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.. COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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FI1.Nt~ERO 0 '5.3
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COJN'IY CODE YEAR. NUt.eER
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DECEDENT'6 NAME (lA6T, FIRST, AND MIDDLE INrTIAL)
MOYER, JOHN M.
DATE OF DEATH (MM-DD-YEAR)
11-09-00
SOCIAL SECURITY NUMBER
180 - 03
- 7603
DATE OF BIRTH (MM-DD- YEAR)
07-14-04
THIS RETURN MUST BE ALED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAl)
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~ 1. Original Rerum
o 4. Limited Estate
o 6. Decedent Died Testate (Allach copy of WIn)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. FLIlUre Interest Compromise ~dt1eo!O&allllJfter 12.12.82\
o 7, Decedent Maintained a Living Trust (~copyolTfUS1)
o 10. Spous.al Poverty Creditldalt 01 de.th ~1Wft:~ '2.31.9' and 1-1-95)
o 3. Remainder Return (elate olelum prior to 12.13-82\
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11. Election 10 lax under Sec. 9113(A) (All.llctl Sctl 0)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
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DOROTHY BITTLE
FIRM NAME I~ .I.p;:liicatl1ej
1421 BRANDT ON ROAD
MEGHANICSBURG, PA 17055
TELEPHONE NUMBER
717-766-0730
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(11
(2)
-'
(3)
(')
(51
(6) 327.577.53
(7)
(8) 327,577.53
(9) 5,827.50
(10) 752.81
3. Closely Held Corp~ratior'\, Partnership or Sole-Proprietorship
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4. Mortgages & Notes Receivable (Schedule OJ
5. Cash, Bank DepDSits & Miscel:aneous Personal Property
(Schedule E)
6. JoinUy Owned Property (Schedule F)
DSeparateBillingRequested
7. Ir,ler-Vlvos Transfers & Miscellaneous Non.Probale Property
(Schedule GorL)
8. Total Gron Assets (latal Lines 1-7)
9. Funeral Expenses & Administrative Cosls (Schedule H)
10. Deb:s of Decedent. Mortgage liabili:ies, & Liens (Schedu!e 1)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election 10 tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(ll) 6,580.31
(i2) 320,997.22
1'3) ?nnn nn
(1'1 318,997.22
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of line 14 taxable at the spousal lax
rale, ortra!)sfers under Sec. 9116 (a)(1.2)
,.0_(15)
318,997.22
,0_(16)
14.354.87
16. Amounl 01 Line 14 taxable at lineal rale
, .'2 (17)
17. Amount of Line 14 taxable at sibling rate
x .15 (18)
18. Amount of Line 14laxable at collateral rate
14,354.87
('9)
19. Tax Due
20,0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
>, > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <..
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Decedent's Complete Address:
ST~EET ADDRtSS
CITY
STATE
MECHANICSBURG
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
717.74
Total Credits (A + 6 + C ) (2)
3. InteresVPenalty IT applicable
D. Interest
E. Penalty
TolallnleresVPenalty ( D + E ) (3)
4. If Line 2 is greater than line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 line 20 to request a refund (4)
ZIP
14.354.87
717.74
5. If Une 1 + Line 3 is greater than line 2, enter the difference. This is the TAX DUE.
11.n,? li
A. Enter the interest on the tax due.
(5)
(SA)
(56)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
13,637.13
Make Check Payable to: REGISTER OF'wILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Yes
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...0
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...........JO
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred;... . .... .. ............
b. retain the right to designate who shall use the property transferred or its income:. ...._............._.
c. retain a reversionary interest; or.................................................
d. receive the promise for life of either payments, benefits or care?.
2. If death occurred after December' 2, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.. . . ._.... ..................
3. Did decedent own an "in trust lor" or payable upon death bank account or security at his or her death?
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ............... ....................
No
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B
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XJ
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
Ur-.:ler penanies of peljury, I de:Jare thaI I heve e~amir\E!d this return, incJuclirlg accompanyirlg s:heduies and s:.a\eme'll$, and 10 the besl 01 my bov.-iedge ami belief. it is lrue,
COffee! and complete.
Dec~a'aliOtl 01 preparer ot'ler :~,an the personal representative is ba~cl on ell inforr:'\3tion ofw"t,ch p'eparer has any kn~e.
DATE
P
ADDRESS
STREET DILLSBURG, PA 17019
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers 10 or for the use of the surviving spouse is 3%
[72 P.S. 19116 (a) p.1} (i)].
For dales of death on or after January 1, 1995, the lax rate imposed on the nel value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)].
The statule does not e>:emot a transfer to a surviving spouse from ta>:, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if
the surviving spouse is the only beneficiary.
For dales of death on or after July 1, 2000:
The lax rate imposed on the nel value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a slepparent 01 the child IS 0% [72 P.S. 19116(a)(1.ZII.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P,S. S9116(1.2) I72 P.S. s9116(a)(1)J.
The tax rate imposed on the net value 01 1ranslers to or for the use of the decedent's siblings is 1Z% [72 P.S. 19116(a)(1.311. A sibling is defined, under Section 9102, as an
individual 'NIlo has at least one parent in common with the deceden~ whether by blood or adoption.
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COMMONWEALTH OF PENNSn VANIA
INHERITANCE T /VI RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTL Y.OWNED PROPERTY
ESTATE OF
FilE NUMBER
MOYER, JOHN M.
If an asset was made joint within one year of the decedent s date of death, it must be reported on Schedule G.
SURVIVING JOiNT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A.
DOROTHY BITTLE
1421 BRANDTON ROAD
MECHANICSBURG, PA 17055
DAUGHTER
B.
c.
JOINTL Y-OWNED PROPERTY:
LETTER CATE OESCRIFTION OF PROPERTY ....OF DATE OF DEATH
"EM FORJQINT MADE Induele name ol financial jnst~u~oo and hank &calu:11 numb/," or simiw idenlitying number. DATE OF OEAT~ DECDS VALUE OF
NUMBER TENANT JOINT Machdeedfcljoin~y-heldreales12\e. VALUE OF ASSET INTEREST DECEDENT S INTEREST
1. A. 1991 350 SHARES PP&L 13,759.20 50 6,879.60
1991 2349 WAYPOINT BANK 23,490.00 50 11,745.00
1991 660 SHARES PNC 44,632.50 50 22,316.25
1991 500 SHARES WISCONSIN PUBLIC SERV 33,875.00 50 16,937.50
1991 CD PNC BANK #21001026807 35,026.01 50 17,513.00
1991 CD PNC BANK #21001026820 80,149.80 50 40,074.90
1991 CD PNC BANK #210010226837 35,171.98 50 17,585.99
1991 CHECKING ACCOUNT PNC BANK 11,927.11 50 5,986.05
#5140045027
1991 CD WAYPOINT BANK #556231456 80,016.28 50 40,008.14
1991 CD WAYPOINT BANK #556233623 35,037.41 50 17,518.70
1991 CHECKING ACCOUNT WAYPOINT BANK 26,820.83 50 63,410.41
1991 CD WAYPOINT BANK #556235845 35,045.98 50 17,522.99
1991 CD WAYPOINT BANK #556258321 50,068,31 50 25,034.15
1991 CD WAYPOINT BANK #560287139 50,089.70 50 25,044.85
TOTAL (Also enter on line 6, Recapitulation) $ 327,577.53
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(If more space is needed, Insert additional sheets of the same size)
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COMMONWf,AlTIi OF PENNSYlVANIA
lNHE.RllANCE lAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
MOYER, JOHN M.
Debts of dee&dent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. FUNERAL
DIRECTOR 5,607.50
MINISTER 100.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative s Commissions.
Name 01 Personal Representative (s) .
Social Security Numoor(s) I EIN Number of Personal Represenlative(s)
StreelAddress
City Stale Zip
Year\s) Corr.m\ss.'ron Paid:
2. Attorney Fees
3. Family E~emption: (If decedent s address is not .he same as claimen: s, at:ach explanation)
Claimant
Street Add:-ess
City Slate lip
Relationshii' of Claimant to Decedent
4. Probate Fees
5. Accountant s Fees 120.00
6 Tax Return Preparers Fees
7.
TOTAL (Also enter on line 9, Reca~tulation) $ 5,827.50
(~more space is needed, insert add.ional sheels of the same ~ze)
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COMMONWEAlTI-l OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
NUMBER
1.
MOYER, JOHN M.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (indude outright spousal distributions)
1.
LIN E. MOYER
712 WILLOW AVENUE
TAKOMO PARK, MD 20912
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
DOROTHY BITTLE
1421 BRANDTON RAOD
MECHANICSBURG, PA 17055
SON
31.899.72
DAUGHTER
287,097.50
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
11. NON.TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
ST PAUL'S LUTHERN CHURCH
N. WARREN STREET
ORWIGSBURG, PA 17961
2,000.00
TOTAL OF PART II- ENTlER TOTAl NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed. insert additional sheets of the same size)
2,000.00
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COMMONWEAlTH OF PENNSYl VAAlA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF
FILE NUMBER
MOYER, JOHN M.
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
AMOUNT
EMERGENCY MEDICAL SOCIETY
413.06
PA NEUROLOGICAL ASSOCIATION
153.88
PP & L
179.70
AT & T
6.17
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
752.81
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, AllOWANCE OR DISAllOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DOROTHV BITTLE
1421 BRANDT ON RD
MECHANICSBURG
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
04-09-2001
MOVER
11-09-2000
21 01-0153
CUMBERLAND
101
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REV-IS41 EX 'FP U2-00)
JOHN
M
Amount Remitted
PA 17055
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 ~
REv=is4-j-Ex-AFP--fi'2:olff-ticificE-oF-'rtiHEifiTANcE-TAX-APPRAySEMEN:r,--AL:rOWAifcE-oi----------- ------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MOVER JOHN M FILE NO. 21 01-0153 ACN 101 DATE 04-09-2001
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of line 14 at Spousal rate (15)
16. Amount of line 14 taxable at lineal/Class A rate (16)
17. Amount of line 14 at Sibling rate (17)
18. Amount of line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
.00 X 00 = .00
318,997.22 X 045 = 14,354.87
.00 X 12 = .00
.00 X 15 = .00
el9)= 14,354.87
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
.00
327,577.53
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage liabilities/liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
( 9)
elO)
5,827.50
752.81
elll
el2)
el3)
el4)
NOTE: To insure proper
credit to your aCGount,
submit the upper portion
of this form with your
tax payment.
327,577.53
'" . li80 3]
320,997.22
2,000.00
318,997.22
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-07-2001 AA477983 717.74 13,637.13
TOTAL TAX CREDIT 14,354.87
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS lESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
COMM0NWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21- D j -- 153
01106475
02-19-2001
REV-1545 EX "FP (09-00l
EST. OF JOHN M MOYER
S.S. NO. 180-03-7603
DATE OF DEATH 11-09-2000
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
[Xl CERTIF.
DOROTHY M BITTLE
1421 BRANDTON RD
MECHANICSBURG PA 17055
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PNC BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, yoU were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from 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 Laws of the Commonwealth
of Pennsylvaniu. Questions may be answered by calling (717) 787--8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 21001026807 Date 01- 23-1997
Established
PART
[!]
30,026.01
50.000
15,013.01
.045
675.59
TAXPAYER RESPONSE
~ .. - . -. -. . . . . . . -. - . . ... - . - . - .. . . . -. -. -. ...... - . ... . - . '. - . -. . . . . - .'. -. .. .... -. -. . ..... - . - .' ... - . - . ...... -. .. .. ' .. . - .. .. . . ... -. .. . . ". . - - - ... . .. - . - - - . - . '. : -. - . -. -. - . . . .... - : . .... ". - . . . . ,...:.: . ..... - . .. .... -:.. . ". '. - . . . .. ..,:.. . . .. -. .: . .. . - .. . . . . . - ... ..
:"":~A:~:~~R~\\:'T~\!':~~~i~~~~\:\:W;tt~~\:m~~~~~\!:)\~~j\jj)~~:m~:~~~~'~~:~:i:;:TA.....
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
x
x
NOTE: If tax payments 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
nine (9) months after the date of death.
Tax
.'.:iWIASED'\i!!ON;;::;THIS!'!'if.tom:IC;Ei!:1ii'
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.........-.-.......-..............-.. ...-.......-.........-.......-.,.....-.... ..........-...,...-.
.....-.......-...'...-..,..-.........-. .-.....'. ....-........,-.......-.........-..... .....
[CHECK ]
ONE
BLOCK
ONLY
A. [] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box ..A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. ~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. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PART
~
TAX RETURN - COMPUTATION
If you indicate a different tax rate, please state your
relationship to decedent:
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
1
2
3
4
.5
6
7
8
x
TAX ON JOINT/TRUST ACCOUNTS
x
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on line 5 of Tax Computation)
I
$
Under penalties of perjury, I declare that the
complete to the best of my knowledge and belief.
1\ j~);;. g~
TAXPAYER SIG ATURE
facts I have reported above are true, correct and
HOME ( )
WORK ( )
TELEPHONE NUMBER
cfbUtJl
/ D E
~OHMONWEALTH Of PENNSYLVANIA
DEPARTHENT Of REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21- () J - J 53
01106477
02-19-2001
REV-1545 EX AFP (U9-UUl
EST. OF JOHN M MOVER
5.5. NO. 180-03-7603
DATE OF DEATH 11-09-2000
COUNTY CUMBERLAND
TVPE OF ACCOUNT
D SAVINGS
o CHECKING
D TRUST
[X] CERTIF.
DOROTHV M BITTLE
1421 BRANDT ON RD
MECHANICSBURG PA 17055
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PNC BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from 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 Laws of the Commonwealth
of Pennsylvania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 21001026807 Date 01-23-1997
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
30,026.01
50.000
15,013.01
.045
675.59
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
x
NOTE: If tax payments 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
nine (9) months after the date of death.
Tax
~RT TAXPAYER RESPONSE
[!]Im~::~~,~~~~~~';';~~:m~!~~~~i:j.~~~~ili:i,~~~j~jjj!~~ii!l!~~!il.~~~~~:~~!~!l!~!~~~'l'l~~~~~~:~~~i:':'!~~l~~ii~il~~'li!!~~.~~!i.i!~tJ~i~~:~ililil1
A. D The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. ~ 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.
[CHECK]
ONE
BLOCK
ONLY
c. D The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ 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
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
6. Tax Due
TAX ON JOINT/TRUST ACCOUNTS
OF
1
2
3
4
5
6
7
6
x
x
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
I
TOTAL (Enter on Line 5 of Tax Computation)
perjury, I declare that the facts I have reported above are true, correct and
my knowledge and belief.
HOME )
WORK ( )
TELEPHONE NUMBER
tfdlf O(
,<
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21- 0 ( - 153
ACN 01106478
DATE 02-19-2001
REY-1545 EX "FP <09-00l
EST. OF JOHN M MOYER
S.S. NO. 180-03-7603
DATE OF DEATH 11-09-2000
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
00 CERTIF.
DOROTHY M BITTLE
1421 BRANDTON RD
MECHANICSBURG PA 17055 ,
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE) PA 17013
PNC BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from 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 Laws of the Commonwealth
of Pennsylvania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 21001026820 Date 01- 23-1997
Established
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Account Balance 80 } 149 . 80
Percent Taxable X 50.000
Amount Subject to Tax 40} 074.90
Tax Rate X .045
Potential Tax Due I} 803.37
PART TAXPAYER RESPONSE
[!] l.l,:.j~~i~~~~~j:j::~~!!ji~~~~~~ijijMi~i~~jll~:~jll~~lijljl~~l:jl:~~j:j.~~fJ~~I~~~jijjl~~~!lill~~~:~~~:~~~l::i!!~~~i::il~~iil:~~~~:m:~~j~~:~j@~.1
NOTE: If tax payments 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
nine (9) months after the date of death.
[CHECK ]
ONE
BLOCK
ONLY
A. [] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. ~ 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. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
TAX ON JOINT/TRUST ACCOUNTS
PART
~
TAX RETURN - COMPUTATION
If you indicate a different tax rate} please state your
relationship to decedent:
LINE
1. Date Established
2.
3.
4.
5.
6.
7.
8.
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Amount Taxable
Tax Rate
Tax Due
OF
1
2
3
4
5
6
7
8
X
X
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
I
$
complete
-( {\
TAX
of perjury, I declare that the facts I have reported above are true} correct and
of my knowledge and belief.
HOME )
WORK ( )
TELEPHONE NUMBER
/j<!rfo/
DA E
COMMONWEALTH OF PENNSYLVANIA
nrQARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO.
ACN
DATE
21- C~l.- J .53
01106479
02-19-2001
REV-154S EX AFP I09-00}
EST. OF JOHN M MOYER
5.5. NO. 180-03-7603
DATE OF DEATH 11-09-2000
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
D CHECKING
D TRUST
[X] CERTIF.
DOROTHY M BITTLE
1421 BRANDT ON RD
MECHANICSBURG PA 17055
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PNC BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, YOU were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from 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 Laws of the Commonwealth
cf Pennsylvania. Questions may be answeled by calling (717) 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 21001026820 Date 01-23-1997
Established
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Account Balance 80,149.80
Percent Taxable X 50.000
Amount Subject to Tax 40 , 074 . 90
Tax Rate X .045
Potential Tax Due 1,803.37
~RT TAXPAYER RESPONSE
[!]lim:i~A:~~~~:miITrq:mR~$JPQ~~mi~i~~~mi:~I$JljITrmm~~:im1l.ijm:Q1FF:~~i~~!~mi:Jt~~:im~$~:~~$~:~~m:::::I!4.$~~!miQ";i:::IH:~$::::iHQm:~~:e.mm:1
;::~;~:~;~:':':':':':':':';:;!;~:';':';';~:~;':';';':::~;':';';:::;';';:::::::::;:;::',:i::'::;:::::::::;:::~::~~~:~~:~:;:~~;~;:;:~:~~:~~:;:::::::~:::~:::~:~:~:;:::~:~:;~:::::::::::::~;:;:;:;~:~;:;:;:::;~;:;:;:;::::;:::;:;::::;::::::::::;':::;~:::;:;:;::::::::::;::::::::':'::~'~::':::':':':':'~';~:..:':';::::::':':':::'::::;:::::;:::::::;:::;:::::;:;:::::;:;:;:;:;~;~;:;:::;:;:;:::;:::;:;:::~:;:;:;:~~::;:;:;:;~;:~:;:;::~::;:
NOTE: If tax payments 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
nine (9) months after the date of death.
[CHECK ]
ONE
BLOCK
ONLY
A. D The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
~ Wills and an official assessment will be issued by the PA Department of Revenue.
B. 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 must complete PART ~ 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
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
1
2
3
4
5
6
7
8
X
TAX ON JOINT/TRUST ACCOUNTS
X
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on line 5 of Tax Computation)
I
$
Under penalties of perjury, I declare that the
complete to the best of my knowledge and belief.
\. @~);1. i3;Jiif~
TAXPA ER SI ATURE
facts I have reported above are true, correct and
HOME )
WORK ( )
TELEPHONE NUMBER
(2JJ?!~V
/DA E
f
, CO~~~EALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21- () r- I ~):3
ACN 01106488
DATE 02-19-2001
REV-154S EX AFP (09-00)
EST. OF JOHN M MOYER
S.S. NO. 180-03-7603
DATE OF DEATH 11-09-2000
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
[Xl CERTIF.
DOROTHY M BITTLE
1421 BRANDT ON RD
MECHANICSBURG PA 17055
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PNC BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from 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 Laws of the Commonwealth
of Pennsylvani~. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 21001026837 Date 01-23-1997
Established
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Account Balance 35 , 1 71 . 98
Percent Taxable X 50.000
Amount Subject to Tax 17 , 585.99
Tax Rate X .045
Potential Tax Due 791.37
PART TAXPAYER RESPONSE
[!] f.mi\~~.~~~~jij!i~~i!:l~~~~~~~::l:~:~i~~l.l;l!~~~~~.i:l:;~~:iij~~i:ii~!~~!~~:~~l~!i.!j~~~\:j::~~~l~~~~~~l:i:!~!~~~'i!:!~~!:.i:~~l~~i:!ll~!~~~i~!!!:::!l
NOTE: If tax payments 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
nine (9) months after the date of death.
[CHECK ]
ONE
BLOCK
ONLY
A. [J The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. ~ 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. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
TAX ON JOINT/TRUST ACCOUNTS
If you indicate a different tax rate, 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
1
2
3
4
5
6
7
8
X
X
PART
@]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on line 5 of Tax Computation)
I
$
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowledge and belief.
'}'
HOME ( )
WORK ( )
TELEPHONE NUMBER
.2/:;ZU)/
DAT
COMMONWEALTH Of PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU Of INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 - () / - i S -;~
01106490
02-19-2001
REY-154S EX .FP 109-00)
EST. OF JOHN M MOYER
5.5. NO. 180-03-7603
DATE OF DEATH 11-09-2000
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
[X] CERTIF.
DOROTHY M BITTLE
1421 BRANDT ON RD
MECHANICSBURG PA 17055
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE~ PA 17013
PNC BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, YOU were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from 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 Laws of the Commonwealth
of Pennsylvania. QUQstior;s may be answered by callin3 (717) 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 21001026837 Date 01- 23-1997
Established
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Account Balance 35 ~ 171 .98
Percent Taxable X 50 . 000
Amount Subject to Tax 17 ~ 585.99
Tax Rate X .045
Potential Tax Due 791 . 37
~n TAXPAYER RESPONSE
[!]I;![;.:~~:~~~"~'il:~~;):;~~~!~~:i!i:~:~~~i!:::~~~~r:r:l:::!:~~!:!:~~ll;l'~'~~!~~l~~~l:):m~r~~l.)::~~~~~~~j~~~j1:1'~~~~!;)i!~~:m'm~!~~!m!~~m1~!~:!:I:;.1
NOTE: If tax payments 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
nine (9) months after the date of death.
[CHECK ]
ONE
BLOCK
ONLY
A. [] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. ~ 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. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
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
TAX ON JOINT/TRUST ACCOUNTS
If you indicate a different tax rate~ please state your
relationship to decedent:
OF
1
2
3
4
5
6
7
8
X
X
PART
@]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
I
TOTAL (Enter on line 5 of Tax Computation)
Under penalties of perjury, I declare that the facts I have reported above are true~ correct and
complete to the best of my knowledge and belief.
{
,.-
HOME )
WORK ( )
TELEPHONE NUMBER
;2/c1.foi
"DA E
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21- [) I -- , 5 3
ACN 01106492
DATE 02-19-2001
REV-154S EX AFP {09-00>
EST. OF JOHN M MOYER
5.5. NO. 180-03-7603
DATE OF DEATH 11-09-2000
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
[X] CHECKING
o TRUST
o CERTIF.
DOROTHY M BITTLE
1421 BRANDTON RD
MECHANICSBURG PA 17055
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PNC BANK .has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent. you were a joint owner/beneficiary of
this account. If you feel this information is incorrect. please obtain written correction from 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 Laws of the Commonwealth
of P~nnsyivania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 5140045027 Date 03-12-1997
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
11,972.11
50.000
5,986.06
.045
269.37
To insure proper credit to your account. two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills. Agent".
x
NOTE: If tax payments 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
nine (9) months after the date of death.
Tax
PART
[!] ;:;mFA:~i~p~~im!~pi:ii:RI~~~~i;I:::
TAXPAYER RESPONSE
'~mll!~~~miiii~~ml!~iiii~l~i~~~i~~~l:lil~~~iiili~~~l~~~:~~:i:ll~~~~ii:i~~iimm!tl~~::::1~~1t1~~:~'ji:j':
[CHECK]
ONE
BLOCK
ONLY
A. c=J The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest. or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. ~ 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. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ 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
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
TAX ON JOINT/TRUST ACCOUNTS
OF
1
2
3
4
5
6
7
8
x
x
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
I
TOTAL (Enter on line 5 of Tax Computation)
;:.'
TAXP
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowledge and belief.
f\
HOME ( )
WORK ( )
TELEPHONE NUMBER
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
* * REVISED NOTICE * * *
REV-154S EX .FP (09-00l
FILE NO. 21-0/-153
ACN 01104063
DATE 02-08-2001
EST. OF JOHN M MOYER
5.5. NO. 180-03-7603
DATE OF DEATH 11-09-2000
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
D CHECKING
D TRUST
[XJ CERTIF .
DOROTHY BITTLE
1421 BRANDT ON RD
MECHANICSBURG PA 1705~,
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
WAYPOINT BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If YOU feel this information is incorrect, please obtain written correction from 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 Laws of the Commonwealth
of Pennsylvania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 560287139 Date 03-15-1996
Established
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Account Balance 50,089. 70
Percent Taxable X 50 . 000
Amount Subject to Tax 25,044.85
Tax Rate X .045
Potential Tax Due 1,127 . 02
PART TAXPAYER RESPONSE
[!] 1:"::'.~~'~:~~~:~'!:!:~~j'm~'~~~~~!!!!1~:~:~~i'i1i!i~~~~m!j.~~ij:.j~~:i!::~j~l~i~~!~~~J:ji:~~~:'i:'~~~:~~~~:~~~:'.j.~~~:~~j::::~~m.:~~:~~lj!:'~~~'~~!~::'::.:1
NOTE: If tax payments 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
nine (9) months after the date of death.
[CHECK ]
ONE
BLOCK
ONLY
A. [] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. ~e above asset has been or will be reported and tax paid with the PennsYlvania Inheritance Tax return
~~ be filed by the decedent's representative.
C. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
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
TAX ON JOINT/TRUST ACCOUNTS
If you indicate a different tax rate, please state your
relationship to decedent:
OF
1
2
3
4
5
6
7
8
X
x
PART
@]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
I
TOTAL (Enter on Line 5 of Tax Computation)
perjury, I declare that the facts I have reported above are true, correct and
and belief.
HOME )
WORK ( )
TELEPHONE NUMBER
!l / j ~j I) 1
llATE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
* * REVISED NOTICE * * *
REV-154S EX ~FP {09-00)
FILE NO. 21-0/-153
ACN 01104061
DATE 02-08-2001
EST. OF JOHN M MOYER
5.5. NO. 180-03-7603
DATE OF DEATH 11-09-2000
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
o CHECKING
D TRUST
IX] CERTIF.
DOROTHY BITTLE
1421 BRANDTON RD
MECHANICSBURG PA 17055
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
WAY POINT BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from 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 Laws of the Commonwealth
of Pennsylvania. Questions may be ans~ered by calling (717) 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 556231456 Date 08- 08 -1992
Established
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Account Balance 80 , 016 . 28
Percent Taxable X 50.000
Amount Subject to Tax 40,008.14
Tax Rate X .045
Potential Tax Due 1,800.37
~n TAXPAYER RESPONSE
[!]l!:::..~~;~~~~;~!..:'~~lm;~~~~~~;:::j~,~:~~:ij;:~~~~'~~l:mi~~l:ll:~~i:ili~i~:~i~~l~~~il;i;~~~:im~~~j~~~~:~~~::::i~~~'~~j;:::~~:l'i:~~:~~m'j~~~:~~i~:::l:lil
NOTE: If tax payments are made within three
(3) months of the decedent's date of death,
you may deduct a 5Z discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
A. [] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. ~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. c=J The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
[CHECK]
ONE
BLOCK
ONLY
If you indicate a different tax rate, 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
1
2
3 X
4
5
6
7 X
8
ON JOINT/TRUST ACCOUNTS
PART
@]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
I
TOTAL (Enter on Line 5 of Tax Computation)
AMOUNT PAID
I
$
perjury, I declare that the facts I have reported above are true, correct and
my knowledge and belief.
HOME )
WORK ( )
TELEPHONE NUMBER
DATE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
REVISED NOTICE * * *
FILE NO.
ACN
DATE
21'-OJ - i 53
01104062
02-08-2001
*
REV-154S EX AFP (09-00>
*
EST. OF JOHN M MOYER
5.5. NO. 180-03-7603
DATE OF DEATH 11-09-2000
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
D TRUST
[RJ CERTIF ,
DOROTHY BITTLE
1421 BRANDTON RD
MECHANICSBURG PA 170SS,
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
WAYPOINT BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from 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 Laws of the Commonwealth
of Pennsylvania. Questions may be ~nswp.red by c~lling (717) 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 556233623 Date 10-05-1992
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
35,037.41
50.000
17,518.71
.045
788.34
TAXPAYER RESPONSE
!'~~,~,~~~~1:\'\~~m:i~j~~~~~':1:'!~i~!~1'1,11:~~.~~i:.l:~~'::.i~~i!i:~~:~j~~:~~!~m,i~~~ml'~~~'~~~~i~~~!:!'!~~~!~~:,i!1~~:i:i!~~:~~:iii'~9~!~~,~i:i:l':1
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
x
NOTE: If tax payments 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
nine (9) months after the date of death.
Tax
x
PART
[!] I':
[CHECK ]
ONE
BLOCK
ONLY
A. [] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "An and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. ~ 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. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
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
TAX ON JOINT/TRUST ACCOUNTS
If you indicate a different tax rate, please state your
relationship to decedent:
OF
1
2
3
4
5
6
7
8
x
x
PART
@]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
I
$
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complet~. to the .,best of my knowledge and belief. HOME )
WORK ( )
TELEPHONE NUMBER
-all 14 0 {
D'A T E
TAXPAY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
FILE NO. 21-01-/53
ACN 01104060
DATE 02-08-2001
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
* * REVISED NOTICE * * *
REV-154S EX AFP <09-00}
EST. OF JOHN M MOYER
5.5. NO. 180-03-7603
DATE OF DEATH 11-09-2000
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
IX] CHECKING
o TRUST
o CERTIF.
DOROTHY BITTLE
1421 BRANDT ON RD
MECHANICSBURG PA 17055
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE~ PA 17013
WAYPOINT BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from 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 Laws of the Commonwealth
of Penn~ylvania. QU9stions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 503003901 Date 01-27-1997
Established
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Account Balance 126 ~ 654.45
Percent Taxable X 50 . 000
Amount Subject to Tax 63 ~ 327 .23
Tax Rate X .045
Potential Tax Due 2 ~ 849. 73
PART TAXPAYER RESPONSE
[!] I':;i;':~~!~~~~:::::~~::i:i~~~~~~~::::!~~i~i:jii!l~~'~~,lj:.:~~i::i:~~:l:ij~~'~:~~!~~~::i'i~~~ii:i,~~~~~~~'~~[-i:,.:!~~!~~j:::,~~j:l!j~~.~~i:':.~~~:~~'~;:: ':1
NOTE: If tax payments 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
nine (9) months after the date of death.
[CHECK ]
ONE
BLOCK
ONLY
A. [] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
~ Wills and an official assessment will be issued by the PA Department of Revenue.
B. The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
o be filed by the decedent.s representative.
C. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
If you indicate a different tax rate~ 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
o. Amount Taxable
7. Tax Rate
8. Tax Due
OF
1
2
3
4
5
o
7
8
TAX ON JOINT/TRUST ACCOUNTS
x
X
PART
@]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
I
$
HOME ( )
WORK ( )
TELEPHONE NUMBER
Under penalties of perjury, I declare that the facts I have reported above are true~ correct and
comp~ete to the best of my knowledge and belief.
~. rJ~
ATURE
_:l~/{y /15 I
D TE If
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
* * REVISED NOTICE * * *
REV-154S EX ~FP <09-00J
FILE NO. 21 -01- J 53
ACN 01104065
DATE 02-08-2001
EST. OF JOHN M MOYER
5.5. NO. 180-03-7603
DATE OF DEATH 11-09-2000
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
o CHECKING
D TRUST
lXJ CERTIF.
DOROTHY BITTLE
1421 BRANDT ON RD
MECHANICSBURG PA 17055
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
WAY POINT BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from 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 Laws of the Commonwealth
of PQnnsylvania. Questions may be answered by calling (717) 71',7-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 556235845 Date 01-06-1993
Established
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Account Balance 35,045.98
Percent Taxable X 50 . 000
Amount Subject to Tax 17 , 522 . 99
Tax Rate X .045
Potential Tax Due 788.53
PART TAXPAYER RESPONSE
[TI ,..::!.:~~'~~~~'~:::ii~~~W::~i~~~~~~'jijil~l~~m!:~~~~'~~!:m.~~:!:::~~m.j~~i~:~~.~~~:,i::~~~:':i:~~~:~~~~:~~~l'il:~!~i~~I::I:~~i'I.:~~:~~'ll,:~~~:~~~,::!::11
HOTE: If tax payments 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
nine (9) months after the date of death.
[ C~~~K ]
BLOCK
ONLY
A. [] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
J( Wills and an official assessment will be issued by the PA Department of Revenue.
B. 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. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
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
TAX ON JOINT/TRUST ACCOUNTS
If you indicate a different tax rate, please state your
relationship to decedent:
OF
1
2
3
4
5
6
7
8
X
X
PART
@]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
I
TOTAL (Enter on line 5 of Tax Computation)
that the facts I have reported above are true, correct and
and belief.
HOME ( )
WORK ( )
TELEPHONE NUMBER
\J. Iff/Of
l)AT
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
* * REVISED NOTICE * * *
REV-1543 EX .FP (09-00)
FILE NO. 21 -- 01-/53
ACN 01104064
DATE 02-08-2001
EST. OF JOHN M MOYER
5.5. NO. 180-03-7603
DATE OF DEATH 11-09-2000
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
o CHECKING
o TRUST
[X] CERTIF .
DOROTHY BITTLE
1421 BRANDT ON RD
MECHANICSBURG PA 17855
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE~ PA 17013
WA YPOINT BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If YOU feel this information is incorrect, please obtain written correction from 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 Laws of the Commonwealth
of Pcnn=ylvania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 556258321 Date 12-02-1994
Established
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Account Balance 50 ~ 068.31
Percent Taxable )( 50 . 000
Amount Subject to Tax 25 ~ 034 .16
Tax Rate )( .045
Potential Tax Due 1 ~ 126.54
PART TAXPAYER RESPONSE
[!] 1:;:,;::FAILURS::::iTO;:mR:ESiPOrmm::WILL:miRESU:ljTmmINm::ANm::O'F:F:ICiIAiljm':TAXmi:ASS'ESSH:ENT:,mBAS:ED.i:i::ON:::':TH'IS:WNOm:ICEi::i:,'1
'""':"':':"':':;:'":':'":'":"':'""::,,,,:,,:,,,,,,,,,,,,,,,,:,,"',,:':':'""":':'""""":'"":':,',',,,,,',,':;,,:':,,:,,,,,,:;:;:;'::;:,,,,,,"':;:;:;:;":;'"':;:"':,:;':',,,,"':,,':,,,,::;:;":;:;:;:;:;:;",,,,:"''':;,,:;:;::":':':"':':;:",:::,:::,:,:,:""':":;':;"'::;:':;:;""",,,,,,,,:,,":""'"':",,,,,,,,,:',,,,:,,,,',,:",,,,,',',,,,,',,::;:;":;:;:;:':,,,:;:;:;:':;:;:;:::,',',
NOTE: If tax payments 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
nine (9) months after the date of death.
[CHECK]
ONE
BLOCK
ONLY
A. c=J The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. ~he above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
.~ ~~ be filed by the decedent's representative.
C. c=J The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
TAX ON JOINT/TRUST ACCOUNTS
If you indicate a different tax rate~ 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
1
2
3
4
5
6
7
8
)(
)(
PART
@]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL CEnter on Line 5 of Tax Computation)
I
$
perjury~ I declare that the facts I have reported above are true~ correct and
my knowledge and belief.
HOME ( )
WORK ( )
TELEPHONE NUMBER
2/lf/0J
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