HomeMy WebLinkAbout12-07-05
r-- --
I
I
I
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
OEPT.280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
STOLTZFUS AMOS
499 S SHADY ROAD
NEWBURG, PA 17240
_n___n fold
ESTATE INFORMATION: SSN: 215-56-5750
FILE NUMBER: 2105-0803
DECEDENT NAME: STOl TZFUS DANIEL K
DATE OF PAYMENT: 12/07/2005
POSTMARK DATE: 11/25/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 08/28/2005
NO. CD 006072
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $50.11
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$50.11
REMARKS:
CHECK#1563
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
'*
INFORMATION NOTICE
~AxiA'~~ES€6NSE
FILE NO. 21 05-0803
ACN 05150340
DATE 11-01-2005
REV-1543 EX AFP (09-00)
200
EST: OF nA~t~L K STOLTZFUS
S.S. NO. 215-56-5750
nATE' OF DEATH 08-28-2005
COUNTY 'i CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
[X] CHECKING
o TRUST
D CERTIF.
(
Cl
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
AMOS Z STOLTZFUS
499 SHADY RD
NEWBURG PA 17240
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 answered by calling (717) 787-83Z7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 103002320 Date 01-03-2001
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
668.09
50.000
334.05
.15
50.11
TAXPAYER RESPONSE
To insure proper credit to your account, two
(Z) 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 5Z discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Tax
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.
[] 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.
PART
~
DATE PAID
J/ -a. '- "'I
DEBTS AND DEDUCTIONS CLAIMED
PART If you indicate a different tax rate, please state your
~ relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LrrfE . Date Establi~had I
....
2. Account Balance 2
3. Percent Taxable 3 X
4. Amount Subject to Tax 4
5. Debts and Deductions 5 ,)'0. J I
6. Amount Taxable 6
7. Tax Rate 7 X
8. Tax Due 8
Amos
PAYEE
2. '.in J t-z. fl, j)
DESCRIPTION
:!Q JI #,/fo YI V +1.1.. )(.
I
$
I
TOTAL (Enter on Line 5 of Tax Computation)
AMOUNT PAID
S-o II
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 (7/7 ) '/2 J -:;-1 S' .2 J' -z..r CJ S-
WORK ( )
TELEPHONE NUMBER DATE
r----~--- -.._--- -------- -----~--~-- ----
DEX55 (9-93)
'*
COMMONWEALTH OF PENNSYlVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
Dear Register of Wills:~
Enclosed you will find: \YJ check(s) 0 documents(s) which were received by the Dep~~ent ot~eve.,u. ~ri3error.
These may be processed according to normal procedures. . ., : ~-~S
. "', "I
REMINDER: The POST MARK DATE on envelope attached to any checks enclosed:mus~ppear' p~ your
Official Receipt 0_ /: _ (:-~)
"'TJ ---,)
Thank you. . - ~}
- '- )
_: n
E-143 EX (3-99)
AYl1 0,) 2 /:; h /1-2 tV)
Llrq5)h~~v' j( I?ad
~wbU7 f~, I?~c:!
Attention: TIC 340
Sincerely,
John Murphy, Chief
Inheritance Tax Division
(717) 787-6201
:21
HARRISBUR~ PA i~
25 NOV 2J)-.o ~,;. Pfv, ..:. 1..
PA DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG PA 17128-0601
1-,)
J:-
,~
- =-'=1
::;:J
....>
1111111111111111111111111111111111111111111111111111
I
-l
'::
'-,,)
..
r--- _~_u ----------------- - ---
c: ," -
'''\ I'
"y -\
~l
"'-}
/
dij
''1 . ~
Iil
Ul
~
0
. ,~ ::r::
E-i
Ul ~ M
~ H 0 r-l
Iil H () ()I 0
~ H Ul ['-
1-,') ~ 0 r-l
() () Iil
......l ~ Ul ,:(
t ~j 0 ~ ~ P-l
1.\) 4;"" ~ 0
~ ~ ::r:: Iil
0 Z Iil E-i H
I Iil E-i ~ ~ Ul
('.1 H Ul Iil H
(!) H l!l 0 H
,,,,1 (!) ~ () 6
Ul Iil
~ ~ () r-l
ro
'g
~ rJl ...-<
~ 1) 0
rJl ~ \D
s::: 1) ro 0
5;:ir-< I
" S:::...-< 00
..... 1) ro 01
4-< :>;:i ...-<
01)"0 r-
..s::: ~ .;; ...-< ...-<
.... 4-< .- 0 <r:
~ O~\D"
1)........0.....
~5~~~
Os;:i~"O
s 'g ro S .~
So.~o!;;
o 1);:i '"
UClo:lo..::I:
n=Ff'T r,'=
-- "'-"'-.'
(:~
r;'~5 r
-7 I" I'') r I
'-1: ;(.: "f 0.;
-
-
!\)
,..!
(I
f...
~-l
L')
..:..
1/1
-
l-
ei
.T
'...
-:1