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Home My WebLink About02-21-06 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 006352 SHIRLEY JOYCE A 7 RANDI RD ENOLA, PA 17025 ACN ASSESSMENT CONTROL NUMBER AMOUNT -------- fold 06104323 I $28.32 ESTATE INFORMATION: SSN: 162-42-6040 , FILE NUMBER: 2106-0163 I DECEDENT NAME: SHIRLEY DONALD R I DA TE OF PAYMENT: 02/21/2006 I POSTMARK DATE: 02/18/2006 I COUNTY: CUMBERLAND I DATE OF DEATH: 1 0/ 1 7 /2005 I I TOT AL AMOUNT PAID: $28.32 REMARKS: CHECK# 1035 INITIALS: MG SEAL 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 06104323 02-07-2006 REY-1543 EX APP (09-00) es~G OF DONALD R SHIRLEY S.S. NO. 162-42-6040 DATE OF DEATH 10-17-2005 ,COUNTY CUMBERLAND TYPE OF ACCOUNT [Xl SAVINGS o CHECKING o TRUST o CERTIF. TODD D SHIRLEY 7 RANDI RD ENOLA PA 17025 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU 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. Questinns may be answered by callin~ (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 44343-00 Date 07-24-2001 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 3,776.03 16.667 629.35 .045 28.32 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 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 [!] 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 [!J 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 S. 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 TOTAL (Enter on Line 5 of Tax Computation) I $ Under penalties complete to the best ,-. . I .} if Ir (J ......-4,-.:;." t'.....-.. ....,j vv......~. of perjury, I declare that the facts I have reported above are true, correct and of my knowledge and belief. HOME (1( -/ ) -;] Z - >1 Y(I WORK I( l> <>0 ) .... c( t - LI(.~ is TELEPHONE NUMBER l~(6-cU DATE TAXPAYER SIGNATUR COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 * %NFORMATION NOTICE AND TAXPAYER ~ESPONSE FILE ACN DATE NO. 21 06104324 02-07-2006 REY-1545 EX AFP [09-00> ; . r [", I . 'EST,.i dF (DONALD R SHIRLEY S.S. NO. 162-42-6040 DATE OF DEATH 10-17-2005 COUNTY CUMBERLAND TYPE OF ACCOUNT IX] SAVINGS D CHECKING D TRUST D CERTIF. JOYCE A SHIRLEY 7 RANDI RD ENOLA PA 17025 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU 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. QUBstiDi'is may be Clnswldn!d by l:Cllllug (717) 787.8j27. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 44343-00 Date 07-24-2001 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 3,776.03 16.667 629.35 .00 .00 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 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 [!] 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. 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 TOTAL (Enter on Line 5 of Tax Computation) perjury, I declare that the facts I my knowledge and belief. I $ have reported above are true, correct and HOME (7/'})? 3;'? -3144- WORK ( / ) 5(,(,. 0300 TELEPHONE NUMBER J-- It-a, DAT ~J, ",\ C) l-J, (.,1 '" I',.) 1'\ b t..1. -, - - ~ i::~ it}' ~... . ~p - -...). ~ ~ v\ {____J ('~ , -, -' ~ ~.-" ~<~.~.. :;,- ~~- ~ ,. ~ t~ ~ ~. ~ fL~~ ~!~ ~~ f ~.'~ -., -- ~ -., --. _. ._0 _ . ~.- \'\ ~-;. -;.f ;~ :::.~ II 0;:;,:::-. ~\~\ ....;.... ~~.~ ~.. ~ . ; :..,;;. ~-=- ~;t_ ~, 1 J :;; ~ E E ,:::- ::::: % -~ \\) I ~~ CV\SS I .. ,'J~ '-- I II' '. ; ". / ~I