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Home My WebLink About04-18-06 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 '* INFORMATION NOTICE . AND TAXPAYER RESPONSE ACN DATE FILE NO.. 21 0& 03'10 05157508 12-27-2005 REV-151i5 EX AFP (119-00) . 08 EST. OF ROBERT A KOHLER 5.5. NO. 208-24-4223 DATE OF DEATH 09-06-2005 COUNTY CUMBERLAND TYPE OF ACCOUNT D SAVINGS [X] CHECKING D TRUST D CERTIF . DEBRA A ANDREE 435 DELANCEY CT MECHANICSBURG PA 17055 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the Department with the inforllation 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 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 h~ ca!li~g (7l7l 787-83~7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 198526-11 Date 11- 07-2000 Established x 749.03 50.000 374.52 .045 16.85 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". Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x NOTE: If tax payments are made within three (3) months of the decedent's date of death, you may deduct a 57. discount of the tax due. Any inheritance tax due will becolle 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. [J 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 S. 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 TOTAL (Enter on Line 5 of Tax Computation) $ of perjury, I declare that the facts I of my knowledge and belief. have reported above HOME ( ~ WORK (V7 TELEPHONE I I I \ 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& () 3q 0 ACN 05157509 DATE 12-27-2005 REY-15li5 EX AFP (09-00) nd EST. OF ROBERT A KOHLER S.S. NO. 208-24-4223 DATE OF DEATH 09-06-2005 COUNTY CUMBERLAND TYPE OF ACCOUNT [X] SAVINGS D CHECKING D TRUST D CERTIF . DEBRA A ANDREE 435 DELANCEY CT MECHANICSBURG PA 17055 REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 HEHBERS 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. Questions may be answpred by ceIling {717l 787--8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 198526-00 Date 11-07-2000 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 602.49 50.000 301.25 .045 13.56 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". x NOTE: If tax payments are made within three (3l months of the decedent"s date of death.. you may deduct a 57. discount of the tax due. Any inheritance tax due will become delinquent nine (9l months after the date of death. Tax PART [!] The above information and tax due is correct. 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. [CHECK ] ONE BLOCK ONLY 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. - I c. [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 ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED PART ~ TAX LINE RETURN - COMPUTATION 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 TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) perjury, I declare that the facts I my knowledge and belief. HOME $ and 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 ANDREE DEBRA A 435 DELANCEY CT MECHANICSBURG, PA 17055 _____u_ fold ESTATE INFORMATION: SSN: 208-24-4223 FILE NUMBER: 2106-0340 DECEDENT NAME: KOHLER ROBERT A DATE OF PAYMENT: 04/19/2006 POSTMARK DATE: 04/17/2006 COUNTY: CUMBERLAND DATE OF DEATH: 09/06/2005 NO. CD 006570 ACN ASSESSMENT CONTROL NUMBER AMOUNT 05157509 I $13.56 05157508 I $16.85 I I I I I I I TOTAL AMOUNT PAID: $30.41 REMARKS: CHECK#1049 SEAL INITIALS: MG RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS 1_.1. '-,! 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