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Home My WebLink About01-12-06 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 NO. CD 006200 FARNSLER DYLAN K 7067 CARLISLE PI KE APT 7 CARLISLE, PA 17013 ACN ASSESSMENT CONTROL NUMBER AMOUNT _nh___ fold 05155263 $26.15 ESTATE INFORMATION: SSN: 208-38-7162 FILE NUMBER: 2105-0662 DECEDENT NAME: MARSHALL ANDREA C DA TE OF PAYMENT: 01/12/2006 POSTMARK DATE: 01/04/2006 COUNTY: CUMBERLAND DATE OF DEATH: 07/04/2005 TOTAL AMOUNT PAID: $26.15 REMARKS: DYLAN K FARNSLER CHECK# 08-390207811 SEAL INITIALS: RSK RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS 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- 0662 05155263 12-16-2005 REV-154S EX AFP (09-00' EST. OF ANDREA C MARSHALL 5.5. NO. 208-38-7162 DATE OF DEATH 07-04-2005 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS !iJ CHECKING o TRUST o CERTIF. PIKE PA 17013 REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 DYLAN APT A 7067 CARLISLE CARLISLE K FARNSLER HEHBERS 1ST FCU has prDvided the Department with the infDrmatiDn listed belDw which has been used in calculating the pDtential tax due. Their recDrds indicate that at the death Df the abDve decedent, YDU were a jDint Dwner/beneficiary Df this aCCDunt. If YDU feel this infDrmatiDn is incDrrect, please Dbtain written cDrrectiDn frDm the financial institutiDn, attach a CDpy tD this fDrm and return it tD the abDve address. This aCCDunt is taxable in accDrdance with the Inheritance Tax Laws Df the CDmmDnwealth ~f Penns~!~ania~ Questions mcy be wnswcrad by calling (717} 787-6327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 188235-11 Date 05-14-2001 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 1,162.02 50.000 581. 01 .045 26.15 TAXPAYER RESPONSE TD insure prDper credit tD YDur accDunt, tWD (2) cDpies Df this nDtice must accDmpany YDur payment tD the Register Df Wills. Make check payable tD: "Register Df Wills, Agent". Tax x NOTE: If tax payments are made within three (3) mDnths Df the decedent's date Df death, YDU may deduct a 5% discDunt Df the tax due. Any inheritance tax due will b,cDme delinquent nine (9) mDnths after the dateDf death. PART ill The ebDve infDrmatiDn and tax due is cDrrect. 1. YDU may chDDse tD remit payment tD the Register Df Wills with tWD cDpies Df this nDtice tD Dbtain a discDunt Dr aVDid interest, Dr YDU may check bDx "A" and return this nDtice tD the Register Df Wills and an Dfficial assessment will be issued by the PA Department Df Revenue. [CHECK ] ONE BLOCK ONLY B. [] The abDve asset has been Dr will be repDrted and tax paid with the PennsYlvania Inheritance Tax return tD be filed by the decedent.s representative. C. [] The abDve infDrmatiDn is incDrrect and/Dr debts and deductiDns were paid by YDU. YDU must cDmplete PART ~ and/Dr PART ~ belDw. 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 PART [!J 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 I TOTAL (Enter on Line 5 of Tax Computation) facts I have reported HOME ( WORK ( TELEPHON I $ r--- ~. ..~l"".....,...~, '0" i- -, },.: .,.1 . '."" )-,', ,),_.'!.. }~'_! ; .' . ns ~I/ .\ '""'. .h.(.-..'I._''',..n'',',..1 .1-, ... .,. "f:€ V# 704 JAN 2OD6 P~! 2 L Attention: TIC 340 PA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG PA 17128-0601 jiHmlii~ ~ 'Q'~ 1- '(, Q..,} - '," h ... ~ .. -':- " '\ .. .! 1 l',t", - " "'; J' ,"." _, ,__., ., _.u .. ',~ .~,. "..' < , "'" 1...111...1...11..1.11..1.11....11..11......11.1..11