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Home My WebLink About11-04-05 COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE BUREAU OF INOIVIOUAL TAXES OEPT. 2B0601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DYMSKI LISA 0 281 HOY ROAD CARLISLE, PA 17013 _nuh_ fold ESTATE INFORMATION: SSN: 002-14-6169 FILE NUMBER: 2105-0410 DECEDENT NAME: LAHAR ELTON B DATE OF PAYMENT: 11/04/2005 POSTMARK DATE: 11/03/2005 COUNTY: CUMBERLAND DATE OF DEATH: 04/20/2005 NO. CD 005971 ACN ASSESSMENT CONTROL NUMBER AMOUNT 05141609 I $112.28 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: LISA 0 DYMSKI CHECK# 683 SEAL INITIALS: RSK RECEIVED BY: REGISTER OF WILLS $112.28 GLENDA FARNER STRASBAUGH REGISTER OF WILLS C'1 CD <.0 ~ M ~... M'" ",,00 ,~ lll'" ""~ ....M ,M 0"" <0 -< ('" ~ CO () "';" -'" UI~~~ oor-:.o :!!!:;:::~ t? >:i<{ Ca..a.. (/ . - CCl~ ct<{CIJ ",0 ::i VI a:: a:: ::::i>-<{ O() J: CD C\l ~, .~ '-<- \,\ <l3 I. '.........'....'... ;;~', ~ ~~ ~~ ~......... ~ ! I! , i .,,")1 ~I " I ')1 .:..1 -I ~ :ij ""-:- -.:: ........ ~I ". ' .0; (~i~) c 4~ J~ J q:J - LIl o .... . 8 l I (U I. ;;.. -......... "U ~ ~ .t~ '-l--""'tS \:) .... \ \... .... ~~ ..... .\1) '- ~ \\...) .-:.... ~,- '" <I,.; ,-+-i:~ f.~k @l-" ~ . ."... ..co r1"l Q r1"l .'- n.J ~ ~~ ~ ~ ~ ~ \ ~ ~l; .. Q tOO - .~ ~ []'" ~ -. t..D ~ '"'G n.J ~ it '\. , \ (': C'- r1"l ..- I'~: r1"l : n.J :N:;( ~I _.: 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 05 - 041 0 05141609 08-29-2005 REV-154S EX AFP [09-001 EST. OF ELTON B LAHAR S.S. NO. 002-14-6169 DATE OF DEATH 04-20-2005 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS Ii] CHECKING o TRUST o CERTIF. LISA D DYMSKI 281 HOY RD CARLISLE PA 17013 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ORRSTOWN BANK has provided the Departllent 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 froll the financial institution, attach a copy to this forll and return it to the above address. This account is taxable in accordance with the Inheritance Tax law.- of the COlln,onwealth of Pennsylvania. Questions lIay be answerHd by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 143000376 Date 09-30-2003 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 1,497.12 50.000 748.56 .15 112.28 TAXPAYER RESPONSE 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 paYllents are made within three (3) months of the decedent's date of death, YoU lIay 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 [!] A. [ CHECK ] ONE BLOCK B. ONLY c. ~ The above information and tax due is correct. 1. You may choose to rellit 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 Oepartment of Revenue. [] 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. [] 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 o 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 PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED 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) Under penalties of perjury, I declare that the facts I complete to the best of my knowledge and belief. I $ are true, correct and -/5''1"1 If-.3 ~ (J~ DATE 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 05- 041 0 05141609 08-29-2005 REY-1543 EX AFP (D9-DDl I EST. OF ELTON B LAHAR S.S. NO. 002-14-6169 DATE OF DEATH 04-20-2005 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS !Xl CHECKING o TRUST o CERTIF. LISA D DYMSKI 281 HOY RD CARLISLE PA 17013 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ORRSTOWN 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 answ@red by calling (717l 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 143000376 Date 09-30-2003 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 1,497.12 50.000 748.56 .15 112,28 TAXPAYER RESPONSE To insure proper credit to your account, two (2l copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". Tax x NOTE: If tax payments are made within three (3l 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 (9l months after the date of death. PART ill A. [ CHECK ] ONE BLOCK B. ONLY c. ~ 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. r=J 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. r=J 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 o 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 PART I!I DATE PAID DEBTS AND DEDUCTIONS CLAIMED OF 1 2 3 4 5 6 7 8 x TAX ON JOINT/TRUST ACCOUNTS x PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) I $ perjury, I declare that the facts I my knowledge and belief. have reported above are HOME ( '7/ 1) tf WORK (h /1-) TElEPHONE NUMBER true, correct and -/['[y il-.3-0S- DATE r o ~flt: f....f<< . *0 ~~~ ....f3 ~ ~ (0) ,..1. "'( ~~ 0 r:J ,..1. ~ s::-~ (.J ~ ~'. ..... (.,1 -, IV. (..1 ~. \J- r-t-. "', ~ h '... -. ,.... ~ '\ ') 0 -. , ..... 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