HomeMy WebLinkAbout01-14-05
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*'
BUREAU oE)aNDmDOA()~ OF
INHERITANcE: I i:t:k~r_~I6N< '" l , '
PO BOX la06D~<(::'r.--, ,- .::: /
HARRISBURG Pild17US'-'06Dl '
NOTICE OF INHERITANCE TAX
APPRAISElIENT. ALLOllANCE DR DISALLOllANCE
OF OEDUCTION~, AND ASSESSlIENT OF TAX ON
JOINTLY HELD DR TRUST ASSETS
IIEV-154BEXAFPC12-04)
ClEP/ OF
OQCI-I'\\F'rYi
~~i~~f ''t;uiOZLQlt/SKI
90 SPRINGER LN
NEW CUMBERLAND PA 17070
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
01-10-2005
KOZLOWSKI
10-16-2003
;lj-(J:=; - 57
CUMBERlAND
167-24-7003
04104632
DESNA
M
luGS Jf\i! 14 Pli 3: 39
AMOunt R..itted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ...
RE-v=is4-i-ii(-AFP--foi-:031------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 01-10-2005
ESTATE OF KOZLOWSKI
DESNA
M DATE OF DEATH 10-16-2003
COUNTY
CUMBERLAND
FILE NO. S.S/D.C. NO. 167-24-7003
TAX RETURN WAS, (X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
04104632
FINANCIAL INSTITUTION, MEMBERS 1ST FCU
ACCOUNT NO.
203950-00
TYPE OF ACCOUNT:
DATE ESTABLISHED
(Y> SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE
04-11-2001
x
2,742.50
0.500
1,371.25
.00
1,371.25
.45
61.71
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
DR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
Account. Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
X
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMDUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 01-18-2005 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 61.71
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 1.41
TOTAL DUE 63.12
* IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. *
I IF TOTAL DUE IS LESS THAN $1, NO PAYKENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( eR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORK FOR INSTRUCTIONS. ]
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*
I1c.r~' ....)-. '0' (\,;"'I("\r L^,r
BUREAU OF mUvli:OUI ti,m,t ,,-
INHERITANCE TA>r,~:;E\'lSION'
PO BOX Z8D60l "t' ':;. "
HARRISBURG PA i7i28-0601
NOTICE OF INHBRITANCE TAX
APPRAISBKENT, ALLOMANCE OR DISALLOMANCE
OF DEDUCTION5, AND ASSBSSKBNT OF TAX ON
JOINTLY HELD OR TRUST ASSBTS
REY~lS48 EX AFP (12-0~1
21JD~i Jf;N 14 PH 3: 38
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
01-10-2005
KOZLOWSKI
10-16-2003
a/ DS c'
CUMBERLAflD-J 7
167-24-7003
04104631
AIIIOUni. Remitted
DESNA
M
(" ......""." C~-
vLt~t(\ ir-
OQ'"" '~\f!"~' r.."..'II,-...,..
I ,r'i"~L;" '! ,) '.)"." ~:< :
DARi~M~ L'KOiLOW~KI
LOT 200
90 SPRINGER LN
NEW CUMBERLAND PA 17070
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-V:is4ii-EX--AFP--roi-:03i------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 01-10-2005
ESTATE OF KOZLOWSKI
DESNA
M DATE OF DEATH 10-16-2003
COUNTY
CUMBERLAND
FILE NO. S.S/D.C. NO. 167-24-7003
TAX RETURN WAS: (X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
04104631
FINANCIAL INSTITUTION: MEMBERS 1ST FCU
ACCOUNT NO.
203950-11
TYPE OF ACCOUNT: () SAVINGS (Xl CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 04-11-2001
Account Balance
Pe~cent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
1,962.75
0.500
981.38
.00
981.38
.45
44.16
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
DR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEl PT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 01-18-2005 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 44.16
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 1. 01
TOTAL DUE 45.17
. 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 OUE IS REFLECTED AS A "CREDIT" [ CRJ, YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FDRH FOR INSTRUCTIONS. J
'""-'S.~