-" \ ! .Ji_ \..11 PO lOX 2806Dl _ ,,- HARRISBURG PA 171Z8-060~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE J:NHERJ:TANCE TAX STATEMENT OF ACCOUNT '* REV-16P7 EX AFP [D3-05) DORIS ,~ MCKOWN 62 OLD FEDERAL RD CAMP HILL PA 17011-2047 I: MAKE CHECK PAYABLE AND REMIT PA~ENT TO: 04-18-2005 RoSTECK 06-29-2004 21 04-1047 CUMBERLAND 04142531 _t _SUed MARIE I E i?: ! 0 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your accountl subDit the upper portion of this fo~ with your tax pey.-nt. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ , ................................................................................................................ REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT -*. ' ESTATE OF RoSTECK MARIE E FILE NO.21 04-1047 ACN 04142531 DATE 114-18-2005 THIS STATEHENT IS PROVIDED TO ADVISE DF THE CURRENT STATUS OF THE STATED ACN IN THE IIAIIED ESTATE. stlDIIN BELDII IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATIDH OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF AP~LICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 03-21-2005 PRINCIPAL TAX DUE: 450.52 PAYMENTS (TAX CREDITS): , \ \ ~ PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) , 11-15-2004 CD004635 \ .00 315.52 03-17-2005 CD005089 .00 135.00 . , I , , I i TOTAL TAX CREDIT i 450.52 BALANCE OF TAX DUE .00 INTEREST AND PEN. , .00 TOTAL DUE I .00 . IF PAlO AFTER THIS DATE, SEE REVERSE . SIDE FOR CALCULATIDH DF ADDITIDHAL INTEREST. I IF TOTAL DUE IS LESS THAH $I, III PAYHENT IS RElIUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR IHSTRUCTIDHS. I I r r ~ t ~ !' r ~ (....jj7C!~.. ;. '," 'T" ,:;U"..... a:: ~..' 0 -, ['I ~- --0> ~~ r S\ /. / '- . .,._.,-~ c>~ '< ~ ~ ~ <":' \01 ... ::(-dg Cli!~'" e< .! -8 Cl.. elf= Q'O:I: iii 5 S' ,:;I('l," ...."'u J J ~r? ~ ~ - ~ - - ~ ....:: - - - - - - - - - - - - - - " - - - - - .- - ('., In ,:.) f? f.;i .,.-, () r.,. .,..J "".._.i "' - ....' _...._,..,...,s....'"" <,,'~-7,,::~'.:~:'I"i'\'\il'l'l'r~"6I..., REV-1162 EX(11-961 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT, 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 005444 RECEIVED FROM: MCKOWN DORIS 62 OLD FEDERAL RD CAMP HILL, PA 17011-2047 ACN ASSESSMENT CONTROL NUMBER AMOUNT -------- fold 101 $108.33 ESTATE INFORMATION: SSN: 157-26-2665 FILE NUMBER: 2104-1047 DECEDENT NAME: ROSTECK MARIE E DATE OF PAYMENT: 06/17/2005 POSTMARK DATE: 06/16/2005 COUNTY: CUMBERLAND DATE OF DEATH: 06/29/2004 TOTAL AMOUNT PAID: $108.33 REMARKS: CHECK# 507 INITIALS: CCP RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS SEAL REGISTER OF WILLS r. J"~ ~ \~ ~ ~ <\) '" 0;:, \;'- ........ ~ ~ t 1,' " II! ~ :.. / r. ~. ,~ '. \ ~~ Allount Rellitted >'Jf\- AJ.P-\rP ?',,?':?~'OO ""C>Jjjk5\\O~ MAKE CHECK PAYABLE AND REMIT PAYMENT TO: 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 DDRIS MCKOWN 62 OLD FEDERAL RD CAMP HILL PA 17011-2047 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN *' RE~-16D7 EX AFP (Q3-05) 04-18-2005 ROSTECK 06-29-2004 21 04-1047 CUMBERLAND MARIE E 'fHI........ -.1 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account I submit the upper portion of this form with your tax payasnt. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ......------ ---------------........~.~~~~~!~~~...~.............................------- PAVMENT: Detach the tap portion of this Notice and sub.it with your paYMent ~ade payable to the name and address printed on the reverSQ side. If paYMent if for a RESIDENT DECEDENT ~ _ake check 01'" lIOl1ey artier payable to: R~ister ofWIIJs, Agent If paYJlant if for a ND"~RESIDENT DECEDENT~ _ake check or maney order payable to: Commonwealth: ofPennsylvllnia Failur. to pay the tax, interest. and penalty dus MY result in the filing of a Usn of record in the appropriate county, or the issuance of an Orpha.n"s COLlrt citation. REFUND (OR): A rofund of e tax crsdit, which was not requested on the Tax Rsturn~ may be requested by cowpleting an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-13l3)' Applications /!Irq available online at www.revsnue.state.oa.us. any Register of Wills Dr Revenue District Office~ Dr fro. the Dapart.ant's Z4~haur answering ssrvic8 for forMS orders: 1-8DD-362-Z050; ssrvices far taxpa~er$ with special hearing and/or speaking needs: 1~8DD-447~3a20 (TT only). ~- 62 OLb F€:RS..JL"R€b R. He KOroN ~ Ro"b e , "HP "ILL, p.... 17011 tf~ i h~ ~ ~~ z./-e.- ~ ~i~~~ ~,J.~~~ ~ ~ ~j2I;1~~ ~ ~r;:d€.~' ..x ~~~~~~ ~.~-eJ-~~ ~ ;?-- --\ ~ ~. PtM/'.s ~ /1 ~aJ;./ b.,,) lJt...fl r.e j)E ILI'fL Ry {'1-mf !I-,;'L PA- I /7011- Sl- 0 tf-I' '~OKHONWEAlTH OF PENNSVLVANIA DEPARTt1ENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Z8-06al '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. , ACN DATE UV.!f4JU",,"-Jl' DORIS MCKOWN 62 OLD FEDERAL RD CAMP HILL PA 11011-2047 TYPE OF ACCOUNT EST. OF MARIE E ROSTECK 0 SAVINGS 5.5. NO. 151-26-2665 0 CHECKING DATE OF DEATH 06-29-2004 G TRUST COUNTY CUMBERLAND gCERTIf. REHIT PAYHENT AND fORHS TO, REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 11013 <Wile IIt:JV; R \. ' has provided the nepart.ent Nlth the infarnUon listed beloN whIch hils bean used in c8lculating the PDt.n~{81 tax due. Their record. indicate that at the de.th of the above decedent, you wara II joint owner/beneficiary of this aCCQunt. If you feel this infor_ation is incorrect, please obt.in written correction froM the financial institution, attach a copy to this forM and return it to ttllll above address. ThJs 8ccount i. teMable In accordence with the Inheritence lex laws of the COlllllloolfel!llth of P_nnsylvanl.. ou.stJnns .8y be en~wAred by callJn~ (117) 787-8321. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. ~'f7'/1,;J.t7"/7~O/oq,ata c>~-/r-I!J.:L.. Established II!J, DOO. 0.0 . 100.00 )p,/)Oc>.,,'" . . 045 J/SO, OO~. ~RT TAXPAYER RESPONSE [!] 1'~P~1.['Jll!~j!d~jjj;F't't~tlll_~.I'I~~1~11;~_1i."IIIII[I(I~~.1';'lr~~~u:,~rplJ \!l!l;';'lj':::;;;:;:,s;;1fl1\~';'i,:m!iit;hm,!~~';h;%!iH;;!;ll!;:,W:;;;j:;,:ljibw';i;;;i;,;;,;':fiiJ,;<;,; i'i';,,';'j1"i,;::i;':~"'~"i!;,p."'~';li;"";'~ll i',wi ,',l;';;N ,J'N: mo,- Inl!..h';, ~)J!'; ;"".,'i;)t'i''';'; i'i;j.",ii'!'''i'i,p;;,'11ii!:i'iii;i'j'';iHi'jiii;;il(!!h';'i';id[l[i1:'i!';!iii;ji;;;;,;i;i;j,:;:;i;lii'l;:ii;:i::'i;;;lil!:!I!i:; Account Balance Percent T.xllbl. AMount Subject to Tax Rate Potential Tax Due To insur_ proper credIt to your ~ccount, two (Z) copi_s of this notlc_ ~ust ~CCO"rftny your pRymAnt to the R_gfster of HIlls. HAk. check I'lIyebl. to: "Register of WillS, Agent". K x NOTE: If tl!lX pllyeents are ..Rd. _Uhln three {3J months of the deelldtlflt"s dstf. of d81!1th, you III~Y dtlduct 8 SX discount of the tllM due. Any inherit~"ce t8x due Nill beCOMe delinquent nine (9) Illonths aftllr the dllte of del!lth. Tax [CHECK ] ONE BLOCK ONLY A. 0 The hbove infor.eUo" and t8x due is correct. 1. Vou "I'ly choose to ..e..it fJI!!IYfII'80t to the Register of Wills wIth two copies of thIs noUCil t.u obtRil1 II discount or avoJd jnt.rest, or yoU IlII'1Y check bOM "A" 1II1ld rill turn this lIotlclII to the Rilgi:!;tAr' of Wills aM en officlel lI.seu.ent win be issued by th_ PA Oepl!lrbrllflt of Re"enue. B. [] The .boye a...t h.. b.en or wfll be reported and teK p.ld with the Pennsylvania Inheritance T8M return to b. filed by th. d.cedant". repre.entatlve. C. 0 The .bove inforlllatlon i~ncorr.ct and/or debb and deductJons dre pl!lJd by you. You .ust cOlllp18te PART l.!.J 8I1d/or PART ill beJow. PART If you indicat. 8 di ff.rent taM' r.t."Jll.... .t.t. your [!J relationship to deeedent: j))fJ.tJ fir. "T~~' TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Data Est-bUshed 1 0 "'-1.5:'- 0.:2., Z. Account BelShee 2 J ~ '" 0 o. 00 3. Percent Taxable 3 X 7 D (). O. 0 4. Allount Subject to Tax 4 ./ ~ /')1"J" D' 00 . S. Debts and Deductions 5 6. Allount Taxable 6 7. T.x Rete 7 X 8. Tax Due 8 / O. ~t!)I!J. DO '.04-r t'- .!d). 0 C) DEBTS AND DEDUCTIONS CLAIMED PART [!] DATE PAID PAYEE DESCRIPTION AMOUNT PAID / TOTAL (Enter on Line 5 of T_x COMPut.tJon) I . Under peneitie. of perjury, I declare that t~ fact. I hev. reported above are true, correct and complete to the best of .y knowledge and b.ll.f. HOME ( WORK ( TELEPHONE ) ) NUMBER DATE TI\XPI\YFR STI>NATlJRE . ':O","ONWEALTIt OF PENNSYLVANIA DEPARTHENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z8D60l HARRISBURG, PA 17128-D601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. ACN DATE IllV-JnJu", '''-''I EST. OF MARIE E ROSTECK 5.5. NO. 157-Z6-2665 DATE OF DEATH 06-29-2004 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING ~ TRUST g CERTIF . DORIS MCKOWN 6Z OLD FEDERAL RD CAMP HILL PA 17011-Z047 REMIT PAYMENT AND FORMS TO. REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 / (PA (!HOl1/ft ) has provld.d the n.part....,t ..ith the Infar_BUo" listed below NhJch hils been used In C.ICUI.~ng'!h. pot.ntl~: tQX due. lh.lr records Indicat. that at the d..th 01 t~ above decedent, you ..ere 8 joint owner/beneficiary of this account. If YOlJ f.el thls iOfor.BUDn h Incorrect, pl..s. obt.Jn wdtt.., currectlon frolll the Hnenclal Institution, l!Ittech a copy to thl. forlll end return it to the above addre,.,.. ThJ. eecount I. ta)(able In I"lccurdance with the Inheritl!f1c8 Tex laws of ths CDJllJIonwealth Df P.nnsylv~ni.. auestlo05 .ay he Bn~wRred bV c~11Jnp (717) 781-8~27. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. .:I>l7-r/';; ~"'I?JytpII.rOete p rI- - /..-oov Established Account Belance 10. COO. &> () P.rcent Taxltbl. X 100.00 Allount Subject to Tax J~ J J) 00 . ~ 0 Tax Rat. X .045 Potential Tex Due l-tls-r;. EJ 0 ;.._. ~. PART TAXPAYER RESPONSE [!] _.i~I"i'~!~~~'!I'JJ_II~&.\'.'.'.I!''lI!r,II_''~!!ii.W. To insure proper crgdlt to ~our account, two (l) coplfts of this notice must ftccompnny your paY,"Rnt to the Register of Hills. MAke check paYllIble to: "Regh,tor of Wills... Agent". NOTE: If tI!lx pRy.ents er. ..Rde within tttrllle (~) 1Il0nths of thll decRdent's dRte of dRllth... you "'II)' d&duet (II Sl discount of the hl)( dUR. Any inheritance tax due "111 becolllR dRllnquent nino (9) Months !!lftor the d1!lte of d"ath. [CHECK ] ONE BLOCK ONLY A. 0 1he hbove inforlllation and tex due is correct. 1. You lIIll1Y choose to relllit pay,,","t to tho Rog.ishll" of Wills with two copies of thIs notIcB to olJtnil1 l!l lHsCDuot or avoid interest... Dr you May check bo)( "A" elld rllturn thIs notlcR to the Reglshw of WIlls and an official as.....ent "111 b. Issued by the PA Dep1!lrbwent of R.~enu.. B. 0 The I!lbove as..t hR. bun Dr "UI be reported end tax paId with the Pennsylvania Inherltanelll lax return to be flied by the decedent's repre..ntatlve. C. 0 The !!lbove Infor.llIt1on is incorrect ..,d/or debts and deducUons w.,.. pald by you. You lIlu.t cD~I.te PART 0 end/or PART [!] b.JOJf. PART If you indicate a different t~r.t., pl.... stat. your [!) rel.'Uonship to dacedent: -U~Jk.~ TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Oete Esbtbl1shed 1 ~ lo/- -/.r;. I} 0:;.., 2. Account Balance 2 / () DOtJ. D 0 3. Percent Taxable 3 X / ~ t!). 40 ~. Allount Subject to Tax ~ / ~ O"t!). tJO 5. Debts and Deductions S 6. Allaunt TliIx8bl. 6 7. Tax Rat. 7 X 8. Tax Due 8 /,,/)&0.00 '.01,1:"'- ~~!!. OD DEBTS AND DEDUCTIONS CLAIMED PART [!] DATE PAID PAYEE DESCRIPTION AMOUNT PAIl> I TOTAL (Enter on Line & of T_x Co~put.tJon) I $ Under penalties of perjury, I d.cl.~. that the fact. I hey. report.d abov. ar. tru., correct and COMplete to the best of my knowl.dge and bell.f. HOME ( WORK ( TELEPHONE ) ) NUMBER DATE TMPAVER 5TflNATlJRE '~OHHONWEAlTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. ZM601 HA~RISBURG~ PA 171Z8-0601 * INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. , ACN DATE nV_lfUlIIIt".U_UI EST. OF MARIE E ROSTECK S.S. NO. 157-26-2665 DATE OF DEATH 06-29-2004 COUNTY CUMBERLAND TYPE UF ACCOUNT o SAVINGS o CHECKING [j TRUST 81 CERTIF. DORIS MCKOWN 62 OLD FEDERAL RD CAMP HILL PA 17011-2047 REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT 1l0USE CARLISLE, PA 17013 I W lie H~ vi f/) , hIlS provlcMd the Dlfpartlll.nt with th. Infar_aUon listed belml whIch has be.n und In C.lcu~lng tho potentle tax du.. Tholr rlteard. Indicate thet at th. d..th of the aboV8 dBc.dent, you wltr. a joint owngr/b~n8flclary of this account. If you f..l this Infor~ation Is Incorrect, pl.as. obtaIn writt.n carr.ctlo" fro~ the financial institution, attach a copy to this forlll end return it to thB above add....... TtJi. account h: talCabl_ in I!IcctJrdanc. .,ith th. Inherlblnc8 TalC LIlws- of tlte COl!llllOrJw.alth of P.nn'Ylv~nf.. QUBstjons .~y b. 8n~w.r.d by c~llJnp (717) 787-8~Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No.~'f7'11,!!1t:l(,(7fi4'/.;/roata JP"L-/.s.--4:;L Established /().I)~O.oO 100.00 Jo, b"" . 00 .045 -0.!J7J.OO_.. PART TAXPAYER RESPONSE fTI ml" !~fl"iI"ii!'ili!~~[",j~i~~~'I';~~"'li!\!i'..ml"i!ii!i!M"I'''I'-1'''I~I~i1 'diil i'''iii..l>'i~'~'~",,1J.r..[...ii:"'M~''i!i''l!!lli'1 ~ ~!I"".~m~1Illll~r~rI"Jffif~~!i!B'l'~~1IJ~,l~~~~.",;,;i~,:,.;".ifJr:w~t'm:!~'~~~~~i~i!!!!!~I!!~~~~ii~!D~~i~~. Account B.I.ne. P.rcent Taxable Anount Subject to Tax Rllt. Pot.nt1.1 Tax Due To Insure p~opgr crgdlt to your account, tWQ (2) copi~g of thIs notic. ~Ugt eCCOMpnny your pllYIlIl!lnt to the RllIgister of Nllls. Httke cheek paylllb18 to: "RagJ.t.r of tUlls, Agent... x x HOlE: If bllC pay.ants ere .lId. within three (3) lIIonths of the decRdwnt'$ dBt. of rlAllth, yOU "'By deduct It SX discount of the t"'l( due. Any Inh.~lt8nc. telC due "Ill bWCOIIIR d811nqu8nt nln. (9) IIIonths .ftsr tha d.t. of death. Tax [CHECK ] ONE BLOCK ONLY A. 0 The above InFor.aUon end t8)( due is corrQct. I. You IIlBy c:hOOS8 to rRlIlit pl!lly".nt to the RogJster of Wills wilh two copIes of this lIotlC~ to obtain 8 discount or avoid interest, or you lIlay ch8ck box "A" find ,.slurn thIs notlce to th. Reglst8r' of WJlls an~ en off1cial esses...nt Nill be Issued by the PA Department of R.V80U8. B. r=J lh. above ass.t has b..n ar will b. r~rt8d end tax paId with the Pennsylvania Inheritance Tax return to be filed by th8 decadent'. r~re..ntat1ve. c. 0 Th8 8hov. InloreaUon 1s Incorrect end/Dr debts end deducUons- WB,.e peid by you. YDU lIlust cOlIPlete PART (!J and/Dr PART [!] below. PART If you indicate _ different t~r~t.1 pl.... st.t. your f2l relationship to decedent: ~~HJ7!F7) ~ "- TAX RETURN - COMPUTATION OF TAX ON JOINT~TRUST ACCOUNTS LINE 1. Data EstltbUshad 1 17 ~ _/...... (>.;;2- 2. Account Balance 2 / ~ I:) () 6J. 00 3. Percent Taxable 3 X / ~ t!). ~ CJ 4. .",ount Subject to Tax 4 /......" /) btJ. 00 5. Debts end Deductions 5 6. A.ount Taxable 6 7. Tax Rate 7 X 8. Ta" Dua 8 I" "06.<90 . : Off'S- !/-:cv. () 0 DEBTS AND DEDUCTIONS CLAIMED PART ~ DATE PAID PAYEE DESCRIPTION AMOUNT PAID I . I TOTAL (Enter Oh Line 5 of rax Comput.tlon) Under penalties of perjury, I declare that the fact. I hay. reported above ere tru., co~r.ct and complete to the best of MY knowI.dge and belJef. HOME ( WORK ( TELEPHONE ) ) NUMBER lJATE T^YP^VFIi' qRNIITllli'F '~DHHONWEAlTH OF PENNSYLVANIA DEPARTHENT Of" REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z&o601 HARRISBURG~ PA 17IZ8-U6ul '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. , ACN DATE lttll.l!;4SEllAF'I"-UI EST. OF MARIE E ROSTECK S.S. NO. 157-26-2665 DATE OF DEATH 06-29-2004 COUNTY CUMBERLAND TYPE UF ACCOUNT o SAVINGS o CNECKING G TRUST g CERTlF . DORIS MCKOWN 62 OLD FEDERAL RD CAMP HILL PA 17011-2047 RENIT PAYNENT AND FDRNS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 (/ I tl}c#p v i,,) . hils proyld.d th. O.pllrtllent ..Uh the .lnfo,..stJon Ibbd belDM which hils been und .In C.ICUl~ng the potential tax dUB. Their records Indlcllt. that .t the ~th of the aboye decedent~ you were II jaint awn8r/bQnefic.lary of this account. If you f.el this Infa~M8tlon is Inoor~8Ct, plellse abtaln ..~itten carrectian fra~ the financlel institution. attach 8 capy to thl!J forlll Bnd return it to ths above I!Iddress. This IIccal,mt is bUlebl. In I"Iccordl!lnce Nith the InherJbll1ce JBX Laws af the COllllllonwel!llth of P.nnsylv",nle. OUestlons .ny be Qno;wered bV cAUJnp (717) 787-'8:\27. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No.Il'f7<!-I.2.PbI7f-OI30Data Of-/5"-~cx- Established /0 I)()CJ.OO . 100.00 10I)O().OO . .045 f,/-$7. OO~. PART TAXPAYER RESPONSE m ri.~~~~~:~~~'l~.l~!;iii~~~~~;i""l_-.r.II!t'oI.I!~ii~'mi~~~~_. Account Selence Parc8Ilt Taxable Anount Subject to Tax Rat. Potential Tex Due To insure praper credit to' your account. two (2) caphts of thIs natice lft{Js-t rtCcDIlfp1my your peYlllent to the Register of W1115. Hnke c:hec:k payltbl. to': "Register of Wllls~ Agent.'. x x HOTE; IJ tex Plly..nts lire Mad. withIn thrlle (3J lIIanths of the dVclldant's dete Dr dll.th~ ~ou IIIBY deduct . 57. discount of thl' tllK dUll. Any Inheritance tllK due "Ill becoMII delinquent nIne (9) .onths IInor the chlte 01 de"th. Tax [CHECK ] ONE BLOCK ONLY A. 0 The above inFarlllatian Bnd ta)!: due Is correct. ]. You IIIBy chaose to' r8111Jt pftYlll8nt to' th. Regist"'r of Wills with two copies af this notir.o tu obtaIn 8 discaunt ar 1!lvold Interest, Dr YOU lIIey check box "A" nnd return thIs noUce to' the RegistAI' af Mills Bnd an offlci.l asses...nt will be issued by the PA DepartMent of Revenue. B. r=J The I!Ibove .ss.t hilS baen or Hill bo reported BOd tax paid with the Pennsylvania InherItance TSK r.turn to be fil.d by the d.cedent's repr..ent.tlve. C. 0 The above Infor.lltlon 1. Incorrect end/or debts and deductions wer. paid by yau. Yau lIlust co.-plet. PART 0 IIf1d/or PART 0 below. PART If you indicat. a different t.'-!'.t.,pl.... .t.t. your ~ relatIonship to decedent: ."J2.41.l'~H 7"F'4? '-. TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE L Dlllte Est.blished 1 /(J. 1It;.'r;.F ~ c..-' cr &'4--/.1-4::2...- 2. Account Belshee 2 / ~ D"O. 0 a 3:. Percent Taxable 3 X I f'J/.). .~ 0 4. AMount Subject to Tax 4 I n ~()tJ. 0 CJ . , 5. Debts and Deductions 5 6. Allount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 /0 /JlJO.()() ~ , ,9 Jk..s- tf-.r'7J. O~ DEBTS AND DEDUCTIONS PART I!l DATE CLAIMED PAID PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Co_put.tion) I . Under penalties of perjury, I decl.~a that the fact. 1 h.ve reported abova are true, correct and co.pl.t. to the best of my knowledga and bellef. HOME ( WORK ( TELEP'lDNE ) ) NUMBER IIATE T^)(P^YFII SrGN^TIIRF '~aHMDHWEAllH OF PENNSYLVANIA DEPARTHENT OF REVENUE BUREAU OF IND]V]DUAl TAXES DEPT. ZS060l HARRISBURG, PA l1ll8-0601 '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. , ACN DATE 1l~,-n-un"F' ,....GJ EST. OF MARIE E ROSTECK 5.5. NO. 157-26-2665 DATE OF DEATH 06-29-2004 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CNECKING G TRUST 8r CERTlF . DORIS MCKOWN 62 OLD FEDERAL RD CAMP HILL PA 17011-2047 RE"IT PAY"ENT AND FOR"S TO: REGISTER DF WILLS CUMBERLAND CO COURT !lOUSE CARLISLE, PA 17013 ( tv /fC-fl() V I II) , has provided the Oepartllent with the tofor.aUa" Usted beIo.. which hl'l!l been und in C.ICU~ the PDt:ntl~1 tex due. Their records Indicate that at the ~.th of the above decedent, YDU were a joint oMn.r/b~neflclarY of this account. If you f8el this infor~atlon Is incorrect, pl.as. obtain written correction fru. the financial institution, attach a copy to this forJII end r.turn it to th. above add,...,. '';i, account is tl!utebl.. In eccordenc. with the Inherihmce TI!lK LSIII. 01 th. Commonwealth of P_nnsylvftnia. QugstJnns .~y ba ftn5w.r.d bv eftllJnp (717) 787-1'1311. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No.:N'7'f/~()~l7f{)/'I-/ O.t. O'l-;..-C&- Established jO,f)c>O.DO 100.00 jlJ,p~o.f)t:J . .045 1Jt..b1), OJ). PART TAXPAYER RESPONSE mllt(l,j\t.~Jimi!!i.~gl~iiii!~~~~~!'i"~~~~~If~'IIII\;l~"r.~1Illll,'~i!~~'i!!I~~I[.lliiil Account Belene. Percent T.xabl. Allount Subject to TaM: R.t. Potential Tax Due fa insure p~oper cr~dlt to your ftCCOU"t, two (Z) copies of this notice .ust accompRny your pSYII.nt to the RegIster of Wills. HtoIke cheek pey8bl. to: "Reglster of Wills, Agent". x HOlE: II b1x pl!ly..nts er. Ml!ld. within three (~) Months of the dWcRdent's dnte of deeth, you ~8Y deduct e 57. dIscQunt of the t~x due. Any Inherltence tex due will beco.. delinquent nln. PH Months after the debt of doath. Tax x [CHECK ] ONE BlOCK ONLY A. 0 The above infor-llIetlo" end tl!llC dug Is COrrlllct. 1. You may C::hoo.. to remit pl!lv_nt to the Register of WIlls with two copIes of thIs natic. lo obtaIn a dIscount or avoId interllst, or you llIey check box "A" Rnd r_turn this noUce to the Reglst.,- of Wills end 8n official IIss.ss~.nt will b. issued by the PA Dgpftrt.ent of Revenue. B. 0 The above esset hilS be.n Dr ",11) b. reparbd and tex paid with the Pennsylvania Inherllanee Tax .....tUf'"n to b. IlIad by the decedent.s representative. C. [] The above inforMation is lncQr.....ct and/or debts and d.ductions were peld by you. You Must cOMpiet. PART ~ end/Dr PART [!] b.low, PART [!j TAX RETURN - COMPUTATION LINE 1. DBt. Est.bIlshod 2. Account Balance 3. rercent TaKable 4. A.ount Subject to TeK 5. Debts and Deductions 6. A.ount Taxabl. 7. Tax R.ta 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS I Otj._/..(-~~ 2 /~.Pl>I!).DO 3 X II'J().D& 4 J Il ,.,,., d. D 0 , 5 6 7 X 8 1& /)J!>J!).8 CJ "'[)r~ 4-.<1) , '" 0 DEBTS AND DEDUCTIONS CLAIMED If you indicat. 8 different t8X,~~, plea~te your relationship to decedent: J~}f PART [!J DATE PAID PAYEE DESCRIPTION AMOUNT PAID I . I TOTAL (Enter on Line 6 of Tax COMPut.tion) Under penalties of perjury, I declare that the fact. I have reported above are true, correct and co~plet. to the best of MY knowledge end ball.f. HOME ( WORK ( TELEPIfONE ) ) NUMBER DATE TI\XPI\YFR <;T~NI\T!lRF COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL r AXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT MCKOWN DORIS 62 OLD FEDERAL RD CAMP HILL, PA 17011-2047 u____n fold ESTATE INFORMATION: SSN: 157-26-2665 FILE NUMBER: 2104-1047 DECEDENT NAME: ROSTECK MARIE E DATE OF PAYMENT: 05/10/2005 POSTMARK DATE: 05/07/2005 COUNTY: CUMBERLAND DATE OF DEATH: 06/29/2004 NO. CD 005308 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04137474 I $2,250.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 505 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $2,250.00 GLENDA FARNER STRASBAUGH REGISTER OF WILLS