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Home My WebLink About04-04-05 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES OEPT. Z80601 c-,~- "";i HARRISBURG, PA 171Z'~~~~lJ\ ,~oM. {/IJINI' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 -<)s- <.1.3 ACN 04146311 DATE 12-14-2004 : :.~ '"JiEV-15U EX AFP lOt-DOl 1\: 52 TYPE OF ACCOUNT EST. OF CALVIN A LOUTZENHISER 0 SAVINGS 5.5. NO. 161-16-6184 iii CHECKING DATE OF DEATH 08-02-2004 0 TRUST COUNTY CUMBERLAND 0 CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 r-,,' DAVID H LOUTZENHISER 764 AMSTERDAM RD MOUNT LAUREL NJ 08054 PHC BANK has provided tha Departllent with the infor.ation listed belDw which has been used in calculating the potential tax due. Their records indicate that at the death Df the above decedent, YDU were a joint Dwner/beneficiary Df this account. If YOU feel this infDr.ation is incorrect, pleasa obtain written cDrrectiDn frD. the financial institutiDn, attach a copy tD this fD'" and return it to the abDve address. This aCCDunt is taxable in accordance with the Inheritance Tax Laws of the Coeaonwealth OT PennsylvaniB. QuesHon.. ny b.. Bns"B,"ed by calling (717) 787-S3Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 5140110933 Dat. 02-01-1970 Established Account Balance Percent Taxabla A.ount Subject to Tax Rate Potential Tax Du. x 26.975.48 16.667 4.496.00 .045 202.32 TAXPAYER RESPONSE TD insure proper credit to your account, tWD (Z) cDpies of this notice .ust aCCD.pany YDur pay.ant to the Register Df Wills. Make check payabla to: "Registar of Wills, Agent". x NOTE: If tax pay.ents are .ade within three (3) .onths of the decedent's dete of death, you .ay deduct a 5X discount of the tax due. Any inheritance tax due will beco.e delinquant nine (9) eonths after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. c=l The above inforeation and tax due is correct. 1. You .ay choose to re.it pay..nt to the Register of Wills with two copies of this notice to Dbtain a discount Dr avoid interest, Dr yoU .ay check box "A" and return this notice to the Register of Wills and an official asseSS8ent will be issued by the PA Oeparteant of Revenue. c=l The above asset has been or will be repDrted and tax paid with the PennsYlvania Inheritance Tax return tD be filed by the decedent's representative. c=l The abDve inforeation is incorrect and/or debts and deductiDns wera paid by you. YDU .ust coeplete PART ~ and/Dr PART ~ below. If you indicat. a different tax ret.. please state your relationship to decedent: PART ~ TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 X 4. A.ount Subject to Tax 4 5. Debts and Deductions 5 6. A.ount Taxable 6 7. Tax Rate 7 X 8. T~~e 8 PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Co~utation) ry. I declare that the facts I owledge and belief. HOME I $ and ~.fi) 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 LOUTZENHISER DAVID H 764 AMSTERDAM ROAD MOUNT LAUREL, NJ 08054-3260 -------- fold ESTATE INFORMATION: SSN: 161-16-6184 FILE NUMBER: 2105-0223 DECEDENT NAME: LOUTZENHISER CALVIN A DA TE OF PAYMENT: 04/04/2005 POSTMARK DATE: 04/02/2005 COUNTY: CUMBERLAND DATE OF DEATH: 08/02/2004 NO, CD 005153 ACN ASSESSMENT CONTROL NUMBER AMOUNT 041 46311 I $202.32 I I I I I I I I TOTAL AMOUNT PAID: $202.32 REMARKS: DAVID H LOUTZENHISER CHECK# 10107 SEAL INITIALS: RSK RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS ~ C t' c.J ...... ~ ~ :- - - - - - - - - :::::. - - - - - ~ - - - - ::... - - - - :- - -::- ;.- - - :- - - - - -:::- ::- -::= tJ~ o ~ ~ ~ ~ ~ ____ ~ CJ" v:-__~ ~ ~ ~ - v~ ....:::<:> p ('"'"') <8- 0" __. ~r? - ~ o ~ q ~ ~ ~ V"' ~ \ ~i <,~~~; ~ l\t\l\\ \ !~ \. ,,"' ....,.1. '\ 1 II