HomeMy WebLinkAbout04-04-05 (2)
COMl1ON\I, , . OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAl TAXES
DEPT. 280601 '-..CrV"T';::'-"
HARRISBURG, PA 171lza:J,O'Dr;U;~U
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INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 -~5. 2.."t3
04146309
12-14-2004
REY-1545 EX AFP C09-001
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TYPE OF ACCOUNT
EST. OF CALVIN A LOUTZENHISER Ii] SAVINGS
5.5. NO. 161-16-6184 o 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
DAVID H LOUTZENHISER
764 AMSTERDAM RD
MOUNT LAUREL NJ 08054
PNC BANK has providad tha DepartJIent with the infonlation listed below which has bean used in
calculating the potential tax due. Thair records indicate that at the death of tha above decedent, YOU were a joint owner/benaficiary of
this account. If you f.el this infor.atian is incorr.ct. please obtain written correction froa the financial institution. attach a copy
to this for. and return it to the above address. This account is taxabla in accordance with the Inheritance Tax Laws of the Coa.onwealth
uf PennSYlvania. Questions .ay be answerea bY calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 5003759197 Date 10-16-2000
Established
x
89,135.87
16.667
14,856.28
.045
668.53
TAXPAYER RESPONSE
To insure proper credit to your account, two
(2) copies of this notice BUst accoapany your
payaent to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
NOTE: If tax pay.ents are .ade within three
(3) .onths of the decedant's date of death,
you _y deduct a 5iC discount of the tax due.
Any inheritance tax due will becoae delinquent
nine (9) .onths after the date of death.
Tax
PART
II]
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
o The above infor.atian and tax due is correct.
1. You .ay choose to r..it pay.ent to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you .ay check box "A" end return this notice to the Register of
Wills and an official assessaent will be issued by the PA Depart.ent of Revenue.
o 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=J The above infor.ation is incorrect and/or debts and deductions were paid by you.
You .ust coaplete PART ~ and/or PART ~ below.
PART
[!]
TAX RETURN - COMPUTATION OF
LINE 1. Date Established 1
2. Account Balance 2
3. Percent Taxable 3 X
4. Amount Subject to Tax 4
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rat. 7 X
8. Tax Due 8
TAX ON JOINT/TRUST ACCOUNTS
If you indicate a different tax rate, please state YOUI'
relationship to decedent:
PART
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
I
TOTAL (Enter on Line 5 of Tax Computation)
facts I
have reported above are true, correct
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and
HOME
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
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: 1 61-1 6-61 84
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 005152
ACN
ASSESSM ENT
CONTROL
NUMBER
AMOUNT
04146309 I $668.53
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: DAVID H LOUTZENHISER
CHECK# 10106
SEAL
INITIALS: RSK
RECEIVED BY:
REGISTER OF WILLS
$668.53
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
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