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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG I PA 17128-0601
'*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 -tJ.1- 39C(
ACN 02107645
DATE 03-07-2002
REY-ln5EXUPU'-DIl
EST. OF HARVEY W BARNES
5.5. NO. 209-12-9320
DATE OF DEATH 09-16-2001
'02 liPI( 16 [) 1 :4Q..OUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
IX] CHECKING
D TRUST
D CERTIF.
TAMMY L BARNES
432 S FAYETTE ST
SHIPPENSBURG PA
c:~.
1725t~7li~
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
ALLFIRST FINANCIAL SERVICES has provided the Depart.ant with the infor.at1on listed below which has been used in
calculating the potential tax dUB. Their records indicate that at the death of tha above decedent# you were II joint owner/beneficiary of
this account. If you feel this inforBation is incorrect, please obtain written correction fr~ the fInancial institution, attach II copy
to this for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of ths COM~nwealth
of Pennsylvania. Questions May be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW
Account No. 0067386210
. . . SEE REVERSE SIDE FOR
D.t. 11-08-1990
Established
FILING AND PAYMENT INSTRUCTIONS
Account Balance
Percent Taxable
A~unt Subject to Tax
Tax Rate
Potential Tax Due
4,466.56
X 50.000
2,233.28
X .15
334.99
To Insurs proper credit to your account, two
(Z) copies of this notice Must aCCOMpany your
payment to the Register of Wills. Make check
payable to: ftRegister of WillS, Agentft.
NOTE: If tax pay.ents are made within three
(3) months of the decedent"s date of death,
yoU may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nins (9) .onths after the date of death.
PART TAXPAYER RESPONSE
[!]1!1!~!I~~~.!:I:!::iJ!.!!:,:!!!!!m!i!i~~:!!1!::!~~!,';~!!!!l_~i*!!;!!II.!ili.~I!::::~~:!U.',!:::;'!!!!!~PJ!:,:,:!!~I._~!!~!!!!.i!i!!.,:!!II.~.iIi!!1
..,.. ,........ ';~:.'-'."""'" ......................,...,...,.,.,.,.,.,.,.,.,.,.,.,.,.,...,.~... .~...,. ,.. ,..... ~.~... .;.;. .-........................,...,.,.,., ,.,.,~;,.,.,..,
,..~....;.. .~. .~~.... .....~.................,.,...,.,...,.,........................ .... .-.......... .........~,...................,....."
A. ~ The above Information and tax due is correct.
~ 1. You may choose to re.it payment to the Register of Wills with two copies of this notice to obtein
a discount or avoid interest, or YOU .ay check box nAn and return this notice to the Register of
Wills and an official assess.ent will be issued by the PA Department of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
B. 0 The above asset has been or wUl be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representativs.
C. D The above infor.ation is incorrect and/or debts and deductions wera paid by you.
You .ust complets PART 0 and/or PART ~ below.
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
If you indicate a different tax rat., please state your
relationship to decedent:
PART
~
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7, Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3
4
5
6
7
8
X
X
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax COMputation)
I
$
perjury, I declare thet the facts I
y knowledge end belief,
heve reported above ere true, correct
HOME (11: ) M~d- ~.:) ?;'-/
WORK ( )
TELEPHON NU R
...d
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O'ATI1'
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREau OF INDIVIDUAL TAXES
DEPT. Z80601
HARRISBURG~ PA 171Z8-06Dl
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
I j -~'i?-I
NO. 21 -c:l.;l- 39 '-{
02107645
03-07-2002
Rn~1545 EX UP 1I9-DDl
TYPE OF
ACCOUNT
D SAVINGS
IX] CHECKING
D TRUST
D CERTIF.
TO:
r~;
'02 Flrri 16
EST. OF HARVEY W BARNES
S.S. NO. 209-12-9320
DATE OF DEATH 09-16-2001
COUNTY CUMBERLAND
:tj ;~
REMIT PAYMENT AND FORMS
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
O'
, I
TAMMY L BARNES
432 S FAYETTE ST
SHIPP ENS BURG PA 172~7'-'17. 39
{;Unlu
ALLFIRST FINANCIAL SERVICES has provided the Deparbent with the infor.ation listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the abovB decedent~ YOU were a joint owner/beneficiary of
this account. If YOU feel this inforlllation is incorrect, pleBse obtain written corraction froe 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 LBws of the Commonwealth
c~ ~Bnr.sylvanla. Qu.stior.~ :ay ~e answ6rej by colling (717) 7!7-e3Z7.
COMPLETE PART 1 BELOW
Account No. 0067386210
J( J( J( SEE
Date
EstablIshed
REVERSE SIDE FOR
11-08-1990
FILING AND PAYMENT INSTRUCTIONS
Account Balance 4 , 466 . 56
Percent T.x.ble X 50.000
Allount Subject to Tax 2,233.28
Tax Rate X .15
PotentIal Tex Due 334.99
PART TAXPAYER RESPONSE
[!]i~ii!.~~.~;i~.~!!"'i~il~~~liiiil_~!~i~li~i.i!I.~.gilii!l~liil~""illl..!lli.i~.~~I!ill.~.il~i,
To insure prop.r credit to your account~ two
(Z) copiBs of this notice must acc~pany your
paY.Bnt to the Register of Wills. Make check
payable to: -Register of Wills, Agent".
NOTE: If tax payments are made within three
(3) months of the decedent's date of dei!lth~
yoU 8ay deduct a 5% discount of the tax due.
Any inheritance tax due will becoMe delinquent
nine (9) .onths after the datB of death.
A. The above inforMation and tax due is correct.
1. You .ay choose to re.it payeent to the Register of Wills with two copies of this notice to obtain
8 discount or avoid interest~ or you may check box "An and return this notice to the Register of
Wills and an official asseSS8ent will be issued by the PA Depart.ent of R.venue.
[CHECK ]
ONE
BLOCK
ONLY
B. 0 The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
c. D The above information is incorrect and/or debts and deductions were paid by you.
You lIust cOlIPletllil PART 0 and/or PART @] below.
PART
@]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
If you indicate a different tax rate, please state your
relationshIp to decedent:
PART
~
TAX RETURN - COMPUTATION OF
LINE 1. Date Established I
2. Account Balance 2
3. Percent Taxable 3
4. Amount Subject to Tex 4
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rete 7
8. Tax Due 8
TAX ON JOINT/TRUST ACCOUNTS
x
x
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
I
$
of perjury, I declare that the fects I
knowledge and belief.
heve reported above ere tru.,
HOME (717) G ?->.;}
WORK ( )
TELEPHONE NUMB R
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COMMONWE;ALTH 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
BARNES TAMMY l
432 S FAYETTE STREET
SHIPPENSBURG, PA 17257-1739
__n_n_ fold
ESTATE INFORMATION: SSN: 209-12-9320
FILE NUMBER: 2102-0394
DECEDENT NAME: BARNES HARVEY W
DATE OF PAYMENT: 04/16/2002
POSTMARK DATE: 04/15/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 09/16/2001
NO. CD 001075
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
02107645 I $334.99
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$334.99
REMARKS: TAMMY l BARNES
CHECK#1543
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
MARY C. lEWIS
REGISTER OF WillS
\.
F}-$,-Y' - /
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG~ PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*'
NOTICE OF INHERITANCE TAX
APPRAISEKENT, ALLOWANCE OR OISALLOWANCE
OF DEOUCTION~<.AND ASSESSNENT OF TAX ON
JOINTLY nELO OR TRUST ASSETS
REV-1548 EX AFP I OlpO!l
TAMMY L BARNES
432 S FAYETTE ST
SHIPPENSBURG PA 17257-1739
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
02-03-2003
BARNES
09-16-2001
21 02-0394
CUMBERLAND
209-12-9320
02107645
AMount R...ltt.d
HARVEY
W
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=is4-i-EX--AFii-[oi-:03j------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 02-03-2003
ESTATE OF BARNES
HARVEY
W DATE OF OEATH 09-16-2001
COUNTY
CUMBERLAND
FILE NO. 21 02-0394
TAX RETURN WAS,
S.S/D.C. NO. 209-12-9320
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
02107645
FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICES
ACCOUNT NO.
0067386210
TYPE OF ACCOUNT,
DATE ESTABLISHED
( ) SAVINGS (Xl CHECKING ( ) TRUST ( ) TIME CERTIFICATE
11-08-1990
X
4,466.56
0.500
2,233.28
.00
2,233.28
.15
334.99
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."
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
X
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
04-15-2002 CDOOI075 .00 334.99
TOTAL TAX CREDIT 334.99
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1, NO PAYRENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRJ, YOU RAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORR FOR INSTRUCTIONS. J
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
I DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*
NOTICE OF INHERITANCE TAX
APPRAISEMENT. ALLOKANCE OR DISALLOMANCE
OF DEDUCTION~<.AND ASSESSMENT OF TAX ON
JDINTLY nELD OR TRUST ASSETS
REV-IS48 EX iFP (U~D5>
TAMMY L BARNES
432 S FAYETTE ST
SHIPPENSBURG PA 17257-1739
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSNI'DC
ACN
02-03-2003
BARNES
09-16-2001
21 02-0394
CUMBERLAND
209-12-9320
02107645
Altount R...itted
HARVEY
W
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-Y=isira-Ex--AFP--fol-=031------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 02-03-2003
ESTATE OF BARNES
HARVEY
W DATE OF DEATH 09-16-2001
COUNTY
CUMBERLAND
FILE NO. 21 02-0394
TAX RETURN WAS:
S.S/D.C. NO. 209-12-9320
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
02107645
FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICES
ACCOUNT NO.
0067386210
TYPE OF ACCOUNT:
DATE ESTABLISHED
( ) SAVINGS (lO CHECKING ( ) TRUST ( ) TIME CERTIFICATE
ll- 08-199 0
X
4,466.S6
0.500
2,233.28
.00
2,233.28
.15
334.99
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."
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
X
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
04-15-2002 CDOOI075 .00 334.99
TOTAL TAX CREDIT 334.99
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
I IF TOTAL DUE IS LESS THAN $1, NO PAYI1ENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRI, YOU NAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS. I